Congenital Heart Disease CHD : Investigation,Diagnosis,Classification

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Cardiology in Children

Congenital Heart Disease : General Aspects

Pediatrics Cardiology in Children

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Congenital Heart Disease

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CONGENITAL HEART DISEASE: GENERAL ASPECTS

Related topics

Definition and Incidence of CHD

Etiology of CHD

Clinical Presentation of CHD

Dr N.C.Joshi
Consultant Pediatrician,
Consultant at Nanavati Hospital,
Ex Dean:-B.J.Wadia Children's Hospital.

INVESTIGATIONS:

The investigative tools that are available for diagnosis of congenital heart diseases include chest radiography, electrocardiography, echocardiography, cardiac catheterization, cineangiography and cardiac MRI. All tests except ECG and radiography are expensive.

Radiography of chest
It there is a suspicion of heart disease on the basis of history and physical examination, radiography which complements clinical findings should be obtained. Interpretation of chest radiograph involves evaluation of cardiac size and classical cardiac contours, lung vasculature, individual cardiac chambers, aortic arch and abdominal situs.
Electrocardiogram
Like radiography, electrocardiogram also complements clinical findings. The electrocardiogram gives valuable information about hemodynamic status of the defect and severity of the defect. A few electrocardiographic patterns are suggestive of certain lesions. Normal values of the various ECG parameters are available and for interpretation, age of the child should be kept in mind. In newborns, normal ECG and radiograph do not rule out serious cardiac defect as it takes few days to evolve.
Echocardiography
With the advent of real-time echocardiography imaging, an elegant elaboration of intracardiac anatomy of all structural defects of heart became possible. Doppler echocardiography can evaluate hemodynamic data regarding pressure difference across the aortic and pulmonary valves, detection of shunt flows, semiquantification of valve insufficiency. It has almost replaced invasive cardiac catheterization and in some centers surgical correction of lesions like PDA, ASD (ostium secundum) is possible without catheterization.

Cardiac Catheterization

The classical invasive tool pertaining to pediatric cardiology remains cardiac catheterization. As mentioned above, echocardiography has reduced diagnostic value of cardiac catheterization but interventional therapeutic catheterization procedures have increased its therapeutic value.

Indications

Preoperative anatomical definition of the lesion
Preoperative physiological assessment of pulmonary artery pressures, pressure gradients, etc.
Therapeutic interventional procedure
- Balloon dilatation of stenotic valves and coarctation of aorta
- Blade and balloon atrial septostomy
- Non-surgical closure of PDA and ASD
- Catheter ablation of arrhythmogenic focus by pacemaker implantation.

CLASSIFICATION AND DIAGNOSIS:

Congenital heart diseases are basically divided into the following groups:

Structural heart defects
Functional heart defects, e.g. congenital cardiac arrhythmias
Positional heart defects, e.g. dextrocardia

Structural heart defects are divided into two main groups:

Acyanotic defects
Cyanotic defects

Each group is subdivided according to:

pulmonary blood flow - increased, decreased or normal
dominant ventricle - left or right
pulmonary hypertension - present or absent

The clinical diagnosis of congenital heart is complex when first considered but with sound anatomy and physiologic principles and proper understanding of clinical manifestations, it may become simple. If information is handled with the framework of following figures, the clinical diagnosis becomes simple.

Clinical diagnosis of congenital heart - figure1

Clinical diagnosis of congenital heart - figure2

Also See Expertise Views On "Congenital Heart Disease" Questions

Bibliography :

Clinical presentation of heart disease in children. Pediatric Cardiology Churchill Livingstone : 191-201,1987.
Jimenez MQ: Ten common congenital cardiac defects. Pediatrician 3-46, 1981.
Jordan SC, Scott O: Heart disease in pediatrics (2nd ed ) 1-7,1981.
Wedikund L : Heart disease in infant and children(1st ed) Edwart Arnold: 27-34, 1980.

Last created on 11-01-2001
Last updated on 01-07-2006