Congenital Heart Disease L-R Shunt Lesions : PDA,Endocardial Cushion Defect

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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CONGENITAL HEART DISEASE-AN OVERVIEW

Related topics

Prevalence,Etiology and Cardiac Malformations Genetic Causes of CHD

Cyanosis and Congestive Heart Failure and Cyanotic CHD

Clinical Manifestations of CHD

Obstructive Lesions of CHD

CHD Associated Anomalies

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

Continue....

L -R SHUNT LESIONS

PDA

It is a common problem in premature infants.

Clinical manifestations :

Asymptomatic with small shunts
CHF with large shunts
Differential cyanosis (If PVOD develops)

Physical Examination :

Systolic ejection murmur - only evidence in newborn
continuous (machinery) murmur develops later
Bounding peripheral pulses

Cardiac findings of patent ductus arteriosus.

A systolic thrill may be present in the area shown by dots.

EKG and chest X-ray : similar to VSD

Treatment :

Medical
- anticongestive measures
- Indomethacin
Surgical
- Indicated if asymptomatic - after 1 year of age
- If symptomatic - any age

Complications of surgery :

Injury to recurrent laryngeal nerve
Injury to left phrenic nerve
Re-opening of the ducts

Differential Diagnosis :

Coronary AV fistula
Pulmonary AV fistula
Venous hum
Collateral murmur (TOF)
VSD with AI
Absent pulmonary valve
Truncus arteriosus
A-P window
PPS

Endocardial Cushion Defect

Types :

Partial - Ostium primum
Complete - Atrioventricular canal

Clinical manifestations :

30% of the defects occur in Down's syndrome
Partial defects are usually asymptomatic
Complete- CHF

Diagrammatic illustrations of complete endocardial cushion defect viewed with the LA and LV posterior wall removed.

Cleft mitral and tricuspid valves with resulting common AV valve are compared with normal AV valves.

Physical Examination :

Undernourished
Hyperactive precordium with holosystolic murmur at LLSB
Loud P2, mid-diastolic rumble at the apex
Liver enlargement

Cardiac findings of complete endocardial cushion defects(ECD), which resemble that of VSD.

A systolic thrill may be present at the LLSB (dotted area), where the systolic murmur is the loudest.

EKG :

Superior QRS axis; 1 st degree AV block
RVH or BVH

Chest X-ray :

Heart size - enlarged
Pulmonary vascularity - increased

Treatment :

Medical
Surgical
- Ostium primum defect at 2-5 years
- Complete defect at 6 months of age.

Next : CHD Associated Anomalies

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