Congenital Heart Disease Obstructive Lesions : Pulmonary Stenosis,Aortic Stenosis

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Results

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

L-R Shunt Lesions of CHD

CHD Associated Anomalies

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

OBSTRUCTIVE LESIONS

Pulmonary Stenosis

Types :

Valvular (90%)
Subvalvular (infundibular)- Rare
Supravalvular-PPS

Clinical manifestations :

Majority asymptomatic - usually does not get worse
Severe cases- CHF, fatigability, syncope

Physical Examination :

Acyanotic
Systolic ejection click varies with respiration
Intensity of the murmur varies with degree of obstruction

EKG: RAD, RVH
Chest X-ray: Post-stenotic dilatation of MPA

Treatment :

Aortic Stenosis (M:F=4:1)

Types :

Valvular : bicuspid valve
Subvalvular:
Membrane (discrete)
Long tunnel
IHSS

Anatomical types of aortic stenosis.

normal
valvular stenosis
supravalvular stenosis
discrete subaortic stenosis
IHSS

Clinical manifestations :

Most are asymptomatic
Severe cases - CHF, exertional chest pain, syncope

Physical Examination :

Acyanotic
Narrow pulse pressure. Higher BP in the right arm than the left in supravalvular AS
Systolic thrill with murmur at RUSB, suprasternal notch and over the carotid arteries
Early ejection systolic click with valvular AS

Cardiac findings of aortic valve stenosis.

Abnormal sounds are indicated in black. Systolic thrill may be present in areas with dots.

EKG: Normal even in severe cases or LVH with strain
Chest X-ray : Heart size > normal with dilated ascending aorta

Treatment :

Aortic valve commissurotomy : When peak gradient > 50 mmHg or valve area < .5 cm2 /M2
Membrane excision
Myectomy - For Tunnel sub aortic stenosis & IHSS
Fabric patch- Supravalvular

Next : Obstructive Lesions of CHD(Contd.)

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