CONGENITAL HEART LESIONS ((C.H.L
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1 CONGENITAL HEART LESIONS ((C.H.L BY THE BOOKS: 0.8 IN FACT: 3-5% INCLUDING: - BICUSPID AORTIC VALVE MITRAL VALVE PROLAPSE LATE DIAGNOSIS -
2 :INCREASED INCIDENCE IN ADULTS BETTER DIAGNOSIS IN INFANCY BETTER TREATMENT: - MEDICAL CATHETERIZATION SURGERY -
3 ALMOST NO LESIONS DO NOT REQUIRE FOLLOW UP GOOD PRACTICE: FOLLOW AT VARYING INTERVALS DEPENDENT ON LESIONS IN 2007 IN CANADA: MORE ADULTS THAN CHILDREN WITH C.H.L
4 C.H.L - CYANOTIC - ACYANOTIC :8 OF IMPORTANCE LESIONS; 300 < ACYANOTIC 6: - Atrial Septal Defect Ventricular Septal Defect Patent Ductus Arteriosus Pulmonic Stenosis Bicuspid Aortic valve) Aortic Stenosis) Coarctation of Aorta - CYANOTIC 2: - Tetralogy of Fallot Transposition of the Great Arteries -
5 :IN ADULTS 3 GROUPS ENCOUNTERED :A) _MINOR LESIONS (ATRIAL SEPTAL DEFECT (SMALL PULMONIC STENOSIS MILD BICUSPID AORTIC VALVE MANY OTHERS +
6 :B) SIGNIFICANT LESIONS Atrial Septal Defect Patent Ductus Arteriosus Single Ventricle + Pulmonic Stenosis Fallot + Pulmonic Stenosis Ebstein Anomaly Eisenmenger Syndrome/ Bicuspid Aortic Valve Mitral Valve Prolapse - ARMY: RECRUITS MANY LESIONS
7 C) REPAIR TOTAL PARTIAL RESIDUAL LESIONS
8 FOLLOW UP- UTMOST IMPORTANCE :FEW LESIONS CURED P.D.A A.S.D MANY TOTAL ANOMALOUS PULMONARY VENOUS RETURN MANY
9 :FOLLOW UP INCLUDES HISTORY PHYSICAL E.C.G ECHOCARDIOGRAM HOLTER ERGOMETRY CATHETERIZATION - OCCASSIONALY
10 CLINICAL EXAMINATION HIGHLIGHTS FEMORAL PULSES SECOND HEART SOUND CLICKS (?SITTING POSITION (STANDING BACK -
11 C.H.L FOLLOW UP :MAJOR MEDICAL ISSUES (ARRHYTHMIAS (INTRINSIC/RELATED REPAIR ENDOCARDITIS HEART FAILURE PULMONARY HYPERTENSION TRANSPLANTATION
12 ARRHYTHMIAS COMMON ATRIAL FLUTTER MOST COMMON ATRIAL FIBRILLATION AGE RELATED TREATMENT: AS IN CASES WITHOUT C.H.L DIFFERENT ANATOMY ABLATION COMPLETE HEART BLOCK PARTLY RELATED TO ANOMALY CORRECTED TRANSPOSITION, POLYSPLENIA LEFT (ISOMERISM
13 ENDOCARDITIS.VERY N.B HIGH INDEX OF SUSPICION PREVENTION OF DENTAL PROBLEMS APPROACH MODIFIED GUIDELINES
14 HEART FAILURE - DYSFUNCTION TIME RELATED AGE RELATED OP. RELATED TREATMENT: AS IN CASES WITHOUT C.H.L?BIVENTRICULAR PACING
15 PULMONARY HYPERTENSION CRITICAL PRE-OP. AS INDICATION FOR SURGERY CRITICAL AT OP. FOR SUCCESS.CRITICAL POST OP N.B.: PREVENT EISENMENGER IF PRESENT: TREATMENT SIMILAR TO CASES WITHOUT C.H.L
16 TRANSPLANTATION USUALLY LATE- BURNED OUT C.H.L OR.POST OP OR TIME RELATED DETERIORATION :SPECIAL SITUATION EISENMENGER - PROTEIN LOSING ENTEROPATHY
17 PREGNANCY.MOST LESIONS, PRE / POST OP NO PROBLEMS NORMAL PREGNANCY / DELIVERY SBE PROPHYLAXIS / PROBABLY INDICATED :N.B.: CONTRAINDICATIONS PULMONARY HYPERTENSION EISENMENGER FROM - MODERATE AORTIC STENOSIS MODERATE LEFT SIDED OBSTRUCTION -
18 SPORT BASED ON BETHESDA CRITERIA [JAAC-2005] N.B. - VENTRICULAR DYSFUNCTION ARRHYTHMIAS PULMONARY HYPERTENSION -
19 C.H.L 8 COMMON LESIONS > 300 LESIONS ALTOGETHER :N.B.: COMPLEX LESIONS HYPOPLASTIC LEFT HEART - HYPOPLASTIC RIGHT HEART SINGLE VENTRICLE ISOMERISM - FINAL COMMON PATHWAY: FONTAN OPERATION
20 FONTAN OPERATION BYPASS RIGHT SIDE OF HEART CONNECT VENA CAVA TO PULMONARY ARTERIES :COMPLICATIONS ARRHYTHMIAS HEART FAILURE THROMBUS PROTEIN LOSING ENTEROPATHY
21
22
23 Single Ventricle - Bidirectional Glenn
24 Single Ventricle - completed Fontan
25 ADULTS CONGENITAL HEART LESIONS NEW SPECIALTY Ra b in Me d ic a l Ce n te r ± Ca s e s Fro m yrs 8 0 yrs Pe d ia tric + Ad u lt c a rd io lo g is t + Ad u lt c a rd io lo g is t Pe rs o n a l Fo llo w u p : 2 0, ye a rs
26 L E S IO N A.S.D. V.S.D. P.D.A. COARC TATION L O N G E V IT Y S C HO O L SPORT B E THE S D A AR MY H IG H E R E D U C A T IO N AL L l IA - AL L IA - AL L IA - AL L IA IB - PREG NA NC Y P H Y S IC A L WORK / / / / / PULMONIC STENOSIS AORTIC STENOSIS AL L ALL IA IB IA IB NO SPORTS - / / / - - // -
27 LESION LONGEVITY EDUCATION WORK Te tra lo g y ± Of Fa llo t Tra n s p o s itio n Mu s ta rd Ja te n e Fo n ta n e a rly: 5 0 % m o rt La te : Be tte r p ro g n o s is ± SCHOOL SPORT BETHESDA ARMY HIGHER ± 3 6 yrs - ALL IA, IB ALL IIA IA IB AS - - PHYSICAL PREGNANCY - -
28
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