Congenital Heart Disease

Lecture Overview

• Lecture #9 in "Introduction to Cardiology" series
• Presented by Joseph Alford, adult cardiologist
• Focus on congenital heart disease (CHD) visible in adults
• Pediatric cardiologists usually handle these cases in childhood

Anatomy Review

• Left ventricle: Pumps blood into aorta
• Right atrium & ventricle: Move blood into pulmonary artery
• Complications: Holes, obstructions, valve issues, ventricle switching

Causes of Congenital Heart Disease

• Abnormal heart development in embryonic life
• Possible causes: Infections, drugs during pregnancy, hereditary factors

Common Forms of Congenital Heart Disease

• Obstructive Form: Valve issues such as aortic or pulmonic stenosis
• Holes in the Heart: Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD)

Acyanotic vs Cyanotic CHD

• Acyanotic (Pink):
  • ASD, VSD, Patent Ductus Arteriosus (PDA), AV Canal
  • Obstructive lesions: Coarctation of the Aorta, Aortic and Pulmonic Stenosis
• Cyanotic (Blue):
  • Tetralogy of Fallot, Tricuspid Atresia, Transposition of the Great Arteries

Obstructive Lesions

• Pulmonic Stenosis:
  • Right ventricle hypertrophy
  • Treatment: Balloon catheter, valve replacement
• Aortic Stenosis:
  • Left ventricle hypertrophy
  • Treatment: Balloon catheter, potential valve replacement
• Coarctation of the Aorta:
  • Narrowing post aortic arch
  • Symptoms: High BP in arms, low BP in legs
  • Treatment: Balloon catheter, surgery

Holes in the Heart

• Atrial Septal Defect (ASD):
  • Left-to-right shunt, increased right ventricle workload
  • Can lead to pulmonary hypertension
  • Treatment: Closure via catheter or surgery
• Ventricular Septal Defect (VSD):
  • Left-to-right shunt, common in childhood
  • Often closes spontaneously or requires repair
• Patent Ductus Arteriosus (PDA):
  • Aorta to pulmonary artery shunt
  • Characteristic continuous murmur
  • Treatment: Catheter closure, surgical intervention

Cyanotic Lesions

• Tetralogy of Fallot: Multiple heart defects requiring early surgery
• Transposition of the Great Arteries: Aorta and pulmonary artery swapped, requires surgical correction

Diagnosis and Treatment

• Diagnosed via physical exam, EKG, echocardiogram, CT, MRI
• Treatment often involves surgical or catheter-based intervention
• Complex cases are managed by pediatric and adult cardiologists

Outcomes

• Most patients with CHD live long, productive lives post-treatment
• Cyanotic CHD patients may have ongoing challenges
• Advances in treatment have significantly improved patient outcomes