1. Congenital Heart Disease
DR. Mohamed Seyam PhD. PT.
Assistant Professor Of Physical Therapy
For Cardiovascular /Respiratory Disorder

2. Relative Frequency of Lesions
Transposition of great arteries 3-5
Hypoplastic left ventricle 1-3
Hypoplastic right ventricle 1-3
Truncus arteriosus 1-2
Total anomalous pulm venous return 1-2
Tricuspid atresia
Double-outlet right ventricle 1-2
Others
Ventricular septal defect %
Atrial septal defect %
Patent ductus arteriosus %
Coarctation of aorta %
Tetralogy of Fallot %
Pulmonary valve stenosis %
Aortic valve stenosis %

3. Classification Noncyanotic CHD (L →R) Cyanotic CHD (R →L)
Ventricular Septal Defect
Atrial Septal Defect
Pulmonic stenosis (PS)
Aortic stenosis (AS)
Patent ductus arteriosus (PDA)
Tetralogy of Fallot
Fallot triology
Tricuspid atresia (TA)
Pulmonary atresia (PA)

4. 1- Atrial Septal Defect Most commonly asymptomatic Three major types
Ostium secundum
most common
In the middle of the septum
2- Ostium primum
Low position
3- Sinus venosus
Least common
Positioned high in the atrial septum

5. 2- Ventricular Septal Defect
Single most common congenital heart malformation, accounting for almost 30% of all CHD
Defects can occur in both the membranous portion of the septum and the muscular portion

6. Types of Ventricular Septal Defect
Three major types
Small, hemodynamically insignificant
Between 80% and 85% of all VSDs
< 3 mm in diameter
All close spontanously
50% by 2 years
90% by 6 years
10% during school years
Muscular close sooner than membranous

7. Moderate VSD 3-5 mm in diameter Least common group of children (3-5%)
Without evidence of CHF or pulmonary hypertension, may be followed until spontaneous closure occurs

8. Large VSD 6-10 mm in diameter Usually requires surgery,
otherwise… Will develop
congestive heart failure (CHF) and
failure to thrive( FTT)
by age 3-6 months

9. Ventricular Septal Defects
Clinical findings
Grade II-IV/VI, medium- to high-pitched, harsh murmur
heard best at the left sternal border with radiation over the entire precordium

10. Treatment of Ventricular Septal Defect
Indicated for closure of a VSD associated with CHF and FTT or pulmonary hypertension
Patients with cardiomegaly, poor growth, poor exercise tolerance,
typically undergo surgical repair at 3-6 month.

11. 3- Patent Ductus Arteriosus

12. Patent Ductus Arteriosus
Persistence of normal fetal vessel joining
the pulmonary artery to the aorta artery.
Closes spontaneously in normal term infants at 3-5 days of age
Accounts for about 6-8% of all cases of CHD
Higher incidence of PDA in infants born at high altitudes (> 10,000 feet)
More common in females

13. Patent Ductus Arteriosus
Treatment consists of surgical correction when the PDA is large except in patients with pulmonary vascular obstructive disease
Transcatheter closure of small defects has become standard therapy
In preterm infants indomethacin is used (80-90% success in infants > 1200 grams)

14. 4- Tetralogy of Fallot
This malformation consists the following tetralogy:
(1) Pulmonary artery Stenosis
(2) Interventricular defect
(3) Deviation of the origin of the aorta to the right
(4) Hypertrophy right ventricle.

15. Tetralogy of Fallot Typical features
Most common cyanotic lesion
(5 to 7 % of all CHD)
Typical features
Cyanosis after the neonatal period
Hypoxemic spells during infancy

16. Tetralogy of Fallot
start around 4 to 6 months of age and are characterized by
Sudden onset or deepening of cyanosis
Sudden onset of dyspnea
Alterations of consciousness
Decrease in intensity of systolic murmur