1. Congenital Heart Disease

2. congenital heart disease can be organized into three major categories:
Malformations causing a left-to-right shunt
Malformations causing a right-to-left shunt
Malformations causing an obstruction
A shunt is an abnormal communication between chambers or blood vessels

3. pulmonary/venous ---- Systemic/arterial
right-to-left shunt:
pulmonary/venous ---- Systemic/arterial
Deoxygenated Oxygenated --- cyanosis
Hypoxia clubbing (hypertrophic osteoarthropathy)
paradoxical embolism

4. left-to-right shunt:
Systemic/arterial ---- pulmonary/venous
Oxygenated deoxygenated--- no cyanosis
right ventricular hypertrophy
Pulmonary congestion hypertension
Rt-to-left shunt (Eisenmenger syndrome)--- cyanosis

5. left-to-right shunt:
- m.C
- ASD, VSD (m.c) , PDA, AVSD

6. right-to-left shunt:
Tetralogy of Fallot m.c
Transposition of the Great Arteries
persistent truncus arteriosus
Tricuspid atresia
total anomalous pulmonary venous connection

7. Obstructive Lesions:
aortic or pulmonary valve stenosis or atresia
coarctation of the aorta
subpulmonary stenosis in TOF

8. ASD Defect in septum primum or secundum
Mortality is low, and long-term survival is comparable to that of the normal population.
Asymptomatic until adulthood

10. Patent Foramen Ovale
foramen ovale/ostium secundum permits continued right-to-left shunting of blood during intrauterine development.
the unsealed flap can open if right-sided pressures become elevated (coughing, /sneezing) can produce brief periods of right-to-left shunting

11. Ventricular Septal Defect
Membranous (m.c), muscular, infundibular
The functional consequences of a VSD depend on the size

13. Patent Ductus Arteriosus
ductus arteriosus---pulmonary artery---aorta
During intrauterine life, it permits blood flow from the pulmonary artery to the aorta, thereby bypassing the unoxygenated lungs.
+ prostaglandin, immuture
Used to save life in pulmonary or oartic valve obstruction or atresia

15. atrioventricular (AV) septal defect
Endocardial cushion defect
Down syndrome

17. Tetralogy of Fallot VSD (2) subpulmonary stenosis/infundibulum
(3) an aorta that overrides the VSD
(4) Right ventricular hypertrophy

19. Transposition of the Great Arteries
Aorta---anterior---right ventricle
pulmonary artery---posterior---left ventricle
Parallel instead of series
incompatible with postnatal life unless a shunt exists for adequate mixing of blood.

21. persistent truncus arteriosus
failure of separation of truncus into aorta and pulmonic trunck .
The truncus overrides both ventricles.
Always accompanied by a membranous VSD.

23. total anomalous pulmonary venous return (TAPVR)
pulmonary veins----innominate vein/coronary sinus
Patent foramen ovale/ or ASD always present

25. Coarctation of the Aorta
Narrowing
2 types
1- infantile: + PDA---- early after birth--- cyanosis in lower ½ of body
2- adult: - PDA---- late presentation---- HTN in upper extremities

27. Aortic Stenosis and Atresia
Valvular--- hypoplastic left heart syndrome
Supravalvular
Subvalvular----- sudden death with exertion