131009_catatan kuliah penyakit jantung bawaaningris
TRANSCRIPT
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Heart Diseases in Infant andChildren
Dr. Mulyadi M. Djer, SpA(K)
Department of Child HealthMedical School University of Indonesia
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Structures of the heart
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Cardiac performance
Preload Afterload
ContractilityRate
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Heart disease in childrenCongenital heart disease
Acyanosis congenital heart diseaseCyanosis congenital heart disease
Acquired heart disease Acute rheumatic feverChronic rheumatic heart diseaseKawasaki disease
Cardiac involvement in systemic diseaseThalasemiaKidney diseaseetc
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Heart disease in childrenCongenital heart disease
Acyanosis congenital heart diseaseCyanosis congenital heart disease
Acquired heart disease Acute rheumatic feverChronic rheumatic heart diseaseKawasaki disease
Cardiac involvement in systemic diseaseThalasemiaKidney diseaseetc
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Heart disease in childrenCongenital heart disease
Acyanosis congenital heart diseaseCyanosis congenital heart disease
Acquired heart disease Acute rheumatic feverChronic rheumatic heart diseaseKawasaki disease
Cardiac involvement in systemic diseaseThalasemiaKidney diseaseetc
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Congenital Heart Disease
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Incidence of Congenital
Heart DiseaseThe incidence: 8-10 in 1000 live birth
Indonesia:
Total population : 220,000,000Birth rate: 2.3 %Incidence CHD per year: 40,000 cases
Jakarta:Total population: 10,000,000Incidence CHD per year: 4,000 cases.
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Classification of CHD AcyanosisNormal pulmonary blood flow
Pulmonary Stenosis (PS) Aortic Stenosis (AS)Coarctatio Aorta (CoA)
Increased pulmonary blood flowPatent Ductus Arteriosus (PDA) Atrial Septal Dfect (ASD) Ventricular Sseptal Defect (VSD)
CyanosisNormal pulmonary blood flow
TGA without PSIncreased pulmonary blood flow
TGA with VSDTruncus arteriosusTotal anomaly pulmonary vein drainage
Decreased pulmonary blood flowToFPulmonary atresiaTicuspid atresia
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Classification of CHD AcyanosisNormal pulmonary blood flow
PS ASCoA
Increased pulmonary blood flowPDA ASD VSD
CyanosisNormal pulmonary blood flow
Transposition of Great Artery (TGA) without PSIncreased pulmonary blood flow
TGA with VSDTruncus arteriosusTotal anomaly pulmonary vein drainage (TAPVD)
Decreased pulmonary blood flowTetralogy of Fallot (ToF)Pulmonary atresia (PA)Ticuspid atresia
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Pathophysiology acyanotic and cyanotic
Hemodynamic acyanotic Hemodynamic cyanotic
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EtiologyGenetic 10 %
Chromosome 7 %Monogenic 3 %Environment 3 %
Multifactor 90 %
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Sign and Symptom of CHDCyanosisDyspneuExercise intolerance
Infant Feeding problemIntermittent feedingProlonged feeding
Big children Dyspneu on exertionOrthopneuRecurrent respiratory tract infectionPoor weight gain
Asymptomatic murmur
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DiagnosisClinical findingSupporting examination
Level 1Periphery blood examination
Arterial blood gas analysisChest X rayElectrocardiography
Level 2Echocardiography
Level 3Cardiac catheterization
DiagnosticTherapeutic
OthersCT ScanMRI
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DiagnosisClinical findingSupporting examination
Level 1Periphery blood examination
Arterial blood gas analysisChest X rayElectrocardiography
Level 2Echocardiography
Level 3
Cardiac catheterizationDiagnosticTherapeutic
OthersCT ScanMRI
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DiagnosisClinical findingSupporting examination
Level 1Periphery blood examination
Arterial blood gas analysisChest X rayElectrocardiography
Level 2Echocardiography
Level 3
Cardiac catheterizationDiagnosticTherapeutic
OthersCT ScanMRI
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DiagnosisClinical findingSupporting examination
Level 1Periphery blood examination
Arterial blood gas analysisChest X rayElectrocardiography
Level 2Echocardiography
Level 3
Cardiac catheterizationDiagnosticTherapeutic
OthersCT ScanMRI
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DiagnosisClinical findingSupporting examination
Level 1Periphery blood examination
Arterial blood gas analysisChest X rayElectrocardiography
Level 2Echocardiography
Level 3
Cardiac catheterizationDiagnosticTherapeutic
OthersCT ScanMRI
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MR-guided diagnostic and interventional procedures
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Early diagnosis is important because:Management of disease and education to parentdepend on itCertain CHD has optimal age to undergo definitivetreatment
TGA: 2 weeksComplete AVSD: 3-6 monthsTruncus arteriosus: < 6 months
Most CHD does not need intervention / surgery attime of diagnosis:
Intervention / surgery will be needed at anyage in which the risk of intervention or surgeryis low (usually above 1- 2 year), but dont late.Early surgery / intervention is needed ifconservative treatment fail.
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Early diagnosis is important because:Management of disease and education to parentdepend on itCertain CHD has optimal age to undergo definitivetreatment
Severe CoA / Interrupted Ao arch: as soon aspossible
TGA: 2 weeksComplete AVSD: 3-6 monthsTruncus arteriosus: < 6 months
Most CHD does not need intervention / surgery attime of diagnosis:
Intervention / surgery will be needed at anyage in which the risk of intervention or surgeryis low (usually above 1- 2 year), but dont late.Early surgery / intervention is needed ifconservative treatment fail.
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Early diagnosis is important because:Management of disease and education to parent
depend on itCertain CHD has optimal age to undergo definitivetreatment
TGA: 2 weeks
Complete AVSD: 3-6 monthsTruncus arteriosus: < 6 monthsMost CHD does not need intervention / surgery attime of diagnosis:
Intervention / surgery will be needed at anyage in which the risk of intervention or surgeryis low (usually above 1- 2 year), but dont late.Early surgery / intervention is needed ifconservative treatment fail.
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Management of Congenital HeartDisease
Do not required treatment or intervention, some of defect closedspontaneouslyTreatment
Medical treatmentInitial treatment (PGE 1, indomethacin)Complication treatment (anti failure, anti spell)Conservative treatment (Eisenmenger)
Palliative
Intervention non-surgery (BAS, PDA stenting)Surgery (BT shunt, PA banding)Definitive
Intervention non-surgery Non-complex CHDSurgery Complex CHD
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Treatment of Congenital Heart
DiseaseMedical treatment
Initial treatment (PGE 1, indomethacin)
Complication treatment (anti failure, anti spell)Conservative treatment (Eisenmenger)
PalliativeIntervention non-surgery (BAS, PDA stenting)
Surgery (BT shunt, PA banding)Definitive
Intervention non-surgery Non-complex CHDSurgery Complex CHD
. ntro uct on
ntro uct on
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Treatment of Congenital HeartDisease
Medical treatmentInitial treatment (PGE 1, indomethacin)
Complication treatment (anti failure, anti spell)Conservative treatment (Eisenmenger)
PalliativeIntervention non-surgery (BAS, PDA stenting)
Surgery (BT shunt, PA banding)Definitive
Intervention non-surgery Non-complex CHDSurgery Complex CHD
. ntro uct on
ntro uct on
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Treatment of Congenital Heart
DiseaseMedical treatment
Initial treatment (PGE 1, indomethacin)
Complication treatment (anti failure, anti spell)Conservative treatment (Eisenmenger)
PalliativeIntervention non-surgery (BAS, PDA stenting)
Surgery (BT shunt, PA banding)Definitive
Intervention non-surgery Non-complex CHDSurgery Complex CHD
. ntro uct on
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State of the Art of Treatmentof Congenital Heart Disease
Invasiveness
E f f e c
t i v e n e s s
Good
Bad
Conventional
Surgery
MinimalInvasiveSurgery
Interven
tion
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ComplicationsHeart failure
preload afterload contractility heart rate
Cyanotic spell
EndocarditisEisenmenger syndromeetc