ĐIỀU TRỊ TIM BẨM SINH, Đ H Y DƯỢC TP HCM

Bài giảng dành cho sinh viên y khoa, bác sĩ đa khoa, sau đại học. ĐH Y Dược TP Hồ Chí Minh.

TREATMENT OF CONGENITAL HEART

DISEASE

Vu Minh Phuc M.D PhD.

Medical and Pharmaceutical University

HCM City

1 INCIDENCE OF CHD

1.1 Common Lesions in CHD and Approximate Incidence

Ventricular septal defect VSD 20%

Atrial septal defect ASD 10%

Patent ductus arteriosus PDA 10%

Aortic Coarctation Coarc 10%

Hypoplastic left heart syndrome HLHS 2%

Interrupted aortic arc IAA 1%

Ebstein’s anomaly 0.5%

Mitral stenosis MS rare

1.2 Acyanotic versus Cyanotic Lesions

in CHD and Approximate Incidence

1.3 Pathological Classification of Lesions

2 TREATMENT OF

CHD

 Severe renal dysfunction

 Evidence of necrotizing enterocolitis

 Preexisting bleeding tendency

2.1 Medical Treatment

 PDA Closure by drugs

 Success rate 19% to nearly 100%

 < 30 wk GA, < 1 wk old :0.2mg/ kg/ dose q12h  3 doses

(maximum dose 0.6 mg/ kg/ 24h)

 < 48 hr old 0.2 – 0.1 – 0.1 2mg/ kg q12h

 2-7 days old 0.20mg/ kg q12h  3 doses

 > 8 days old 0.25mg/ kg q12h  3 doses

 10 mg/ kg

 5 mg/ kg at 24 and 48 hours from the initial dose

• Pulmonary atresia ( VSD)

• Severe pulmonic stenosis

• Tricuspid atresia

 Systemic blood flow is ductus dependent

– Pale and/ or gray – Left ventricular obstruction

• Interrupted aortic arc

• Critical coarctation of the aorta

• Hypoplastic left heart (aortic or mitral atresia)

 Inadequate mixing : TGA

2.1 Medical Treatment

 Manipulation of ductus arteriosus with PGE1

 Dosage of PGE1 : 0.05-0.1 g/ kg/ min infusion

 Side Effects of PGE1

 Hypotension, vasodilation, bradycardia

 Fever, tremors, seizures

2.1 Medical Treatment

 mPAP > half mSBP and mPAP 

PAP  causes tachycardia and falling toe temperature

2.2 Interventional Cardiology

 Baloon atrial septostomy

 Blade atrial septostomy

 Atrial septostomy with static balloon dilation

 Pulmonary, aortic valvuloplasty

 Balloon valvuloplasty of mitral valve stenosis

 Balloon valvuloplasty of tricuspid valve

 Aortic coaratation

 Hypoplastic or stenotic pulmonary arteries

 Angioplasty of other venous structures

BLADE ATRIAL SEPTOSTOMY

Balloon pulmonary valvuloplasty

Balloon angioplasty of the coarctation

Stent placement

in the severe aortic coarctation

Right pulmonary artery

balloon angioplasty

Stent placement in

the stenotic right and left pulmonary

arteries

Coils for PDA closure

PDA closure by coil

Amplatzer septal occluder

ASD closure with Amplatzer septal occluder

Amplatzer muscular VSD occluder device

VSD closure by Amplatzer occluder device

Vascular embolization therapy

2.3 Cardiac Surgery

Total repair requires

2 ventricles each capble of supporting the full cardiac output

2 AV valves, or a common valve that can be devided into 2 appropriate sized valves, and 1 AV valve

connects to each ventricle

A ventricular outflow to the aorta from the left ventricle

2.3 Cardiac Surgery

Total repair means that

There are 2 ventricles, 2 AV valves, 2

outflows from the heart

The right ventricle pumps to the lungs and the left to the body

There are no large residual septal defects

2.3 Cardiac Surgery

Palliation

Low pulmonary blood flow –

Blablock-Taussig shunt (BTS, mBTS)

High pulmonary blood flow – PA banding

Inadequate ventricular outflow to the aorta – Norwood or Damus-Kaye-Stansel (DKS ) Fontan circulation – absolute necessity for low/normal pulmonary vascular resistance

Classic BTS

Modified BTS

PA banding

Norwood

Stage 1

Norwood

Stage 1

Norwood

Stage 1

Norwood Stage 1

Norwood Stage 2 (Hemi-

Fontan)

Norwood Stage 3

(Complete-Fontan)

Thanks for your

attention