CONGENITAL HEART DISEASE , TIM BẨM SINH Ở TRẺ EM, ĐH 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. Definition Incidence Etiology Classification

CONGENITAL HEART DISEASE (CHD) Vũ Minh Phúc MD PhD CONTENTS Definition Incidence Etiology Classification DEFINITION The deformities of the heart structure and vessels :  cardiac position  myocardium  lateral wall and septum  heart chambers  valves  systemic and pulmonary veins  great arteries, coronary arteries INCIDENCE • In the world : 0.7-0.8% live births – Ventricular septal defect VSD 20% – Atrial septal defect ASD 10% – Patent ductus arteriosus PDA 10% – Aortic coarctation – Aortic stenosis CoA AS – Tetralogy of Fallot – Pulmonary stenosis 10% TOF PS 10% 10% 10% INCIDENCE • In Children’s Hospital # – HCMC – 2007 – Congenital heart disease : 1160 49.8% – Miscellaneous : 751 32.2% – Other heart and vascular diseases : 242 10.3% (Kawasaki’s disease = 121) – Arrhythmias : 91 3.9% – Juvenile rheumatoid arthritis : 70 3% – Rheumatic fever : 16 0.6% Total 2007 : 2330 100% INCIDENCE • Congenital heart disease : 1160 VSD 313 (27.0%) PDA 306 (26.4%) ASD + VSD 175 (15.1%) ASD 164 (14.1%) TOF 084 (07.2%) AVSD 031 (02.7%) PS 010 (0.90%) Other complex CHD 42 Truncus arteriosus TGA DORV Single Ventricle Aortic Stenosis ALCAPA Tricuspid stenosis DOLV Pulmonary atresia Aortic coarctation Tricuspid atresia TAPVC 1083 (93.4%) INCIDENCE • Mortality of CHD ETIOLOGY 3.1 Gene and Family factor • Gene mutation - inheredity – Chromosome abnormalities : 13, 18, 21, 22 – Gender chromosome abnormalities : XO, XXY • Heredity according to the Mendel’s law 3% of CHD – Valvular deformities – Cardiomyopathy – Deformities of great vessels due to hereditary enzyme disturbances ETIOLOGY 3.1 Gene and Family factor • Dominant heredity – Syndromes have CHD and many other deformities • • • • Erhler Danlos Holt Oram Noonan Leopard AR, MS VSD PS PS + HCM – Only have CHD • • • • Romanoward Barlow DCM Cardiac conduction disturbance ETIOLOGY 3.1 Gene and Family factor • Recessive heredity – Blood-relation marriage • Friedrich • Jervell • Ellis Van Creveld – Gender chromosome heredity • Duchene disease • Hunter syndrome ETIOLOGY 3.2 From enviroment In pregnancy (1st trimester),mothers contact with • X ray, radioactive ray • Wine, cocaine • Sedatives: thalidomide, amphetamine, trimethadione Hydantoin Productive hormones • Viruses: rubella, measles, HSV, CMV, Coxsackie B • Chronic diseases: SLE, diabetes, phenylketonuria CLASSIFICATION OF CHD • General – Innocent or normal murmurs – Cardiac malposition – Ventricular inversion (corrected TGA) – Complete heart block CLASSIFICATION OF CHD • General – – – – Innocent or normal murmurs Cardiac malposition Ventricular inversion (corrected TGA) Complete heart block • Acyanotic – without a shunt (normal or  pulmonary blood flow (PBF)) – with left-to-right shunt ( PBF) • Cyanotic   PBF – Normal or  PBF THANKS FOR YOUR ATTENTION ... Children’s Hospital # – HCMC – 2007 – Congenital heart disease : 1160 49.8% – Miscellaneous : 751 32.2% – Other heart and vascular diseases : 242 10.3% (Kawasaki’s disease = 121) – Arrhythmias : 91... rheumatoid arthritis : 70 3% – Rheumatic fever : 16 0.6% Total 2007 : 2330 100% INCIDENCE • Congenital heart disease : 1160 VSD 313 (27.0%) PDA 306 (26.4%) ASD + VSD 175 (15.1%) ASD 164 (14.1%) TOF... Etiology Classification DEFINITION The deformities of the heart structure and vessels :  cardiac position  myocardium  lateral wall and septum  heart chambers  valves  systemic and pulmonary veins