CONGENITAL HEART DISEASE , TIM BẨM SINH Ở TRẺ EM, ĐH Y DƯỢC TP HCM

CONGENITAL HEART DISEASE
(CHD)
Vũ Minh Phúc MD. PhD.


CONTENTS
1. Definition
2. Incidence
3. Etiology
4. Classification


1. 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


2. 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%


2. INCIDENCE
•

In Children’s Hospital # 1 – 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%


2. 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

6

TGA

6

DORV

5

Single Ventricle

5

Aortic Stenosis

4

ALCAPA

2

Tricuspid stenosis

2

DOLV

1

Pulmonary atresia

1

Aortic coarctation

1

Tricuspid atresia

1

TAPVC

1

1083 (93.4%)


2. INCIDENCE
• Mortality of CHD

3. 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


3. 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


3. ETIOLOGY
3.1. Gene and Family factor
• Recessive heredity
– Blood-relation marriage
• Friedrich
• Jervell
• Ellis Van Creveld

– Gender chromosome heredity
• Duchene disease
• Hunter syndrome

3. 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


4. CLASSIFICATION OF CHD
• General
– Innocent or normal murmurs
– Cardiac malposition
– Ventricular inversion (corrected TGA)
– Complete heart block


4. 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