Complications of Congenital Heart Disease in Children

Complications of Congenital Heart Disease

Heart disease with failure

·        Definition: inability of myocardium to meet metabolic needs of the body

·        Causes:

o  Congential Heart disease: 

§  Lesions with left to right shunt: Large VSD (® ­blood to pump ® overloaded heart), AV canal defect, Patent ductus 

§  Left outflow obstruction: Hypoplastic left heart, Coarctation of the aorta, aortic stenosis

o  Arrhythmia: usually SVT

o  Cardiomyopathy: Usually ischaemic, due to birth asphyxia

·        Incidence by age:

o  Infants: congential heart lesions, rarely arrhythmias (eg SVT)

o  > 1 year: cardiomyopathy, right heart disease, dysrhythmias

·        Symptoms of heart failure: ­respiratory effort, sweating, poor feeding (no energy to suck), failure to thrive (hypermetabolic state and poor feeding due to breathlessness)

·        Signs of heart failure: Tachycardia (­160 in infants), tachypnoea (intercostal indrawing, wheeze), gallop rhythm, hepatomegaly

·        Features not found in children:

o   ­JVP

o   Peripheral oedema

o   Crepitations in lung fields

·        Key differential to acute onset is sepsis

·        Treatment:

o   Rest

o   Diuretics

o   Digoxin

o   O2

o   Adequate calories: fortified feeds

o   Treatment of underlying cause (arrhythmias, infections, anaemia, etc)

Eisenmenger’s Syndrome (Pulmonary Hypertension)

·        Sequalae of large L ® R shunt with untreated VSD, PDA or ASD.  Rare – as there usually corrected

·        Usually present in 3^rd to 4^th decade

·        ­ Pulmonary flow ® oversupply of blood ® pulmonary capillary hypertrophy ® ­resistance ® pulmonary hypertension ®:

o   Reversal of shunt (R ® L) ® development of cyanosis

o   RH hypertrophy and failure

·        Also abnormal flow ® mural thrombosis ® endocarditis (as in most congenital defects)

·        Clinical:

o   Signs of pulmonary hypertension: RV heave, loud P2, hepatomegaly

o   Little or no murmur

o   Cyanosis, clubbing

·        Prognosis:

o   Arrhythmias and sudden cardiac death 

o   ­Hb due to cyanosis (polycythaemia) ® ­viscosity ® clotting problems

o   ­Risk of systemic emboli (lungs don‟t act as a filter for emboli)

o   Haemoptysis due to pulmonary infarct/haemorrhage

·        Treatment: Supportive or heart-lung transplant