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Acyanotic

Types of Acyanotic Heart Disease

Patent Ductus Arteriosus (PDA)

In PDA, or patent ductus arteriosus, is a persistent connection between the aorta and the pulmonary artery. The PDA is a normal connection when the baby was still in the uterus. When the baby is in the uterus, it depends on the PDA to get oxygen from the mother. When the baby is born, there are hormonal changes in the baby that normally close off the PDA, since the baby is now breathing, and no longer needs the PDA. A PDA defect is when this ductus doesn't close as it normally should. Persistence of the PDA may cause an excessive amount of blood to go to the lungs. Depending on the size of the PDA and the condition on the lung, the baby may have no symptoms, or may have severe heart failure.

PDAs should be closed because there is a real risk of endocarditis, or a heart infection, over the course of a lifetime. PDA's are often closed in the cardiac catheterization laboratory, by the insertion of specially designed coils. These coils sit in the PDA, and expand to the point where they prevent all of the blood flow. The traditional way of closing a ductus is through an operation and closure under direct vision, although this method is now typically reserved for premature neonates and if an interventional cardiac catheterization laboratory is not readily available. Closure of a PDA by either interventional cardiac catheterization or surgery is safe and carries negligible morbidity and mortality.

The risk of Patent ductus arteriosus risk is also increases at higher altitude because of the lower concentration of oxygen.

Coarctation of the Aorta

The aorta is the main artery that sends oxygen rich blood from the heart to the body. Coarctation of the aorta is a constricted segment of the aorta that obstructs blood flow to the body. The left ventricle has to pump harder because the pressure is high. Because of this, the heart may enlarge. Coarctations typically occur as isolated defects, but may occur with a ventricular septal defect, subaortic stenosis, or complex congenital heart defects. Surgery may be needed to correct the defect, depending on the severity of the coarctation and the presence of other congenital defects. Another option may be a balloon angioplasty. This procedure is done in the cardiac catheterization lab. Your physician should discuss the various options for your child.

Atrial Septal Defect (ASD)

The septum of the heart separates the right and left sides of the heart. A hole in the wall between the two upper chambers is called an atrial septal defect, or ASD. This is one of the simplest forms of congenital heart disease, and was one of the congenital heart defects to be repaired surgically. Normally, blood entering the right side of the heart stays on the right side (this is low oxygen blood), and blood on the left side of the heart stays on the left side (this is oxygen rich blood) which is then pumped to the body. When a defect or "hole" is present between the atria (or upper chambers), some oxygen rich blood leaks back to the right side of the heart. It then goes back to the lungs even though it is already rich in oxygen. Because of this, there is a significant increase in the blood that goes to the lungs. Over the course of several years, this may impair the function of both the heart and the lungs, resulting in a markedly foreshortened life expectancy. This defect is usually corrected with open heart surgery to restore normal blood circulation.

Atrial septal defect is the 5th most common Congenital Heart Disease.

Ventricular Septal Defect (VSD)

A ventricular septal defect, or VSD, is the most common kind of congenital heart defect. This is what many people refer to as a "hole in the heart". The septum is the wall that separates the right and left sides of the heart. A hole in the wall between the two lower chambers is called a ventricular septal defect, or VSD for short.

Normally, blood entering the right side of the heart stays on the right side (this is low oxygen blood), and blood on the left side of the heart stays on the left side (this is oxygen rich blood) which is then pumped to the rest of the body. When a defect or "hole" is present between the ventricles (or lower chambers), blood from the left side of the heart is forced through the defect to the right side every time the heart beats. It then goes back to the lungs even though it is already rich in oxygen. Because of this, blood that is not yet oxygen rich cant get to the lungs. The most common signs and symptoms are trouble eating and gaining weight, breathlessness and easy fatigability. A baby with a large VSD tires quickly after not eating very much, falls asleep, wakes us in a short while quite hungry, tries to eat again, tires easily. This cycle is repeated.

Because the heart has to pump extra blood, it may enlarge. Also, because theres more blood going to the lungs, high pressure may occur in the blood vessels there. This may cause permanent damage to the walls of the blood vessels over time. Many, if not most, of all VSDs will close on their own. Those that close on their own are usually small and do so in the first year of life. Large VSDs, especially those that don't close in the first year of life, will usually need to be closed surgically. VSD closure is one of the most commonly performed congenital heart operations, and is a safe and effective operation. The child would be expected to have virtually normal growth, development, and life expectancy following repair.

Premature infants are 10 times more likely to have this defect than full term infants.

Atrioventricular Septal Defect (AVSD)

This defect is best described as a large hole in the middle of the heart. It results from a lack of separation of the atria and the ventricles into separate chambers, and a lack of separation of the mitral and tricuspid valves into two separate valves. Therefore there is a large connection between the two atria, between the two ventricles, and a single atrioventricular (or AV) valve, whereas there should be separate mitral and tricuspid valves. A very complex defect indeed! The defect is named an atrioventricular septal defect, or AVSD. An old name for this defect is an atrioventricular canal defect, or AV canal for short. In its simplest form, there is only an atrial septal defect, and this this is treated just like an ASD.

More complex forms of AVSD also include the opening between the two ventricles, along with the lack of separation of the AV valve into separate mitral and tricuspid valves. In the most complex form, not only are there defects between the atria, the ventricles, and the mitral/tricuspid valves, one of the ventricles may not be properly formed, the valves may be 'over-riding' or 'straddling', there may be obstruction to the aorta, and other things. The reason this defect may be so complex is that it probably occurs during the very first stages of fetal development. The large hole in the center of the heart lets blood from the left side of the heart (this is oxygen rich blood) pass into the right side of the heart. It then goes back to the lungs even though it has already been oxygenated. Because of the large amount of extra blood going to the lungs, high blood pressure may occur there and over time can damage the blood vessels. Additionally, the valve between the upper (atrial) and lower (ventricular) chambers does not close properly. Blood then leaks backward from the ventricular chambers to the atrial chambers. This leak is referred to as an insufficiency of the valve. When the valve leaks, the heart has to pump more blood. This can lead to many other problems, including enlargement of the heart. This defect is usually corrected in infancy with open heart surgery to restore normal blood circulation through the heart. Surgical repair consists of separation of the common AV valve into two valves, along with closure of the VSD and ASD. The operation represents a surgical separation of the valves, ventricles and atria, so it tends to be a big operation. Some children, however, may have too complex a defect to correct in infancy, and would initially require a pulmonary artery banding. This will decrease blood flow and reduce the high pressure in the lungs. When the child is older, the band will be removed and the defect corrected with open heart surgery.

Sixty-nine per cent (69%) of all AV canal patients have Down syndrome.

Aortic Stenosis (AS)

Stenosis means narrowing. Aortic stenosis is then a narrowing of the aortic valve or a narrowing of the aorta directly above (supravalvar) or below (subvalvar) the aortic valve. Normally, oxygen rich blood is pumped from the left ventricle, through the aortic valve and into the aorta. The aorta is the main artery that sends oxygen rich blood to the body. When aortic stenosis, it makes it very hard for the heart to pump blood to the body. Depending on the severity of the stenosis, open heart surgery may be needed to correct the defect. Another option may be a balloon valvuloplasty. This procedure is done in the cardiac catheterization lab. Your physician should offer you the best option for your child.

Pulmonary Stenosis (PS)

Stenosis means narrowing. Pulmonary stenosis is then a narrowing of the pulmonary valve. Normally the pulmonary valve opens to let low oxygen blood flow from the right ventricle to the lungs where the blood is oxygenated. Because of the narrowing the right ventricle has to pump harder to get past the stenotic valve. This can sometimes lead to enlargement of the right ventricle. Depending on the severity of the pulmonary stenosis, open heart surgery may be indicated to correct the defect. Another option may be a balloon valvuloplasty. This procedure is done in the cardiac catheterization lab. Your doctor should offer you the best option for your child. Some of these defects can be corrected by surgical treatment. Fortunately, surgical treatment is often possible a week after the child is born and full recovery is possible.

Other causes of congenital heart defects are the occurrence of rubella (German measles) in a woman during the first three months of pregnancy and intake of and a number of drugs, including anti-epileptic agents by a woman while during the pregnancy. These heart defects can be diagnosed through prenatal ultrasonography and amniocentesis.

Pulmonary stenosis is the second most common congenital heart disease.

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