Moffitt Report Pearls 8/4/2015: Congenital Heart Defects in Adults

Pearls from YY

  • Pulmonic stenosis in ToF (overriding aorta, VSD, pulmonic stenosis, RVH) can be protective of the pulmonary vasculature and prevent pulmonary HTN
  • Patent ductus arteriosus
    • causes LV volume overload first -> LV failure -> THEN pulmonary HTN and RV issues. So expect to see LV dysfunction as the first thing in PDA
    • Differential cyanosis: in an uncorrected adult, there can be eventual difference in cyanosis, with the lower extremities more cyanotic than the upper extremities. This is because the PDA can deliver unoxygenated blood to the lower extremities since the connection to the aorta is after the takeoff of the left subclavian artery.

Congenital Heart Disease in adults

Differential diagnosis congenital heart disease seen in adults (without corrective operation at birth). This list is different than the standard congenital heart disease list, since many defects are not compatible with survival into adulthood without correction.

  • Stenotic lesions
    • Aortic valve: bicuspid valve, unicuspid valve, subaortic membrane or hypertrophic cardiomyopathy
    • Pulmonic stenosis
  • Regurgitant lesions
    • Ebstein’s anomaly of the Triscupid
    • Myxomatous mitral valve disease
  • Shunts
    • ASD
    • VSD
    • PDA
  • Abnormal connections:
    • Anomalous origins of the coronary arteries (e.g. ALCAPA)
    • Partial anomalous pulmonary venous return
    • Congenitally corrected transposition of the great arteries (L-TGA, as opposed to D-TGA)
  • Complex or combinations
    • Tetralogy of Fallot

Further reading

Evernote link: https://www.evernote.com/shard/s248/sh/d3ef4331-447e-4a0d-a1dd-02e2baa84862/d59574fe5674017128edd007e24f30f4

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