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Congenital Heart Disease & Hemiparesis

Congenital Heart Disease & Hemiparesis. Congenital Heart Disease.

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Congenital Heart Disease & Hemiparesis

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  1. Congenital Heart Disease & Hemiparesis

  2. Congenital Heart Disease Congenital heart disease (CHD) is the most common type of birth defect. CHD refers to a problem with the heart’s structure that occurred because of abnormal development in the heart before birth. CHD consists of 2 categories: Cyanotic CHD and Acyanotic CHD. CHD is a risk factor for emboli development which can contribute to cerebrovascular accidents.

  3. Occurrence & Risk Factors • Most cases of CHD occur in isolation • CHD can be associated with various genetic disorders such as Down Syndrome, Marfan Syndrome, Turner Syndrome and Trisomy 13 • Risk factors: • Associated with maternal intake of retonic acid (for acne), alcohol, chemical exposureand rubella

  4. Acyanotic CHD • Presentation • Pink in coloring • Normal oxygenation saturation • Involves left-to-right shunting so that oxygen rich blood is shunted to the lungs unnecessarily • Defects associated with acyanotic CHD • Atrialseptal defect • Ventricular septal defect • Patent ductusarteriosus • Aortic coarctation • Pulmonary stenosis • Aortic stenosis

  5. Cyanotic CHD • Presentation • Cyanosis (blue) in coloring • Oxygen saturation is 15 to 30% below normal • Involves right-to-left shunting so that unoxygenated blood is shunted to the body • Defects associated with CCHD • Tetralogy of Fallot (TOF) • Transposition of the Great Artery • Tricuspid Atresia • Pulmonary atresia • TruncusArteriosus • Total Anomalous Pulmonary Venous Return • Hypoplastic Left-Sided Heart Syndrome

  6. Hemiparesis and CHD • In study of children with brain abscesses, one pre-disposing factor was unoperated CCHD. This group of children with CCHD tended to have more significant cerebral complications (mid-line shift and cerebral edema) following drainage of the abscess. Other complications included hemiparesis and seizures for this group.

  7. Cerebrovascular Accidents and CHD • 1/5 to 1/3 of ischemic childhood strokes can be attributed to underlying congenital heart defects • Due to paradoxical cerebral emoblism: emboli from the systemic venous circulation passes to arterial circulation from large septal defects, single ventricle, total anomalous pulmonary venous return, truncusarteriosus • Single ventricle physiology with right-to-left shunting is especially vulnerable to systemic emboli

  8. References • Kirton A, DeVeber G. Ischemic stroke complicating pediatric cardiovasculardisease. Nat ClinPractCardiovasc Med. 2007 Mar;4(3):163-6. • Mehnaz A, Syed AU, Saleem AS, Khalid CN. Clinical features and outcome ofcerebralabscess in congenital heart disease. J Ayub Med CollAbbottabad. 2006 Apr-Jun;18(2):21-4. • Salih MA, Al-Jarallah AS, Abdel-Gader AG, Al-Jarallah AA, Al-Saadi MM, KentabAY, Alorainy IA, Hassan HH. Cardiac diseases as a risk factor for stroke in Saudi children. Saudi Med J. 2006 Mar;27 Suppl 1:S61-8. • Wu YW, Lynch JK, Nelson KB. Perinatal arterial stroke: understanding mechanisms and outcomes. Semin Neurol. 2005 Dec;25(4):424-34. Review.

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