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1. SIRKULASI JANINDr. Sevina Marisya, Mked(ped), SpA 2. Fetal circulation* Differs from adult circulation in several ways* Almost all differences are attributable to thefundamental defference in the site of gas exchangeAdult: lungsFetus: placenta 3. Course of Fetal CirculationThere are 4 shuntsin fetal circulation:• Placenta• Ductus venosus• Foramen ovale• Ductus Arteriosus 4. Some important aspects of fetal circulation:1. The placenta receives the largest amount of combinedventricular output(55%) and has the lowest vascularresistance in the fetus2. SVC drains the upper part of the body, IVC drains thelower part of the body and placenta. O2 saturation inthe IVC(70%) is higher than in the SVC(40%)3. Most of SVC blood goes to the RV. One third of the IVCblood is directed by the crista dividens to the LA throughthe foramen ovale, the remaining two third enters theRV and PA.4. Less oxygenated blood in the PA flows through thewidely open ductus arteriosus to the descending aortaand then to the placenta for oxygenation. 5. Changes in Circulationafter BirthThe primary change in circulationafter birth is a shift of blood flowfor gas exchange from theplacenta to the lungs.The placental circulationdisappears, and thepulmonary circulationis established. 6. 1. Interruption of the umbilical cord result in the following:a. Systemic vascular resistance >>as a result of the removal ofthe very low resistance placentab. Closure of the ductus venosusas a result of lack of blood returnfrom the placenta2. Lung expansion results in the following:a. Pulmonary vasc resistance andfall in PA pressureb. Functional closure of foramen ovaleas a result of increased pressurein the LAc. Closure of patent ductus arteriosus(PDA) as a result of increasedarterial oxygen saturation. 61 7. Thank you (/download/link/penyakit-jantung-katup13) Download 8. PENYAKIT JANTUNGBAWAAN All materials on our website are shared by users. If you have any questions about copyright issues, please report (/document/report/penyakit9. Structures of the heart jantung-katup13) us to resolve them. We are always happy to assist you. 10. Normal Heart 11. • Penyakit jantung bawaan (PJB):– Non-sianotik terbesar• Defek Septum Ventrikel (DSV) : 30%• Defek Septum242 PENYAKIT JANTUNG KATUP'13 Atrium (DSA)• Duktus Arteriosus Persisten (DAP)• Stenosis Pulmonal– Sianotik• TOF (Tetralogi of Fallot)• Atresia views by nova-ci-necis Pulmonal• TGA (Tranposisi Great Artery)• Single Ventrikel on May 27, 2015 Category: Download: 0 12. Defek Septum Ventrikel• Insiden 30 % dari PJB• Anatomi Defek subarteri : di bawah katup aorta dan pulmonal Report (/document/report/penyakitComment: 0 DOCUMENTS Defek Perimembran: below aortic valve at parsmembranous septum Defek Muskular jantung-katup13) (/category/documents.html) 13. • Menurut besarnya diklasifikasikan:– DSV kecil : < 5 mm2/m 2 luas permukaan tubuh– DSV sedang : 5-10 mm2/m 2 luas permukaan tubuh– DSV besar : defek lebih dari ½ diameter aorta atau> 10 mm2/m 2 luas permukaan Comments tubuh 14. VSD 15. Ventricular Septal Defect 16. Ventricular Septal defectLA LVPA AORV RASystemicLungsQp > Qs 17. Ventricular septal defectRARVRA LALALV RV LV 18. Defek Septum Ventrikel 19. Defek Septum Ventrikel• Clinical findingsDay 1st after birth: murmur (-)After 2-6 weeks : murmur (+)Murmur : Description pansystolic grade 3/6 or higherat LSB 3Small muscular defect: early systolic murmurSignificant defect: Mid diastolic murmur at apex Download Penyakit jantung katup'13 20. Small VSDLarge VSDVentricular Septal DefectMurmur: pansystolicgrade 3/6 or higher atLSB 3 21. Ventricular Septal DefectKardiomegaliKonus pulmonalis menonjolVaskularisasi paru meningkatApex down ward Transcript 22. Defek septum VentrikelDiagnosis Differential PDA with PH Tetralogy Fallot non cyanotic Inoscent murmur 23. Defek septum ventrikelManagement:Definitive : VSD closure Surgery Transcatheter closureGagal Jantung : 1. SIRKULASI JANINDr. Sevina Marisya, Mked(ped), SpA Digoksin 0.01 mg/kg/hari dibagi 2 dosisInfeksi Sal. Nafas: antibiotik 2. Fetal circulation* Differs from adult circulation in several ways* Almost all differences are attributable to 24. DSVHeart failure (+) Heart failure (-)Anti failureAortic valveprolapsFail SuccessPABEvaluatein 6 thefundamental defference in the site of gas exchangeAdult: lungsFetus: placenta mthsInfundibularstenosisPH Spontaneous SmallerclosureCathPVD(-) PVD(+) CathCathFR1.5Reactive Non3. Course of Fetal CirculationThere are 4 shuntsin fetal circulation:• Placenta• Ductus venosus• Foramen ovale• reactiveConservativeSurgical closure/Transcatheter closure Ductus Arteriosus 25. Ventricular septal defectVSD before occlusion 4. Some important aspects of fetal circulation:1. The placenta receives the largest amount of combinedventricular 26. Ventricular septal defectVSD during deployingthe device output(55%) and has the lowest vascularresistance in the fetus2. SVC drains the upper part of the body, IVC drains 27. Ventricular septal defectVSD after occludedusing ASO thelower part of the body and placenta. O2 saturation inthe IVC(70%) is higher than in the SVC(40%)3. Most of SVC 28. Defek Septum Atrium (DSA)• Insiden : + 10 % : ratio = 1,5 to 2 : 1• Anatomi : DSA Sekundum: Defect on blood goes to the RV. One third of the IVCblood is directed by the crista dividens to the LA throughthe foramen ovale, foramen ovale DSA Sinus venosus: Defect at SVC and RA junction DSA primum: Defect at ostium primum the remaining two third enters theRV and PA.4. Less oxygenated blood in the PA flows through thewidely open ductus 29. ASD arteriosus to the descending aortaand then to the placenta for oxygenation. 30. Atrial Septal Defect 5. Changes in Circulationafter BirthThe primary change in circulationafter birth is a shift of blood flowfor gas exchange 31. Atrial Septal DefectDiagram of ASD from theplacenta to the lungs.The placental circulationdisappears, and thepulmonary circulationis established. 32. LA LVPA AORV RASystemicLungsQp > QsAtrial septal defect 6. 1. Interruption of the umbilical cord result in the following:a. Systemic vascular resistance >>as a result of the 33. RARVLALVRARVLALVAtrial septal Defect removal ofthe very low resistance placentab. Closure of the ductus venosusas a result of lack of blood returnfrom the 34. KlinisDefek Septum Atrium- Asymptomatic- Auskultasi:- Bunyi jantung I normal atau mengeras- Bising ejeksi placenta2. Lung expansion results in the following:a. Pulmonary vasc resistance andfall in sistolik di daerah pulmonum- Bising diastolik daerah trikuspid PA pressureb. Functional closure of foramen ovaleas a result of increased pressurein the LAc. Closure of patent ductus 35. Atrial Septal DefectAuscultation :1st HS N or loudwidely split and fixed 2nd HSEjection Sistolic Murmur arteriosus(PDA) as a result of increasedarterial oxygen saturation. 36. Atrial Septal DefectECG : RBBB right ventricular hypertrophy 7. Thank you 37. Pembesaran atrium kananKonus pulmonum menonjolVaskularisasi parumeningkat sesuai besarnyapirauAtrial 8. PENYAKIT JANTUNGBAWAAN Septal DefectChest X-Ray 9. Structures of the heart 38. Defek Septum AtriumDiagnosis Differential Primary Atrial Septal DefectECG : LAD Partial Anomalous 10. Normal Heart Pulmonary VeinDrainage Pulmonary Stenosis Innocent Murmur 11. • Penyakit jantung bawaan (PJB):– Non-sianotik terbesar• Defek Septum Ventrikel (DSV) : 30%• Defek Septum 39. Defek Septum AtriumManagementSurgery : Preschool age 4-5 thnRecent treatment: transcatheter closure Atrium (DSA)• Duktus Arteriosus Persisten (DAP)• Stenosis Pulmonal– Sianotik• TOF (Tetralogi of Fallot)• Atresia usingASO (Amplatzer septal occluder) Pulmonal• TGA (Tranposisi Great Artery)• Single Ventrikel 40. ASDSmall Shunt Large ShuntObservationEvaluationAt age 5-8 yrsCathFR1.5ConservativeInfants 12. Defek Septum Ventrikel• Insiden 30 % dari PJB• Anatomi Defek subarteri : di bawah katup aorta dan pulmonal Children/AdultsHeartFailure (-)HeartFailure (+)Age >1yrsW >10kgTranscatheter closure (Secundum ASD) /Surgical Defek Perimembran: below aortic valve at parsmembranous septum Defek Muskular Closure(others)ConservativeAnti failureSuccess FailPH (-) PH (+)PVD(-)PVD(+)HyperoxiaReac13. • Menurut besarnya diklasifikasikan:– DSV kecil : < 5 mm2/m 2 luas permukaan tubuh– DSV sedang : 5-10 mm2/m tiveNonreactiveSurgicalClosure 2 luas permukaan tubuh– DSV besar : defek lebih dari ½ diameter aorta atau> 10 mm2/m 2 luas permukaan tubuh 41. Atrial septal defect 14. VSD 42. Atrial septal defectASD before occlusion 15. Ventricular Septal Defect 43. Atrial septal defectDuring balloonsizing 16. Ventricular Septal defectLA LVPA AORV RASystemicLungsQp > Qs 44. Atrial septal defectASD after occludedusing ASO 17. Ventricular septal defectRARVRA LALALV RV LV 45. PENYAKIT JANTUNG BAWAANSIANOTIK 18. Defek Septum Ventrikel 46. Tetralogy FallotInsiden5-8% dari PJBAnatomiCause: Left-anterior deviation of infundibularseptumSindroma 19. Defek Septum Ventrikel• Clinical findingsDay 1st after birth: murmur (-)After 2-6 weeks : murmur (+)Murmur : consist of 4 items: VSD pulmonal stenosis aortic over-riding RVH pansystolic grade 3/6 or higherat LSB 3Small muscular defect: early systolic murmurSignificant defect: Mid diastolic 47. Tetralogy Fallot murmur at apex 48. Tetralogy FallotHemodynamic acyanotic Hemodynamic cyanotic 20. Small VSDLarge VSDVentricular Septal DefectMurmur: pansystolicgrade 3/6 or higher atLSB 3 49. Tetralogy Fallot• DiagnosisKlinis:- sianosis PS- jari tabuh setelah 6 bln- sianotik spell : sesak mendadak, 21. Ventricular Septal DefectKardiomegaliKonus pulmonalis menonjolVaskularisasi paru meningkatApex down ward nafas cepatdalam, lemas, kejang, koma- Squatting (sering jongkok)- Single 2nd HS, ejection systolic murmur 22. Defek septum VentrikelDiagnosis Differential PDA with PH Tetralogy Fallot non cyanotic Inoscent murmur 50. Tetralogy FallotSingle 2nd HS, ejection systolic murmur 23. Defek septum ventrikelManagement:Definitive : VSD closure Surgery Transcatheter closureGagal Jantung : 51. Tetralogi Fallot Digoksin 0.01 mg/kg/hari dibagi 2 dosisInfeksi Sal. Nafas: antibiotik 52. Foto thoraks:- Boot-shaped- Apeks jantungterangkat- Konus pulmonaliscekung- Vaskularisasi 24. DSVHeart failure (+) Heart failure (-)Anti failureAortic valveprolapsFail SuccessPABEvaluatein 6 paruberkurangTetralogy Fallot mthsInfundibularstenosisPH Spontaneous SmallerclosureCathPVD(-) PVD(+) CathCathFR1.5Reactive Non53. Tetralogy FallotECG : RADEchocardiography : to confirm diagnosis reactiveConservativeSurgical closure/Transcatheter closure 54. Tetralogy Fallot• Diagnosis Differential Pulmonary Atresia Double outlet right ventricle and pulmonary stenosis 25. Ventricular septal defectVSD before occlusion Transposisi of great arteri and pulmonary stenosis 26. Ventricular septal defectVSD during deployingthe device 55. • Management Sianotic spell:- knee-chest position- O2 sungkup 5-8l/i- Morfin sulfat 0.1-0.2 mg/kg/subkutan27. Ventricular septal defectVSD after occludedusing ASO Sodium bikarbonat 1 mEq/kg/iv- Propanolol 0.1 mg/kg/iv cegah dehidrasi dan rumatan propanolol Bedah:- Paliative 28. Defek Septum Atrium (DSA)• Insiden : + 10 % : ratio = 1,5 to 2 : 1• Anatomi : DSA Sekundum: Defect on treatment: Blalock-Taussig shunt- Definitive: total correction foramen ovale DSA Sinus venosus: Defect at SVC and RA junction DSA primum: Defect at ostium primum 56. Tetralogy of Fallot< 1 yr > 1 yrspell (+) spell (-)propranololfailed cathsucceedBTSsmall PA good sized PAtotal 29. ASD correction• clinically• ECG• CXR• echoage 1 yrcath BTS/PDA Stentevaluation 30. Atrial Septal Defect 57. Tetralogy Fallot 31. Atrial Septal DefectDiagram of ASD 58. Tetralogy Fallot 32. LA LVPA AORV RASystemicLungsQp > QsAtrial septal defect 33. RARVLALVRARVLALVAtrial septal Defect Please download to view 34. KlinisDefek Septum Atrium- Asymptomatic- Auskultasi:- Bunyi jantung I normal atau mengeras- Bising ejeksi sistolik di daerah pulmonum- Bising diastolik daerah trikuspid 35. Atrial Septal DefectAuscultation :1st HS N or loudwidely split and fixed 2nd HSEjection Sistolic Murmur 36. Atrial Septal DefectECG : RBBB right ventricular hypertrophy 37. Pembesaran atrium kananKonus pulmonum menonjolVaskularisasi parumeningkat sesuai besarnyapirauAtrial Septal DefectChest X-Ray 38. Defek Septum AtriumDiagnosis Differential Primary Atrial Septal DefectECG : LAD Partial Anomalous Pulmonary VeinDrainage Pulmonary Stenosis Innocent Murmur 39. Defek Septum AtriumManagementSurgery : Preschool age 4-5 thnRecent treatment: transcatheter closure usingASO (Amplatzer septal occluder) 40. ASDSmall Shunt Large ShuntObservationEvaluationAt age 5-8 yrsCathFR1.5ConservativeInfants Children/AdultsHeartFailure (-)HeartFailure (+)Age >1yrsW >10kgTranscatheter closure (Secundum ASD) /Surgical Closure(others)ConservativeAnti failureSuccess FailPH (-) PH (+)PVD(-)PVD(+)HyperoxiaReactiveNonreactiveSurgicalClosure 41. Atrial septal defect 42. Atrial septal defectASD before occlusion 43. Atrial septal defectDuring balloonsizing 44. Atrial septal defectASD after occludedusing ASO 45. PENYAKIT JANTUNG BAWAANSIANOTIK 46. Tetralogy FallotInsiden5-8% dari PJBAnatomiCause: Left-anterior deviation of infundibularseptumSindroma consist of 4 items: VSD pulmonal stenosis aortic over-riding RVH 47. Tetralogy Fallot 48. Tetralogy FallotHemodynamic acyanotic Hemodynamic cyanotic 49. Tetralogy Fallot• DiagnosisKlinis:- sianosis PS- jari tabuh setelah 6 bln- sianotik spell : sesak mendadak, nafas cepatdalam, lemas, kejang, koma- Squatting (sering jongkok)- Single 2nd HS, ejection systolic murmur 50. Tetralogy FallotSingle 2nd HS, ejection systolic murmur 51. Tetralogi Fallot 52. Foto thoraks:- Boot-shaped- Apeks jantungterangkat- Konus pulmonaliscekung- Vaskularisasi paruberkurangTetralogy Fallot 53. Tetralogy FallotECG : RADEchocardiography : to confirm diagnosis 54. Tetralogy Fallot• Diagnosis Differential Pulmonary Atresia Double outlet right ventricle and pulmonary stenosis Transposisi of great arteri and pulmonary stenosis
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