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Wockhardt Heart Hospital
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 DISEASES & DISORDERS

CONGENITAL HEART DISEASE

Congenital Heart Disease is a structural malformation of heart or great vessels present at birth not necessarily detected at birth.

Abnormalities in the heart and great vessels at birth maybe due to intrauterine development errors or to the failure of the heart and blood vessels to adapt to the extra uterine life (involution).

 
Possible causes
 
  • Fetal and maternal infection occurring during first trimester (primarily rubella)
  • Effects of drugs (lithium) and alcohol
  • Maternal dietary deficiencies
  • Genetic factors (trisomies)
  • Maternal age greater than 40yrs
  • Maternal insulin dependent diabetes
  • Frequently associated with other congenital defects

Types
 
Acyanotic Congenital Heart Disease
 
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Atrial Septal Defect (ASD)
Is an abnormal opening in the septum between the left atrium and the right atrium so the oxygenated blood from the left atrium (high pressure area) flows to the right atrium (low pressure area) resulting in increased blood to the right ventricle and right ventricular enlargement.

Ventricular Septal Defect (VSD)
Is an abnormal opening in the septum between the right and left ventricle. So oxygenated blood from the left ventricle (High pressure) mixes with deoxygenated blood of right ventricle (low pressure).

Patent Ductus Arteriosus
Before birth, the Ductus Arteriosus joining the arch of the aorta and the pulmonary artery allows blood to pass from the pulmonary artery to the aorta. At birth, when the pulmonary circulation is establishes, the Ductus Arteriosus should close completely.
If it remains patent (unclosed) the blood regurgitates from the aorta to the pulmonary artery. Hence, after birth oxygenated blood from the higher-pressure area (aorta) flows to the lower pressure area (pulmonary circuit) resulting in decreased blood supply to the peripheral tissues and increased volume in the lungs.This condition is called Patent Ductus Arteriosus.

Aortic Valvular Stenosis
This is a condition of obstruction to the left ventricular out flow to the aorta at the level of the aortic valve. This leads to an increase in pressure in the left ventricle to overcome the resistance of the obstructed valve. Myocardial Ischemia may occur because of increased oxygen requirements of enlarged left ventricular musculature leading to failure of the left ventricle.

Pulmonic Stenosis
Refers to any lesion that obstructs the flow of blood from right ventricle to the pulmonary artery.In this case right ventricular pressure increases to maintain normal cardiac out put which results in hypertrophy (enlargement) of the right ventricle and its failure (Right sided Heart failure).

Coarctation of Aorta
Is a narrowing of aorta at any point usually distal to the origin of Arch of Aorta. Narrowing of the aorta increases left ventricular pressure and workload leading to failure (Left Sided heart failure).

Mitral Valve Stenosis
A disorder that narrows or obstructs the Mitral opening, which prevents adequate blood flow between the left atrium and ventricle (left).Congenital Mitral stenosis alone is rare. It more commonly occurs as a component of complex cardiac abnormalities.

 
Cyanotic Heart Disease
 

Tetrology of Fallot

It consists of 4 defects:

  1. Pulmonary Valve Stenosis
  2. Ventricular Septal Defect
  3. Aortic Misplacement - the origin of the aorta is misplaced to the right so that it is immediately above the Septal defect
  4. Right ventricular hypertrophy - to counteract the pulmonary stenosis

Unoxygenated blood is shunted from the right ventricle through the ventricular septal defect directly into the aorta and right ventricle becomes enlarged because of pulmonary stenosis and VSD. Cardiac function is inadequate to meet the needs of the growing child.

Transposition of Great Vessels
Occurs when pulmonary artery originates from the left ventricle and aorta originates from the right ventricle.To sustain life there must be an accompanying defect that provides for the mixing of oxygenated and unoxygenated blood between the circulations (ASD or VSD or PDA).

Uni Ventrical Heart
Is a condition where only one ventricle is present. This leads to mixing of the oxygenated and unoxygenated blood.

 
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