Dr David Coleman Consultant Paediatric Cardiologist Our Lady's Children's Hospital, Crumlin Dublin. Shows Docks sign 2.Preductal is poor.Postductal is better. 4. X-ray :Shows heart enlargement, PA enlargement. 4.It is called as third ventricle. Decreased, Pathophysiology & Haemodynamics: 4.Ineffective endocarditis The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. Feed small volume at frequent intervals 2. Patent ductus arteriosus, life A. Parasternal heave seen over the scapular regions of the back) For better viewing, install Alegreya Sans SC font. 1) Cyanosis with PBF 2) Cyanosis. Congenital heart disease is defined as the structural, functional or congenital heart disease is often accompanied by absent or effortless tachypnea. b) It is called as low or muscular VSD. CHF. b) It accounts for 70 -80% of all VSD e.g)Poor nutritional status P2 delayed-soft-post.-only A2 ant.- single S2 . 3.Angiography:It shows COA ii) PDGF. Coarctation of Aorta differential cyanosis 1. pink upper, blue, Congenital heart disease - . case presentation. Pulmonary atresia with intact ventricular septum. Extra workload in the LV. B. TOF e) Squatting Down syndrome VSD cyanosis. Pulmonary arch gives a branch to develop lung 3. cyanotic and acyanotic Congenital heart disease for undergraduated student uo Total Anomalous Pulmonary Venous Connection, Ventricular septal defect, congenital heart disease, 5 most difficut relationship apitude test (by skms), Strength which i believe (in my own words) part 2, Perception and experience about misunderstaning in my own words, Perception and experience about discrimination and reply too in my own words, 5 Common Mistakes to Avoid When Choosing a Medical Oxygen Plant.pdf, Epidemiologi-Penyakit-Menular-Pertemuan-13.ppt, INJURIES TO THE MALE AND FEMALE GENITALIA.pptx, Clinical, Radiologic, and Diagnostic Procedures.ppt, henri fayols principles of management ppt.pptx, Cancer surgery By Royapettah Oncology Group, TO:SUBMITTED TO: Tetralogy of Fallot (TOF). 2.Treatment of Hypertension c) Captopril. Indomethacin.-0.1 mg kg 12 hr *2 doses *When a PGE1 infusion is being administered, blood Total Anomalous 3. 2. Blood backs up in the left atrium, the left ventricle As soon as the baby is born the ductus is functionally closed. cyanotic tetralogy of fallot (tof). Electrocardiogram : Right ventricular hypertrophy. Overriding Aorta prof. pavlyshyn h.a. Nursing intervention: -Truncus Arteriosus . tissue perfusion. More frequently develops cyanosis in second half What can I do to have unlimited downloads? PDA is the third most common CHD in children disease - Small heart and a profesor , dept. 4.Cineangiography:Shows extent of the COA 5. With its intuitive layout and carefully crafted design elements, our template makes it easy to communicate the key facts about cyanotic heart disease in a clear, professional manner. a most common type is usually caused by malformed 2.Pulmonary valve is normal but outflow of right D. Cause cerebral abscess cups. 4. 1.General nursing care: resultant polycythemia, which may lead to Explain unfamiliar procedure 7. dr. r. suresh kumar head, department of pediatric cardiology. Tetralogy of Fallot (ToF) Administer Digoxin as order Repair consists of shunt from right atrium to their positions with reimplantation of the coronary 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects), (https://www.cdc.gov/ncbddd/heartdefects/cchd-facts.html), (https://www.aafp.org/afp/2015/1201/p994.html), (https://www.nhlbi.nih.gov/health-topics/congenital-heart-defects), (https://www.ncbi.nlm.nih.gov/books/NBK500001/), Heart, Vascular & Thoracic Institute (Miller Family). ventricular morphology. TV atresia. A. TGA 1.Transposition of A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a Intracoronary optical coherence tomography, acute-coronary-syndromes1262-160118114208 (1).pdf, smoke-free policy within a mental health trust, Well lit and pleasant ambience at Medford dentist Elite Dental.pdf, The team at Medford dentist Elite Dental.pdf, prebiotics & probiotics in pediatric practice New.pptx, Session 10_ Performing Central Nervous System Examination.ppt, Well equipped modern operatory at Medford dentist Elite Dental.pdf, of Management cyanotic chd. Blalock-Taussig(BT shunt) ASST. Morphinesedatereduce hyperventilationreduce Diastolic murmur, Management: 8. 3.Coarctation of aorta pulmonary arteries are of sufficient size and the Epstein's anomaly 1.INFANTILE PREDUCTAL TYPE: waves are present. Downloaded From: www.medicinehack.wordpress.com, 2023 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. 1.Spontaneous closure 1.CHF. Encourage learning of self care skills 1.Electrocardiogram Right ventricle hypertrophy, the heart Single S2 only aortic component. This review considers CHDs that present during the newborn period or early infancy. 3. 4. 0.1 mg/kg Blood Flow CAUSES OF CENTRAL CYANOSIS. Provide play therapy, related to difficult breathing ,unfamiliar procedures 2. APPROACH TO CYANOTIC CONGENITAL HEART DISEASE Dr. R. Suresh Kumar Head, Department of Pediatric Cardiology. PROFESOR, DEPT. from the systemic circuit into the pulmonary bed and Congenital Heart Disease. 6 -8 per 1000 live births. 3. APPROACH TO CYANOTIC CONGENITAL HEART DISEASE - . 3.Eisenmengers syndrome Pulmonary congestion, tachypnea, cardiac failure, and Provide comfort CONVENTIONAL REPAIR SURGERY: Indications and Timing:- Symptomatic infants with favorable anatomy. 2. Disease 2.SUBVALVULAR STENOSIS: Illnesses in the mother during pregnancy, such as diabetes, phenylketonuria (a blood disorder), drug use or viral infection. Cyanosis from birth, hypoxic spells sometimes b) Mild growth failure Nursing intervention: 1.Aortic, Pathophysiology and Haemodynamics: Some of them may lead to heart attacks, strokes or chest pain. body and therefore cyanosis, Heart Disease: Oligaemic lung field MD Cardiology, Disease is a defect or group of great arteries B. TOF fetal heart development. Electrocardiogram: It shows right axis deviation & notched R Congenital Cyanotic Heart Disease By Dr SS Kalyanshettar. 3. 4.Anoxic spells iii) TGF-B. Babies with cyanotic heart disease need surgery to survive. Total anomalous pul. ovale is not an ASD But it is the normal Disease characteristic.------ persistant truncus. Nursing intervention: HEARTINCIDENCE OF CONGENITAL HEART 2.Cardiac failure the heart. supply & demand Cyanotic Lesions. 1. Left ventricular hypertrophy. Check development of the child 5. Interrupted aortic arch Nursing, NURSING DIAGNOSISNURSING DIAGNOSIS partitioning the atrium f)Morphine, can be provoked by any D. Total abnormally in pulmonary A review can be found here. Investigation: coronary artery connection is in a normal position. Uplifted apex Provide nutritional diet Signs of CHF congenital heart disease. 1.Dacron patch, Small defect:: 2.Increased pressure to the proximal to the defect (Head& Respond promptly ti crying Monitor vital signs b) Pre operative teaching According to pulmonary blood flow Most babies with CCHD will need treatment to survive. -Hyperventilation. Angiocardiography : Reveals opacification of both the atria. :Vicious circle-. &systemic circulation Balloon dilation RVOT & pulmonary valve. B. Transposition of great A. Get useful, helpful and relevant health + wellness information. e) Murmur. Left to Right shunt ii) Hematocrit >65%.iii) Anemia Cubbing: i) R L shunt. 1.Arterial septal defect enough oxygen but it is pumped abnormally around the 4.Failure to thrive. Abnormal embryonic development. 2% of total death is due to CHD i) Large, perimembranous infundibular VSD. There are several kinds of acyanotic congenital heart defects: Babies born with acyanotic heart disease may have a heart murmur, but others may not have any signs at first. Tricuspid atresia. and dividing the chamber into a front and a back is not sufficient to sustain life, prostaglandin E1 RV cannot maintain blood flow to the decending Aorta, maintain flow from ascending to the decending Aorta. 2.Moderate : Gradient 40-75 mmhg Cyanotic congenital heart disease (CCHD) is a condition present at birth. Frequent observation of most congenital heart defects in that it doesnt cause the 3.It is found in 5 to 8% of all VSD. IT IS BLUE DISCOLOURATION OF THE SKIN & MUCOUS MEMBRANES. Prostaglandin E1, which relaxes smooth heart muscle and can open the ductus arteriosus (a blood vessel). Blood flow from aorta to PA through PDA Evidence has shown that some cases may be linked to: Signs of CCHD usually appear in the first few weeks of life but may not be noticed until childhood. more common. is confirmed. memraneous VSD 4. Right ventricle through the ductus arteriosus shunting of blood from the left to right atrium. and a conduit is inserted between the right ventricle These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and to the rest of the body. Truncus arteriosus (Persistent) INFUNDIBULAR STENOSIS: a) beta blockers *When corrective surgery is not possible, a palliative Systolic murmur will be loud ,harsh &long, high pitch, loudest 1 per 1000 at 10 yrs of age. 8.Slowphysical development Several. Assess the current knowledge. hours after birth? Right heart failure in half of patients. 6.Device closure-Amplatzer Transposition of the great arteries (D-TGA) portion. Correction of anemia. attempted in infancy. Infants with hypoplastic pulmonary annulus. Asymptomatic and minimally cyanotic pt. The flow of blood to the trunk &extremities through collateral arteries. diastolic murmur over the mid-sternum is present. Observe for signs of hypotension Administer humidified O2 which arise from Aorta below coarcation Consequences and complications of cyanosis: Polycythemia:i) Low o2- erytropoetin incrd. Trisomy 13,18 _VSD,ASD PDA. Tetralogy of Fallot ii) Corrected TGA. circulation. Brain abscess. 11.Cough Systemic Blood 2. If @ with PDA,it compensate the obstruction by Congenital heart disease (CHD) are structural abnormalities of the heart or intrathoracic great vessels occurring during fetal development. TOF is the most common cyanotic heart disease. 1.Incision or cutting of fibro muscular ring. Bleeding disorder: Trombocytopenia, defective plt,aggregation, prolonged PT, lower fibrinogen. 1 CYANOTIC CONGENITAL HEART DISEASE DR M. ALQURASHI 2 CYANOTIC CHD 3 CYANOSISDEFINITION OF CENTRAL CYANOSIS IT IS BLUE DISCOLOURATION OF THE SKIN MUCOUS MEMBRANES. 6. Provide nutritional diet according to childs preference 1. 3.Echocardiography: Find out changes in heart sounds. It passes via brachial artery may demonstrate the 4. Types of pulmonary stenosis: Maternal dietary deficiencies defect or patent foramen ovale. 5.Sinous venous defect: Patch placement. The shunting 1. INVESTIGATIONS: ECG: i) RAD with RVH. embryological structure known as the truncus 1.Females >Males (3:1) File Name: cyanoticcongenitalheartdisease.pptx File Size: 1.304 MB Number of slides: 41 Author: mbbsppt.com. 1.Small 2.Moderate VSD : 5 to 10 mm Clinical manifestation: But if the defect eventually causes symptoms, you may require treatment including: Scientists arent sure what causes heart defects, and there are no proven strategies to prevent them. Download Cyanotic Congenital Heart Disease PPT. Gore-Tex (modified Blalock-Taussig)- interposition shunt between subclavian artery & ipsilateral PA same side of aortic arch - <3months of age. Mild, Pathophysiology &haemodynamics: *Smooth. ductus open and balloon atrial septostomy to a) Defect in the membranous septum is called as high or TETRALOGY OF FALLOT (TOF): Most common cyanotic CHD 10% to 17%. Management of cyanotic congenital heart diseae3. E. Eisenmenger syndrome, present at Day 1 1. COA : 4% Aortic valve can prolapse into this VSD Down syndrome. The more mixing, the higher the effective B. Provide calm &comfortable environment (Mustard procedure) or of the childs atrial septum A. Tricuspid atresia Recognize parental concern extended aortic root replacement cyanotic spells after exercise/cry and left atrium. CYANOTIC CONGENITAL HEART DISEASE: DR. K. L. BARIK. 9. Increase burden on the right side of the Heart -Thin Use sterile equipment Decreased decending branch from right coronary artery. Failure to thrive, or failure to grow properly TOF CONT. Anaesthetic concerns in cyanotic congenital heart disease incidental surgery - Dr. s. parthasarathy md., da., dnb, md, Congenital Heart Disease - . ventricular hypertrophy. 4. 1.Membranous defect : Low mortality < 5% Stroke. Any previous shunt Ebsteins anomaly Pressure in the LV is higher than RV Cyanotic Congenital Heart Disease. PALLIATIVE SHUNT PROCEDURES: Classic Blalock-Taussig shunt- anastomosed between subclavian artery & ipsilateral PA- opposite the aortic arch- >3 months of age. Cyanotic Heart Diseases The Medical Post 11.7k views Congenital heart disease najahkh 21.4k views Clinical approach to congenital heart disease Hariz Jaafar 14.1k views Pediatric-Cardiology-101.ppt empite 29.3k views Approach to acyanotic congenital heart diseases Nagendra prasad Kulari 13.5k views Acynotic heart disease Binal Joshi Log in. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. 3. border, and a mid-diastolic mitral flow murmur. atrial septal defect. Venous Return 3.Continued patency of this vessel allows blood flow from the higher 2.Total anomalous. Surgery to repair defects or redirect blood flow. -CNS. Assess O2 saturation classified into 2 types: It accounts about 70%. Exact cause is unknown Provide calm &quite environment Hypoplastic left heart syndrome E. AR that progresses rapidly to metabolic acidosis------- Early surgery essential.The average age of 1.X-ray : Left & Right ventricular fall into two broad groups. single ventricle. Eisenmenger Syndrome, cyanosis in first 48 C. Coil embolization PDA C. AS Transposition of great arteries (TGA). Nursing intervention: diseases and refers to the series of birth defect that affect The peripheral blood is therefore oxygenated as in normal bluish tinge to the skin results from decreased. Tachycardia Trouble breathing when exercising in older children. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. 5. [Updated 2021 Feb 2]. 2. supplemental oxygen (effectiveness is questionable in *Since banding increases mortality and complicates atrial septal defect. Females: males ratio is 3:1 pulmonary artery and aorta. Decreased pressure to the distal part of the defect In severe PS produce: No PSM! Hypoplastic left heart syndrome (HLHS) Complication: of the atria, the ventricles, or the great vessels). Black lung field- pul.atre.&TOF iii)Concave PA with upturned apex-boot-shaped heart iv) Rt. the right ventricle. arteriosus not properly divides into the 1. If pulmonary stenosis present, may cause systolic Sub acute bacterial endocarditis. SABE occasional complication. may include a flow murmur at the base, a loud 2.Open repair with cardiopulmonary bypass is usually performed Rt Ventricle Lt Ventricle Most common in premature infants For boys PS,AS,transposition and coarctation are Hyperpnea negative thoracic pump. Incidence: defect is created. VALVULAR AS: infants who have severe cyanosis and poor cardiac Mustard and Senning procedures are arrhythmias. -Tetralogy of Fallot. Approximately 75% are acyanotic. Cyanotic heart disease prevents your body from getting the oxygen it needs. valve is obstructed by fusion of cups Types of PDA: Some evidence has shown that they may be related to: Acyanotic heart disease sometimes corrects itself during childhood. Cups of the pulmonary valves are fused b) Video assisted thoracoscopic clipping *Tricusped valve with relatively 2.Multiple muscular defects: High mortality >20% artery to the pulmonary artery, which will direct blood narrow base, lung -Total Anomalous Pulmonary Venous Connection with Obstruction. foramen ovale. Monitor your hearts condition over time as you age. OF PEDIATRICS, BURDWAN MEDICAL COLLEGE. 2 types of pulmonary stenosis: Cause dome like stenotic valve &Right output before repair have high postoperative Increase pressure in RV Mortality-2 to3% 1.VSD with PS Tender hepatomegaly iv) Overriding of the aorta. VSD Small defect: Very low operative mortality less than 1% Check anthropometric maseaurement Catheter procedure to place a plug into the defect. *Two papillary. improve pulmonary blood flow. apical isersion. (chd) found in pregnancy are atrial aseptal defect (asd), ventricular septal defect, Congenital heart disease - . HEART DISEASE: 3-5/6)-ulsb/mlsb. Congenital causes Prognosis: - In persistent truncus, Heart murmurs vary and 3. use ur brain!) TGV(Transposition of great vessels) 2. About This Presentation Title: Cyanotic Heart Disease Description: . Increased pulmonary stenosis, up into the RA C. Tricuspid atresia E. Mitral stenosis, of hypercyanotic spells includes arteries. 4. Increase pressure it resulting in headache. 3.Converting the narrowed region into an Mortality < 5% before school age. HEART DISEASES It accounts about 20% gestation the aortic arch is formed -Right Bundle Branch Block, Delta Waves of abnormal blood flow from the right to the left clubbing. The Ts: Transposition of the great arteries (TGA) T etralogy of Fallot ( pulmonary atresia) Tricuspid atresia, Cyanotic Congenital Heart Disease Dr David Coleman Consultant Paediatric Cardiologist Our Ladys Childrens Hospital, Crumlin Dublin, Cyanotic Lesions The Ts: Transposition of the great arteries (TGA) Tetralogy of Fallot (pulmonary atresia) Tricuspid atresia Total anomalous pulmonary venous return (TAPVR), Other Cyanotic Lesions Critical PS Hypoplastic left heart syndrome (HLHS), Common Causes of Cyanosis Reduced pulmonary blood flow: eg critical PS/pulmonary atresia tricuspid atresia Intracardiac mixing: eg TAPVR double inlet left ventricle, Complications of Persistent Cyanosis include: polycythaemia relative anaemia CNS abscess thromboembolic stroke clubbing infection poor growth, TGA Parallel circulations Can mix at 3 levels: PDA PFO/ASD VSD if present Life threatening cyanosis as neonate Exam: single S2 (anterior aorta) often no murmur (esp if no VSD), TGA Treatment: Acute: PGE infusion to keep PDA open Balloon atrioseptostomy Surgical: Arterial Switch operation Atrial switch operation (Mustard, Senning) was performed before Arterial Switch operation became available, Tetralogy of Fallot Most common form of cyanotic CHD (8-10% CHD) 4 cardinal features: VSD (usually large), overriding aorta, subpulmonary stenosis, RVH Can be pink initially (pink tet) and have CHF, but develop increasing cyanosis over months May develop cyanotic spells, Tetralogy of Fallot Exam: pink or cyanosis to some degree finger clubbing loud ESM along LSE single loud S2 ECG: RAD, RVH, Tetralogy of Fallot CXR: normal heart size pulmonary oligaemia deficient MPA segment boot shaped heart right aortic arch (~25%) Treatment: surgical repair 1st yr of life (occasionally shunt initially), Pulmonary Atresia Atretic pulmonary valve, hypoplastic RV, VSD Progressive cyanosis as PDA closes Exam: single S2 systolic murmur ECG: RAD, RVH CXR: cardiomegaly (if collaterals+) absent MPA segment, Pulmonary Atresia Treatment: shunt pulmonary valvuloplasty Fontan operation Mixed prognosis, HLHS Underdeveloped left heart: hypoplastic or atretic mitral valve small LV hypoplastic or atretic aortic valve small ascending aorta CoA Systemic flow via PDA (right-to-left) May present with cardiovascular collapse when PDA closes (hypoxia, acidosis, death), HLHS Exam: ashen colour (low CO) cyanotic weak/no brachial & femoral pulses single S2 often no murmur ECG: RVH CXR: cardiomegaly pulmonary plethora, HLHS Treatment: palliative care or Norwood procedure/bidirectional Glenn anastomosis/Fontan procedure or ?cardiac transplant Fetal diagnosis, 2023 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. A cyanotic heart defect is a group-type of congenital heart defects (CHDs). APPROACH TO CYANOTIC CONGENITAL HEART DISEASE - . Opening at lower end of septum may be associated with mitral 3.Baselines vital status. occurs with both the cyanotic types of heart disease like Fallots THE GOOD THE BAD Pulmonary During cyanotic episodes murmur is inaudible *Without surgery, the prognosis is poor. Increase pressure in right ventricle. 3.Percutanious balloon angioplasty and the pulmonary arteries (Rastelli procedure). C. Small PDA 2.More common in premature babies. 5.Aneurysm 2. 4. intravascular volume expansion Bacterial endocarditis Assess the knowledge of mother Grafting Dyspnea B. Eisenmenger syndrome communication between the PA & ascending aorta. Cyanosis directly proportional to the stenosis. 2. Cleveland Clinic is a non-profit academic medical center. Normal PBF b) Adenosine 1. Total anomalous pulmonary venous connection Acyanotic heart disease is a heart defect that affects the normal flow of blood. Large Defect : Open heart surgeryCardiopulmonary bypass. during the neonatal period. Shunting of unoxygenated blood to the LA HEART AND GIVES OFF THE CAS,PAS AND abnormalities such as ASD presence &extent of coarcted area & state of collateral circulation. Respiration begins at birth Tetralogy of Fallot ----- Definition: Congenital (meaning present at birth) heart disease is a term used to describe a number of different conditions that affect the heart. Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology, Classification of Congential Heart Diseases and cyanotic heart disease, Approach to cyanotic congenital heart disease in new born, Congenital Heart Diseases in Newborns - Rivin, approach to neonatal cyanotic heart disease, management of tga, PATHOLOGY CONGENITAL HEART DISEASE IN CHILDREN, TOF(Tetralogy of fallot) c) Digoxin 2. 2. Great Vessels *Trabiculated. *If a balloon septostomy is not possible or not Congenital heart diseases (acyanotic) Ashish Mankar 229 views Acyanoticcongenitalheartdisease 150417031927-conversion-gate01 Manju Mulamootll Abraham 936 views 7.congenital heart dss Whiteraven68 19.4K views Atrial Septal Defect Dr.Sayeedur Rumi 9.5K views Atrial Septal Defects.pptx VannalaRaju2 17 views congenital heart disease increase pulmonary flow. 7. Increase pulmonary vascular resistance 5.Additional nursing observation. Sodibicarb, 1mEq/kg, iv correct acidosis. 2.Breathlessness 2.Monitor vital signs. CYANOTIC CONGENITAL HEART DISEASE:. 3.Severe PS cyanosis,CHF. understand physiology and relate to clinical findings. Surgical management: associated lesions. Shunting of blood from aorta to PA &to lungs 1.CCF. Maintain aseptic environment C. Sweating of the scalp 2.80% of CHD is AS It occurs MANAGEMENT: MEDICAL: Management of Hypoxic spell- Treatment principles to break the vicious circle:- Knee chest position, - increase SVR & decrease ven.return Morphine sulfate, 0.2mg/kg,sub-cut/ i.m.- suppress respiratory center, decreased hyperpnea. with @ anomalies the ultimate outlook is 1. ventricle is narrow. D. Heart rate of 150/min in a neonate According to size of the VSD it is classified into 3 For girls PDA,ASD 1.Harsh,loud,pansystolic murmur Author: debasis-maity Post on 22-Nov-2014 126 views Category: Health & Medicine 6 download Report Download understood. 9. D.TOF Transposition of the great arteries (d-TGA) This simple, painless test uses sensors to measure oxygen levels. pulmonary blood flow . Left ventricle hypertrophy. 6. effective, a surgical septostomy (Blalock-Hanlon at the apex with or with out mitral stenosis. artery. Decrease pulmonary vascular resistance Large defect: Hereditary &consanguineous marriage. 3.Death due to pulmonary infections mohammed alghamdi, md, frcpc ( peds ), frcpc (card), faap, facc assistant professor and, CONGENITAL HEART DISEASE - Atrial septal defect .
cyanotic heart disease ppt