1. Clinical Assessment of a Child with Heart Disease 1
Shakuntala S Prabhu, Sumitra Venkatesh
Gestational and natal history 1; Maternal conditions 2; Birth history and
weight 2; Family history 2; Postnatal history 3; Physical examination 6;
Cardiovascular assessment 8; Precordial examination 12
2. X-ray Chest for Evaluation of Pediatric Heart Diseases 26
Savitri Shrivastava
X-ray chest in left-to-right (L to R) shunts 30; Obstructive lesions 31;
Cyanotic heart disease 33
3. The ECG: A Practical Approach to the Pediatric Electrocardiogram 40
BRJ Kannan
Basics of recording and interpretation 40
4. Imaging in Pediatric Cardiology 54
A. Echocardiography
BRJ Kannan, R Krishna Kumar
Basics of echocardiography 54
B. Role of CT, MRI and Radionuclide Scans in
Pediatric Cardiopulmonary Disease
Hemant Telkar, Bhavin Jhankharia, Abhijit Raut, Sona Pungavkar
Role of 64 slice MDCT 63; MRI in congenital heart disease 66; Role of
cardiac MR in fetal cardiology 71; Radionuclide imaging in pediatric
cardiology 73
5. Diagnostic Cardiac Catheterizations in Children 75
Snehal Kulkarni
Precatheterization assessment 77; Premedication and sedation 77;
Transport of neonate or sick infant to the catheterization laboratory 80;
Imaging 80; Specific cardiovascular diseases and cardiac catheterization and
angiography 80; Complications of cardiac catheterization 83
6. Heart Failure in Children 86
Sreekanthan Sundararaghavan, R Krishna Kumar
Management of CHF 91
Contents
xviii Pediatric Cardiology
7. Systemic Hypertension in Children 95
Uma S Ali, Alpana Ohri
Measurement of blood pressure 96; Causes 97; Investigations 100
8. Pulmonary Hypertension in Children 109
Usha Krishnan
Definition and classification 109; Persistent pulmonary hypertension of the
newborn 110; Childhood pulmonary hypertension 111; Pathobiology of
pulmonary hypertension 111; Diagnosis and investigations 112; Treatment 114
9. Syncope in the Young 119
S Deshmukh, P Hingorani, S Deshpande, Y Lokhandwala
Definition 119; Epidemiology 119; Evaluation of a patient with syncope 124;
Management of syncope 127; Prevention of syncope on long-term basis 128
10. Chest Pain in Childhood 133
M Zulfikar Ahamed, S Lakshmi
Causes of chest pain 133; Specific types of chest pain 135; Laboratory
Evaluation (Investigations) 136; Management 140
11. Arrhythmias in Children 142
BRJ Kannan, R Krishna Kumar
Classification of arrhythmias 142; Presentation of cardiac arrhythmias 144;
Diagnosis and management of tachyarrhythmias 146
12. Congenital Heart Disease Introduction,
Epidemiology and Classification 153
Nitin Rao
Congenital heart disease prevalence—the Indian scenario 155; Epidemiology 157
Maternal factors 158; Classification of CHD 162; A clinical classification of
congenital heart disease general 163; Cyanotic 164
13. Left-to-Right Shunts 168
R Krishna Kumar, Abhay Divekar
Definition of terms 168; Perinatal changes in vascular resistances influencing;
Left-to-right shunting 171; Factors determining magnitude of left-to-right
shunts 171; Pathophysiology 172; Hemodynamics 173; Clinical features 173;
The untreated large left-to-right shunt lesions 175; Management of patients with
left to right shunts 175
14. Cyanotic Congenital Heart Disease 180
Swati Garekar, Richard A Humes
Total anomalous pulmonary venous return 181; Tricuspid atresia 183; Ebstein’s
anomaly 185; Tetralogy of Fallot 187; Tetralogy of Fallot with pulmonary
atresia 189; Pulmonary atresia with intact ventricular septum 192;
Double-outlet right ventricle 194; Hypoplastic left heart syndrome 195;
Transposition of the great arteries 197; L-transposition of the great vessels 199;
Truncus arteriosus 200; Univentricular atrioventricular connection 202
15. Obstructive Acyanotic Congenital Heart Diseases 205
Snehal Kulkarni
Left sided obstructions 205; Right sided obstructions 215
16. Miscellaneous Congenital Cardiac Conditions 221
Amar Taskande
Aortopulmonary septal defect 221; Aneurysm of the sinus of valsalva 222;
Arteriovenous fistula, coronary 222; Arteriovenous fistula, pulmonary 223;
Contents xix
Arteriovenous fistulas, systemic 223; Anomalous origin of the left coronary
artery from the pulmonary artery 224; Congenital pericardial defect 224;
Cervical aortic arch 225; Cor triatriatum 225; Congenital mitral stenosis 226;
Congenital mitral insufficiency 226; Common atrium 227; Congenital
anomalies of vena caval connection 227; Double-chambered right
ventricle 228; Diverticulum of the left ventricle 229; Ectopia cordis 229;
Hemitruncus arteriosus 229; Idiopathic dilatation of the pulmonary artery 230;
Kartagener’s syndrome 230; Pulmonary artery stenosis 230; Patent foramen
ovale 231; Pseudocoarctation of the aorta 231; Rubella syndrome 231;
Scimitar syndrome 232; Taussig-bing anomaly 232
17. Timing of Surgical or Catheter Intervention in
Congenital Heart Disease 235
R Krishna Kumar
Predicting the natural history of congenital heart disease 235;
Spontaneous closure of defects 238; Procedural outcome 239;
Guidelines for individual lesions 240
18. Rheumatic Fever and Rheumatic Heart Diseases in Children 245
M Zulfikar Ahamed, NC Joshi
Historical perspective 245; Epidemiology 246; Carditis 251; Chorea 254
Investigations 256; Dilemma in evaluation 264; Treatment 265;
Prophylaxis 269; Anaphylaxis 269; Chronic rheumatic valvular disease 271;
Mitral regurgitation 271; Mitral stenosis 273; Correlation between valve
area and mean MV gradient 275; Rationale of drug therapy 276; Aortic
stenosis 277; Aortic regurgitation 280
19. Myocardial Disease 287
R Krishna Kumar
Dilated cardiomyopathy 287; Diagnostic approach for dilated
cardiomyopathy in children 289; Treatment 296
20. Pericardial Disease 303
Harinder R Singh
Anatomy and physiology 303
21. Infective Endocarditis in Children 317
Anita Saxena
22. Kawasaki Disease: Diagnosis and Management 328
M Zulfikar Ahamed
Historial perspective: a brief history of Kawasaki disease 328; Epidemiology 328;
Etiopathogenesis 330; Laboratory evaluation 334; Terminologies in KD 337;
Other investigations 338; Standard protocol followed in our institution 340;
Kawasaki disease—other modalities of therapy 341; Long-term management 343
23. Cardiac Manifestations in Systemic Illness 346
Sumitra Venkatesh, Shakuntala S Prabhu, Mahesh K
Storage disorders 346; Collagen vascular diseases (connective tissue
diseases, rheumatic diseases) 350; Endocrine and metabolic conditions 355;
Hematological conditions 358; Neuromuscular diseases 359; Disorders of
collagen synthesis 361
24. Fetal Cardiology 365
Shakuntala Prabhu, Sumitra Venkatesh
Fetal echocardiography 365; Importance of fetal echocardiography 365;
Optimal timing of screening 366; Intrauterine interventions 374
xx Pediatric Cardiology
25. Diagnosis and Initial Management of Heart Disease in the Newborn 376
R Krishna Kumar
Diagnosis of heart disease in the newborn 376; Circulatory support and inotropes 383;
Transportation of sick newborn infants with heart disease 384
26. Cardiac Implications of Changing Lifestyle: Prevention of
Adult Cardiovascular Disease 388
S Sivasankaran
Magnitude and definition of the problem 390
27. Genetics of Congenital Heart Disease 402
Sankar VH
Importance of identifying the genetic basis of CHD 402; Chromosomal
disorders 403; Microdeletion syndrome and fish 404; Single gene disorders 406
Evaluation for genetic basis in children with CHD 408; Genetic counseling in
genetic syndromes with CHD 409
28. Catheter-based Interventions in Children 413
Shreepal Jain and Bharat Dalvi
Atrial septostomy procedures 413; Balloon valve dilatations 414; Transcatheter
closure of intracardiac shunts 422; Cardiac interventions in complex
congenital heart disease 426; Intravascular stents in congenital heart disease 427
29. Surgery for Common Congenital Cardiac Defects 433
Krishna S Iyer, S Vijay
General aspects of cardiovascular surgery 434
30. Pediatric Cardiac Postoperative Intensive Care 451
Rakhi B, Suresh G Nair, R Krishna Kumar
Specific aspects of cardiac surgery that impact patient care 451; Mechanical
ventilation 456; Sedation, paralysis and pain management 458; Fluid and
electrolyte management 460; Nutrition 463; Management issues associated
with specific surgeries 465; Corrective procedures 468; Common postoperative
problems after pediatric cardiac surgery 476; End organ injury 486
31. Follow-up of Children Following Cardiac Surgery and
Percutaneous Interventions 501
BRJ Kannan
Patent ductus arteriosus (PDA) interruption (surgical or transcatheter
intervention) 502; Atrial septal defect 502; Valvar pulmonary stenosis 503;
Valvar aortic stenosis 504; Coarctation of aorta 504; Blalock-taussig shunt
(systemic artery to pulmonary artery) 505; Tetralogy of Fallot 505; D-transposition
of great arteries 506; Operations requiring the use of conduits 507; Pulmonary
artery banding 507; Bidirectional Glenn shunt 507; Fontan procedure 508;
Children on oral anticoagulation 508
32. Drug Dosages 510
Shakuntala Prabhu
Index 531