Recurrent respiratory tract infections may occur in all of the following except –


#1

Recurrent respiratory tract infections may occur in all of the following except –

    1. Ventricular septal defect
    1. Tetrology of Fallot
    1. Transposition of great arteries
    1. Total anomalous venous return

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ANS:

Chest infections are frequent in the following two groups of congenital cardiac anomalies.

a) Left to right shunts → This group includes

  • Atrial septal defect

  • Ventricular septal defect

  • Patent ductus arteriosus

  • This group of CHD’s are characterized by frequent chest infections.

  • There is large flow of blood in the lungs which causes lung infections.

  • Each attack of cold seems to turn into Bronchopneumonia.

  • It is not uncommon for these patients to have 6-8 attacks of pneumonia in the first year of life.

b) Cyanosis with increased pulmonary blood flow.

  • A large no. of conditions result in a combination of cyanosis with increased pulmonary blood flow.
  • Common to these conditions is the presence of abnormal mixing of pulmonary venous blood with the systemic venous blood and absence of obstruction to pulmonary blood flow.
  • The anomalies included in this group are
  1. Transposition of great vessels
  2. Total anomalous pulmonary venous connection
  3. Single ventricle without obstruction to pulmonary blood flow.
  4. Persistent truncus arteriosus
  5. Tricuspid atresia with absence of obstruction to pulmonary blood flow.
  6. Double outlet right ventricle without pulmonary stenosis.
  • Clinically these patients are characterized by
  1. Cyanosis
  2. Cardiomegaly
  3. Almost 80% of these patients are lost due to congestive cardiac failure or pulmonary infection.

Congenital heart diseases which are not predisposed to pulmonary infection

  1. Right to left shunts
  • This group includes
  • Tetralogy of Fallot
  • Ebstein’s anamoly
  1. Obstructive lesions
  • This group includes
  • Aortic stenosis
  • Coarctation of Aorta
  • Pulmonary stenosis

Characteristic of this group is

  1. Presence of cyanosis
  2. Absence of chest infections

Clinical characteristic of this group

  • Absence of frequent chest infections and cyanosis
  • Absence of precordial bulge
  • Presence of forcible or heaving cardiac impulse.