Anatomic Pathology: Cardiac Pathology

• Isolated VSDs are the most common form of congenital heart disease. Most VSDs (85% to 90%) close spontaneously by 1 year of age, and only defects that are large or associated with other cardiac anomalies require early surgical intervention. VSDs account for approximately 40% of congenital cardiac defects, and ASDs account for approximately 10%; the combined frequency is approximately 50%.

• Shunting is typically classified as left-to-right (VSD, ASD, and patent ductus arteriosus) or right-to-left (tetralogy of Fallot, transposition of the great arteries, tricuspid atresia).

• Bicuspid aortic valves are notable for their frequency and late complications. Most often, bicuspid aortic valve is asymptomatic and is detected in childhood only when present with aortic stenosis. Affected individuals remain asymptomatic and usually develop stenosis or incompetence after age 40.

• Patent ductus arteriosus can be lifesaving in infants with obstructed pulmonary or systemic blood flow and is kept open with prostaglandin E until corrective surgery can be performed.

Hoffman JI, Kaplan S: The incidence of congenital heart disease. J Am Coll Cardiol 2002;39(12):1890-1900.

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