Summary

Tables 1-4 provide a summary for each of the conditions.

Table 1 Left-to-right shunts

Table 1 Left-to-right shunts
Lesion	Symptoms	Signs	Management
ASD	None	ESM at ULSE	Catheter device
– secundum		Fixed split S2	Closure at 3–5 years
– partial AVSD	None	ESM at ULSE Fixed split S2 PSM at apex	Surgery at 3 years
VSD
– Small (80-90% of cases)	None	PSM at LLSE	None
– Large (10-20% of cases)	Heart failure	Active precordium, loud P2, soft murmur, tachypnoea, hepatomegaly	Diuretics, captopril, calories Surgery at 3–6 months old
PDA	None	Continuous murmur at ULSE ± bounding pulses	Coil or device closure at cardiac catheter at 1 year, or ligation.

Table 2 Right-to-left Shunts

Summary of right-to-left shunts

Lesion	Symptoms	Signs	Management
Tetralogy of Fallot	Cyanotic 'spells'	Cyanosis Clubbing Harsh ESM RVH when older	Medical management of cyanotic spells Surgery at 6 months
TGA	Cyanosis	Cyanosis Lous S2	Medical management of cyanosis Balloon septostomy Surgery
TGA: Transposition of the great arteries; ESM: ejection systolic murmur; RVH: right ventricular hypertrophy; S2: second heartsSound

Table 3 Outflow obstruction in the well child

Lesion	Signs	Management
Aortic stenosis	Murmur, upper right sternal edge Carotid thrill	Balloon dilatation
Pulmonary stenosis	Murmur, upper left sternal edge No carotid thrill	Balloon dilatation
Coarctation (adult type)	Systemic hypertension Radio-femoral delay	Stent insertion or surgery

Table 4 Outflow obstruction in the sick infant

Lesion

Signs

Management

Coarctation of the aorta

Collapse within first week

Severe heart failure, absent femoral pulses

Prostaglandin infusion, surgical repair