| Acyanotic lesions |
| Ventricular septal defect | Size of defect dictates hemodynamic presentation. In 30 to 40% of cases, spontaneous closure occurs within the first 6 months. |
| Surgical repair required if infant exhibits failure to thrive, pulmonary hypertension or right-to-left shunt > 2:1. |
| Atrial septal defect | Often asymptomatic; 87% of secundum types close by age 4. Primary and sinus types require surgery. Late sequelae include mitral valve prolapse, atrial fibrillation or flutter, and pulmonary hypertension. |
| Atrioventricular canal | Combination of the primum type of atrial septal defect, ventricular septal defect and common atrioventricular valve. Presentation similar to that of ventricular septal defect. Palliative pulmonary artery banding in refractory congestive heart failure. |
| Pulmonary stenosis | May be asymptomatic or may result in severe congestive heart failure. Prostaglandin E1 infusion at birth may be helpful. Valvular type may require balloon valvuloplasty. |
| Patent ductus arteriosus | In premature infants, spontaneous closure or indomethacin-induced closure may occur. In term infants, spontaneous closure is less likely, and indomethacin is not helpful. Recurrent pneumonia may occur. Surgical ligation usually required. No long-term sequelae if adequately treated. |
| Aortic stenosis | May be asymptomatic. Valve replacement and anticoagulation may be required. |
| Coarctation of the aorta | 98% of cases occur at origin of left subclavian artery. Blood pressure higher in arms than legs. Bounding pulses in arms and decreased pulses in legs. Surgical repair usually required between 2 and 4 years of age. |
| Cyanotic lesions |
| Tetralogy of Fallot | Most common CHD beyond infancy. Defects include ventricular septal defect, right ventricular hypertrophy, right outflow obstruction and overiding aorta. Intermittent episodes of hyperpnea, irritability, cyanosis with decreased intensity of murmur. Palliative shunting may be necessary. Surgical repair required before age 4. |
| Transposition of the great arteries | Transposition of pulmonary artery and aorta. Ductus-dependent. Consider palliative balloon atrial septostomy, but definitive surgical switch of aorta and pulmonary artery required as soon as possible. Late complications include pulmonary stenosis, mitral regurgitation, aortic stenosis, coronary artery obstruction, ventricular dysfunction and arrhythmias. |