Predisposing Factors Genetic Predisposition Maternal age >40 years old Fetal Maturity

Precipitating Factors Poor maternal nutrition Maternal alcoholism Viral Maternal illness during pregnancy Diabetes Mellitus Stress

3rd-to-4th week of gestation

Development of the heart and blood vessels

Fusing of two endothelial tube

Tubular heart elongates

Alternate dilation and constriction

Single atrium and ventricle along with bulbus cordis

Formation of tronchus arteriosus and sinus venous

4th-to-5th week of gestation

Formation of Endocardial cushions

Partitioning of the AV canal, Atria & Ventricles

6th-7th week of gestation

Partitioning and compartmentalization of atria and ventricular septum

8thweek of gestation

Spiral twisting and vertical partitioning

Viruses or bacteria

Teratogenic factor

Environmental exposure

Chromosomal defect

Impaired formation, partitioning, compartmentalization and spiraling

Openning of septum

Blood shunting

Right to left shunt

Left to right shunt

Mixing of unoxygenated and oxygenated blood via VSD

Narrowed pulmonary valve

Increase pumping ability

Enlarge myocardial wall