Cardiac Disability Score (CCDS)

Based on Indian Journal of Thoracic and Cardiovascular Surgery, 2020

Patient Details

Years
Months
Days

Step 1: Heart Disease Category (HDC)

Select the category based on the anatomy/defect.

View Reference Tables 5, 6, & 7 (Full Criteria)

Table 5: Group A (Score 5)

Mild/No hemodynamic abnormalities. Expected CCDS < 40.

[cite_start] [cite_start] [cite_start]
CategoryCriteria
Unoperated (A1)PFO/small ASD < 6mm, Small fenestrations, Bilateral SVC, Isolated IVC interruption [cite: 2][cite_start].
Partial anomalous pulmonary venous drainage (single vein) without PAH[cite: 2].
Ebstein’s Grade I/II (mild TR). [cite_start]Cleft MV (mild) [cite: 2][cite_start].
Bicuspid AV (mild regurg, gradient < 20mmHg)[cite: 2].
Small VSD (no PAH/chamber enlargement). [cite_start]Tiny PDA (silent) [cite: 2][cite_start].
Mild Coarctation (gradient < 20mmHg)[cite: 2].
Post-Corrective Surgery (A2)Acyanotic HD post-intervention with no residual dysfunction [cite: 2][cite_start].
TOF repair (no TAP) with no residual lesions [cite: 2][cite_start].
Post Pulmonary Valvotomy (gradient < 30mmHg)[cite: 2].
MV repair (mild MR). [cite_start]TAPVC repair (no PAH) [cite: 2][cite_start].
ALCAPA repair (no dysfunction)[cite: 2].
Post-Palliative (A3)Viral myocarditis (recovered). [cite_start]Cardiac tumor (regressed) [cite: 2][cite_start].
Mild HCM (no gradient/syncope) [cite: 2][cite_start].
VSD closed spontaneously or post-PA band (normal pressure) [cite: 2][cite_start].
RHD (mild regurgitation on prophylaxis) [cite: 2][cite_start].
Kawasaki (coronary dilation reverted)[cite: 2].
Valvar PS (< 30mmHg). AS (< 20mmHg). [cite_start]MS (mean < 5mmHg)[cite: 2].
Hypertension (A4)Primary/Residual PAH (Mean PAP < 30mmHg) [cite: 2][cite_start].
Borderline/Mild systemic HTN (controlled)[cite: 2].
Arrhythmia (A5)Cured by RF ablation. [cite_start]WPW pattern on ECG without SVT[cite: 2].

Table 6: Group B (Score 10)

Significant hemodynamic effect. Expected CCDS 40-70.

[cite_start] [cite_start] [cite_start] [cite_start] [cite_start]
CategoryCriteria
Unoperated (B1)Pre-tricuspid: Primum/Sinus Venosus ASD, CS ASD, PAPVC (1-2 veins) [cite: 13][cite_start].
Post-tricuspid: VSD (mod PAH, PAP < 2/3 systemic), PDA (continuous murmur, mild-mod PAH)[cite: 13].
Ebstein’s Grade I/II (mod TR). [cite_start]Corrected TGA (no TR/arrhythmia) [cite: 13][cite_start].
Cleft MV (mod gradient/regurg)[cite: 13].
Bicuspid AV (mod regurg/stenosis < 40mmHg). [cite_start]PS (< 60mmHg) [cite: 13][cite_start].
Coarctation (gradient ≤ 20mmHg, diastolic spill) [cite: 13][cite_start].
Marfan’s (Aortic root dilated < 40mm)[cite: 13].
Post-Corrective Surgery (B2)Residual mild-mod lesions (MR/AR/TR/PR) after 12 months [cite: 13][cite_start].
TOF/DORV/TGA repair with mild residual RVOT/LVOT obstruction [cite: 13][cite_start].
Coarctation stenting with mild residual gradient [cite: 13][cite_start].
Bicuspid AV post-balloon (gradient < 40mmHg)[cite: 13].
Post-Palliative (B3)Glenn Shunt/Fontan (symptomatic > routine activity) [cite: 13][cite_start].
PA Banding (SPO2 > 85%) [cite: 13][cite_start].
Palliative Switch/Senning[cite: 13].
Hypertension (B4)Primary/Residual PAH (Mean PAP < 40mmHg) [cite: 13][cite_start].
Systemic HTN with mild end-organ defect[cite: 13].
Arrhythmia (B5)Bradycardia (pacemaker or not) [cite: 13][cite_start].
Controlled tachyarrhythmia/Long QTc [cite: 13][cite_start].
Complete Heart Block (HR > 70, narrow QRS)[cite: 13].

Table 7: Group C (Score 20)

Severe abnormalities/Complex anatomy. Expected CCDS > 70.

[cite_start] [cite_start] [cite_start] [cite_start] [cite_start]
CategoryCriteria
Unoperated (C1)Eisenmenger Syndrome (SPO2 < 95%) [cite: 4][cite_start].
Large VSD/PDA/AVSD with CHF or PAH [cite: 4][cite_start].
Severe Obstructive Lesions (AS/PS/Coarctation) with dysfunction [cite: 4][cite_start].
Cyanotic CHD (TOF, TGA, Truncus, Tricuspid Atresia, Single Ventricle) [cite: 4][cite_start].
Complex Anatomy (Univentricular heart, HLHS, Criss-cross heart)[cite: 4].
Ebstein’s (Severe TR). [cite_start]HCM (Gradient > 35mmHg/Syncope)[cite: 4].
Dilated CMP (LVEF < 40%). [cite_start]Restrictive CMP [cite: 4][cite_start].
Symptomatic Constrictive Pericarditis[cite: 4].
Post-Corrective Surgery (C2)Significant residual lesions, ventricular dysfunction, or desaturation [cite: 4][cite_start].
Non-resolving PAH [cite: 4][cite_start].
Post-Heart Transplant [cite: 4][cite_start].
Post-CABG with no recovery[cite: 4].
Post-Palliative (C3)Fontan/TCPC with complications (PLE, Cirrhosis, SPO2 < 80%) [cite: 4][cite_start].
PA Banding (SPO2 < 80%, persistent CHF) [cite: 4][cite_start].
Unifocalization of MAPCAs[cite: 4].
Hypertension (C4)PAH (Mean PAP ≥ 30mmHg, PVR > 240) [cite: 4][cite_start].
Systemic HTN with organ dysfunction/cardiac dysfunction[cite: 4].
Arrhythmia (C5)Life-threatening arrhythmia (ICD implanted) [cite: 4][cite_start].
Arrhythmogenic RV Dysplasia (ARVD) [cite: 4][cite_start].
Intractable Tachyarrhythmia [cite: 4][cite_start].
Complete Heart Block (Wide QRS/Low rate)[cite: 4].

Step 2: Subjective Criteria

Please enter age above to see options.
View Reference Table 2 (Detailed Symptoms)
[cite_start]
Score Below 14 Years (Ross) 14 Years & Above (NYHA)
0Asymptomatic (Grade 1)
SPO2 > 95%[cite: 6].		 NYHA I
No limitation. [cite_start]Can exercise 30 mins[cite: 6].
10 Mild Symptoms (Grade 2)
Tachypnea only. No feeding issues. [cite_start]SPO2 > 95%[cite: 6].		 NYHA II (Mild)
Symptoms on moderate exertion (climbing stairs). [cite_start]Comfortable at rest[cite: 6].
20 Moderate Symptoms (Grade 2-3)
Tachypnea + Diaphoresis. Altered feeding/weight gain. [cite_start]SPO2 > 95%[cite: 6].		 NYHA II-III (Moderate)
Symptoms on daily activities (walking, housework). [cite_start]Comfortable at rest[cite: 6].
30 Severe Symptoms (Grade 3)
Growth failure. Marked dyspnea. SPO2 < 95%. [cite_start]History of cyanotic spell[cite: 6].		 NYHA III-IV (Severe)
Symptoms on light activity. Unable to do clerical work. [cite_start]Home O2 on exertion[cite: 6].
40 Very Severe (Grade 4)
Symptoms at rest (retractions, grunting). Recurrent spells. [cite_start]SPO2 < 90%[cite: 6].		 NYHA IV (Very Severe)
Symptoms at rest. Unable to move without help. [cite_start]Home O2 at rest[cite: 6].

Step 3: Objective Criteria

Select all that apply (Max Score capped at 40)

View Reference Table 3 (Full Objective Criteria)
[cite_start] [cite_start] [cite_start] [cite_start]
1. InvestigationsECG/Holter/Echo/CT/MRI showing significant ischemia, strain, severe ventricular hypertrophy, rhythm disorders, or channelopathies [cite: 8][cite_start].
Echo showing structural HD with hemodynamic effects (correctible or non-correctible) [cite: 8][cite_start].
EF < 40%, TAPSE < expected, Fractional shortening < 30%[cite: 8].
2. Functional Capacity6-minute walk test < 400 meters [cite: 8][cite_start].
Abnormal Exercise Test (MET < 7, VO2 max < 14ml/kg/min) [cite: 8][cite_start].
Abnormal stress test (TMT/Thallium)[cite: 8].
3. Heart Failure SignsSystemic congestion (Raised JVP, Hepatomegaly, Pedal Edema) [cite: 8][cite_start].
Pulmonary congestion (Crepts, Pulmonary Edema) [cite: 8][cite_start].
Radiological Cardiomegaly/PVH [cite: 8][cite_start].
BNP > 140 pg/mL or NT-proBNP > 1700 pg/mL [cite: 8][cite_start].
Systemic Hypoxia (Hct > 55%)[cite: 8].
4. History/TherapyHistory of Palliative procedure or Cardiac Syncope [cite: 8][cite_start].
Presence of Pacemaker (PPI) or ICD [cite: 8][cite_start].
Requirement for Inotropes, Pulmonary Vasodilators, or Non-invasive ventilation[cite: 8].