先天性心脏病英文

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,11/7/2009,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,1.Genetic factor (internalfactor) :Genetic and chromosomal aberrations,2. Environmental factor (external factor): High altitude,4. Inherited factor,3. Other related factors: Viral infections of pregnancy , Mothers who are diabetic, alcoholics or drug addictive Drugs and metabolic factors,Etiology,第一页，共四十七页。,The health protection of pregnant woman should be enhanced.,High risk factors, such as drugs, radiation, viral infection, et.should be avoided.,Suit dosage Folic Acid should be filled up in early pregnancy stage,.,Prevention,第二页，共四十七页。,Does the child have heart disease?,Evaluating a child with a heart murmur,Is it congenital heart disease?,If it is congenital heart disease,what is the lesion?,What is the severity of the lesion?,第三页，共四十七页。,Assessment of a child for the presence of heart disease,Major,Systolic murmur garde III or more specially with a thrill,Diastolic murmur,Cyanosis,Congestive heart failure,Minor,Systolic murmur less than grade III in intensity,2. Abnormal S2,3.Abnormal ECG,4.Abnormal X-ray,5.Abnormal BP,第四页，共四十七页。,CHD,Acyanotic,CHD,Cyanotic,CHD,L to R shunts,ASD,VSD,PDA,Obstructive lesions,Pulmonic stenosis,Aortic stenosis,Coarctation of aorta,Mitral regurgitation,R to L shunts,TOF,Complete TGA,第五页，共四十七页。,TOF,PDA,VSD,ASD,Four Congenital Cardiac Anomalies in Children,返回,第六页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,(ASD),ASD is the most frequent congenital lesion of major importance in adults. It is often not diagnosed until adult life, even in the present era, because it rarely produces symptoms in childhood and the associated physical signs are easily confused with the cardiac findings in normal children.,第七页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Three types of atrial septal defect,are classified on an anatomic basis,: ostium secundum,第二孔, sinus venosus, and ostium primum,第一孔,. All three types are associated with a left-to-right shunt at the atrial level and volume overwork of the right ventricle.,第八页，共四十七页。,第九页，共四十七页。,房间隔缺损,第十页，共四十七页。,房间隔缺损原发孔型,位于房间隔的下部，紧邻房室瓣,。,第十一页，共四十七页。,房间隔缺损继发孔型,亦称中央型或卵圆孔型,第十二页，共四十七页。,房间隔缺损静脉窦型,位置接近上腔静脉,第十三页，共四十七页。,房间隔缺损,第十四页，共四十七页。,第十五页，共四十七页。,第十六页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Blood is chronically overcirculated through the lungs at normal intracardiac pressure levels. Increased flow through the pulmonary valve produces a characteristic pulmonary systolic ejection murmur. The pulmonary valve closes late because of the reduced impedance,阻抗,in the pulmonary arterial system, causing a wide splitting of the second heart sound, the other classic finding in ASD.,第十七页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,The splitting remains relatively fixed in relation to respiration;,the aortic and pulmonary components remain audibly split during expiration. A chest x-ray usually reveals enlargement of the heart and signs of pulmonary overcirculation, such as a large pulmonary trunk and increased pulmonary vascular markings. The relative severity of these conditions reflects the size of the left-to-right shunt.,第十八页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Two major complications of ASD are pulmonary arterial hypertension and right ventricular failure. Pulmonary arterial hypertension is caused by elevated pulmonary vascular resistance; it develops after adolescence in about 15 percent of cases. In the most severe cases, an irreversible plexiform arteriopathy,丛状的动脉病, similar to that seen in Eisenmenger syndrome or primary pulmonary hypertension, is present.,第十九页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,As a result of pulmonary hypertension, the left-to-right shunt first decreases, then becomes bidirectional, and finally reverses; a right ventricular pressure overload develops, pulmonary blood flow is reduced, and the patient becomes cyanotic.,第二十页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Right ventricular failure develops as a result of long-standing volume overload; it usually affects patients older than 40 years. Right ventricular failure,is usually associated with,atrial flutter or fibrillation and,is often linked to,tricuspid regurgitation. Eventually, a syndrome of right- and left-sided congestive heart failure develops, and at this stage, it may be difficult to,differentiate clinically between,ASD and such conditions as cardiomyopathy and mitral valve disease.,第二十一页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Surgical closure of ASD is a very safe and highly effective procedure. Prophylactic surgery is therefore indicated in any patient in whom the ratio of pulmonary blood flow to systemic blood flow is 2:1 or greater. Nearly all patients in whom ASD can be clinically diagnosed exhibit at least this degree of left-to-right shunt.,第二十二页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Surgery is contraindicated,治疗或处置不当,when pulmonary hypertension approaches the pressure level of the systemic circulation because in such patients the operative mortality is high and the elevated pulmonary vascular resistance does not fall after surgery.,第二十三页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Nonsurgical closure using cardiac catheterization with an umbrellalike device has been accomplished in patients with defects less than 2 cm in diameter, most of whom have been infants or small children.,第二十四页，共四十七页。,房间隔缺损封堵伞,第二十五页，共四十七页。,房间隔缺损封堵过程,第二十六页，共四十七页。,Congenital Cardiac Anomalies in Children,Ventricular Septal Defect (VSD),VSD is the most common congenital cardiac anomaly in infants. It is rarely seen in adults because substantial VSD that are not corrected surgically are associated with a high mortality. In addition, the incidence of spontaneous closure of VSD is relatively high; closure occurs particularly often in infancy but also in later years.,第二十七页，共四十七页。,第二十八页，共四十七页。,VSD,第二十九页，共四十七页。,VSD,第三十页，共四十七页。,Congenital Cardiac Anomalies in Children,Ventricular Septal Defect,The VSD that do appear in adults as isolated anomalies are usually less than 1 cm in diameter. Because the opening is quite small, normal systolic pressure can be maintained in the right ventricle and in the pulmonary artery.,第三十一页，共四十七页。,Congenital Cardiac Anomalies in Children,Ventricular Septal Defect,In infants with a large VSD, medical management has two aims: to control heart failure and to prevent the development of pulmonary vascular disease. Therapeutic measures are aimed at the control of heart failure symptoms and the maintenance of normal growth.,第三十二页，共四十七页。,Congenital Cardiac Anomalies in Children,Ventricular Septal Defect,Indications for surgical closure of VSD,include patients at any age with large defects in whom clinical symptoms and failure to thrive cannot be controlled medically.,Infants between 6 and 12 mo of age with large defects associated with pulmonary hypertension, even if symptoms are controlled by medication.,第三十三页，共四十七页。,Congenital Cardiac Anomalies in Children,Ventricular Septal Defect,Surgical closure is usually undertaken to prevent infective endocarditis . The incidence of this complication is not well established, but surgery appears to be highly effective as a prophylactic,measure.,第三十四页，共四十七页。,室间隔缺损封堵伞,第三十五页，共四十七页。,室间隔缺损封堵,第三十六页，共四十七页。,Patent Ductus Arteriosus,PDA, Persistence of the normal fetal vessel that joins the PA to the Aorta.,Normally closes in the 1,st,wk of life.,Accounts for 10% of all CHD, seen in 10% of other congenital hrt lesions and can often play a critical role in some lesions.,Female : Male ratio of 2:1,Often associated w/ coarctation & VSD.,第三十七页，共四十七页。,动脉导管未闭PDA,第三十八页，共四十七页。,Patent Ductus Arteriosus,Question:,What TORCH infection is PDA associated with?,Answer,:,Rubella,第三十九页，共四十七页。,Patent Ductus Arteriosus,Hemodynamics,As a result of higher aortic pressure, blood shunts L to R through the ductus from Aorta to PA.,Extent of the shunt depends on size of the ductus & PVR:SVR.,Small PDA, pressures in PA, RV, RA are normal.,第四十页，共四十七页。,Patent Ductus Arteriosus,Hemodynamics,Large PDA, PA pressures are equal to systemic pressures. In extreme cases 70% of CO is shunted through the ductus to pulmonary circulation.,Leads to increased pulmonary vascular disease.,第四十一页，共四十七页。,Patent Ductus Arteriosus,Clinical Signs & Symptoms,Small PDAs are usually asymptomatic,Large PDAs can result in symptoms of CHF, growth restriction, FTT.,Bounding arterial pulses,Widened pulse pressure,Enlarged heart, prominent apical impulse,Classic continuous machinary systolic murmur,Mid-diastolic murmur at the apex,第四十二页，共四十七页。,Patent Ductus Arteriosus,Treatment,Indomethacin, inhibitor of prostaglandin synthesis can be used in premature infants.,PDA requires surgical or catheter closure.,Closure is required treatment heart failure & to prevent pulmonary vascular disease.,Usually done by ligation & division or intra vascular coil.,Mortality is 1%,第四十三页，共四十七页。,动脉导管未闭封堵伞,第四十四页，共四十七页。,法洛四联症紫绀型,第四十五页，共四十七页。,Case report,One girl with 6 year old,Symptoms: recurrent chest infections/wheeze,Physical signs,A fixed and widely split second heart sound,An ejection systolic murmur best heard in the third left intercostal space,第四十六页，共四十七页。,内容总结,1.Genetic factor (internalfactor) :Genetic and chromosomal aberrations。4. Inherited factor。2. Abnormal S2。Physical signs,第四十七页，共四十七页。,