儿童先天性心脏病各论.pptx

VentricularSeptalDefect（VSD）,1,.,VentricularSeptalDefect,ThedisorderofembryologicaldevelopmentofinterventricularseptumMostcommonformofCHDinchildrenAccountingfor25,2,PositionofVSD：Membranous(60-70%):thecommonestlocationtSubpulmonic(3-6%):riskofaorticvalveprolapseMuscular(20-30%):occuranywhereinthemuscularpartofseptum,AnatomicTypes,3,SizeofVSD,Small:10mm,4,HemodynamicCharacteristics,5,SmallVSDasymptomaticPan-systolicmurmurofgradeheardatleftsternalborderinthe3rd4thintercostalspaces,radiatingoverprecordium(34LSBSMo),ClinicalManifestations,6,MediumLargeVSD(symptoms)Pulmonaryplethora-RecurrentchestinfectionSystemicbloodflow-Failuretothrive(slowweightgain）Poorcardiacfunction:Cyanosiswhenright-to-leftshuntoccurs,mostlyduetoseverepulmonaryhypertension,ClinicalManifestations,7,MediumLargeVSDPoorcardiacfunction:atinfancy：difficultywithfeeding,sweating,tachypnea,andhepatomegaly;inolderchildren：dyspneaonexcursion,easyfatigability,palpitation,exerciseintolerance,ClinicalManifestations,8,MediumLargeVSD(signs)24LSBSMoDMatapexduetolargebloodflowacrossnormalmitralvalve(relativemitralstenosis)P2increasedwithsplitCyanosiswithclubbinginlatestage,ClinicalManefestation,9,Electrocardiogram,SmallVSD:ECGusuallynormalMediumlargeLVhypertrophywhenpulmonaryvascularresistanceisnormalBothLVdeepeningofcyanosis;irritabilityorsyncope;convulsion；absenceofcardiacmurmur（ahallmarkofseveresituation）,ClinicalManifestations,47,48,49,Signs：CyanosisClubbingoffingersandtoes3LSBSM0,radiatingwidelyP2decreasedS2usuallypredominantlyaorticandsingle,ClinicalManifestation,50,Clubbing杵状指,51,LaboratoryFindings,Reponsestoanoxia:HemoglobinincreasedHematocritelevatedRBCcountincreasedbloodmucosityincreased,52,Electrocardiogram,Rightaxisdeviation&RVhypertrophyinalmostallcasesRAexpandinsomecases,12-year-oldboywithTOF,53,ChestX-ray,Decreasedvascularmarkingsinlungs“Boot-shaped”heartusuallyinnormalsizeConcavePAsegmentEnlargedaortawith25%rightaorticarch,54,Echocardiogram,EnlargedoverridingaortawithlargesubaorticVSDNarrowingofRVoutflowtract(ISand/orPS)withsmallMPAThickeningofRVwall,55,Prognosis&Complications,AllpatientsrequirheartsurgeryComplications:EmbolismAbscessinthebrainInfectiveendocarditisArrhythmias,56,MedicalManagement,PreventionfromembolizationCyanoticspell:propranolol,morphine,NaHCO3Maintainpatencyofductus:prostaglandinEIncrea