CHDs儿童先天性心脏病各论课件.pptx

VentricularSeptalDefect VSD 1 医药交流PPT VentricularSeptalDefect ThedisorderofembryologicaldevelopmentofinterventricularseptumMostcommonformofCHDinchildrenAccountingfor25 2 医药交流PPT PositionofVSD Membranous 60 70 thecommonestlocationt Subpulmonic 3 6 riskofaorticvalveprolapse Muscular 20 30 occuranywhereinthemuscularpartofseptum AnatomicTypes 3 医药交流PPT SizeofVSD Small 10mm 4 医药交流PPT HemodynamicCharacteristics 5 医药交流PPT SmallVSD asymptomatic Pan systolicmurmurofgrade heardatleftsternalborderinthe3rd 4thintercostalspaces radiatingoverprecordium 3 4LSBSM o ClinicalManifestations 6 医药交流PPT Medium LargeVSD symptoms Pulmonaryplethora RecurrentchestinfectionSystemicbloodflow Failuretothrive slowweightgain Poorcardiacfunction Cyanosiswhenright to leftshuntoccurs mostlyduetoseverepulmonaryhypertension ClinicalManifestations 7 医药交流PPT Medium LargeVSDPoorcardiacfunction atinfancy difficultywithfeeding sweating tachypnea andhepatomegaly inolderchildren dyspneaonexcursion easyfatigability palpitation exerciseintolerance ClinicalManifestations 8 医药交流PPT Medium LargeVSD signs 2 4LSBSM oDMatapexduetolargebloodflowacrossnormalmitralvalve relativemitralstenosis P2increasedwithsplitCyanosiswithclubbinginlatestage ClinicalManefestation 9 医药交流PPT Electrocardiogram SmallVSD ECGusuallynormalMedium large LVhypertrophywhenpulmonaryvascularresistanceisnormal BothLV RVhypertrophywhenpulmonaryhypertensionoccursduetoincreasedvascularresistance increasedflow RVhypertrophyinEisenmenger ssyndrome 10 医药交流PPT ChestX ray SmallVSD maybenormalMedium largeVSD Increasedvascularmarkingsinlungs Heart chestratio 0 55 EnlargementofLVand orRV Dilatedmainpulmonaryarterysegment Smalleraortainsize 11 医药交流PPT Echocardiogram DisplaypositionandsizeofthedefectDisplayshuntingMeasurepressuregradientDisplaysizeofchambersandvessels EnlargedLA LVand orRV 12 医药交流PPT Echocardiogram 2DE CDEdisplaysVSD 13 医药交流PPT Prognosis Complications Asymptomatic30 50 closespontaneouslyby2yearsofageCongestiveheartfailurePulmonaryhypertensionInfundibulumstenosis 漏斗部狭窄 Prolapseofaorticvalve 主动脉瓣脱垂 Infectiveendocarditis 感染性心内膜炎 14 医药交流PPT MedicalManagement PhysicalactivitiesproperlyPreventionandcureofinfectiontimelyFollow upregularlyAnticongestivemeasures digitalis 洋地黄 diuretics 利尿剂 vasodilators 扩管药物 Transcatheterclosure 经导管封堵术 15 医药交流PPT IndicationsforSurgicalRepair CongestiveheartfailurewithfailuretothriveorrecurrentpneumoniaProgressivepulmonaryhypertensionEvidenceofinfundibulumstenosisEvidenceofprolaseofaorticvalveSupracristalVSDHistoryofinfectiveendocarditis 16 医药交流PPT AtrialSeptalDefect ASD 17 医药交流PPT AtrialSeptalDefect ThedisorderofembryologicaldevelopmentofinteratrialseptumAccountingfor10 ofCHD 18 医药交流PPT fossaovalisASD 75 SinusvenosusASDs 5 OstiumprimumASD 15 AnatomicTypes CoronarysinusASD 2 19 医药交流PPT 20 医药交流PPT HemodynamicCharacteristics 21 医药交流PPT SymptomsaresimilartoVSD s suchaspoorgrowthanddevelopment recurrentpneumonia poorcardiacfunction butoccurlessfrequentlyininfants Somepatientsevenremainasymptomaticthroughlife ClinicalManifestations 22 医药交流PPT Signs 2 3LSBSM oThemurmuriscausedbyincreasedflowacrosspulmonicvalves i e relativepulmonarystenosis 4LSBDMcanoftenbeheard relativetricuspidstenosis P2increasedwithfixedsplit 固定分裂 ClinicalManifestations 23 医药交流PPT Electrocardiogram Axisrightdeviation V1 V3Rhaveincompleterightbundlebranchblockdiagram 导联以S为主 导联以R为主 电轴右偏 RaVR 0 5mv R S 1 V1呈RSr QRS 0 08 示不完全右束支转导阻滞 RV1 SV5 2 5mv 提示右室大 24 医药交流PPT ChestX ray IncreasedvascularmarkingsinlungsHeart chestratio 0 55EnlargementofRA RVDilatedmainpulmonaryarterysegmentSmalleraortainsize 25 医药交流PPT Echocardiogram DisplaypositionandsizeDisplayshuntingDisplayparadoxicmotion 矛盾运动 ofventricularseptumDisplaysizeofchambersandvessels EnlargedRAandRV DilatedMPA SmallerAO 26 医药交流PPT Echocardiogram ostiumprimumASD ostiumsecundumASD 27 医药交流PPT Prognosis Complications Asymptomatic ofteninchildhood Heartfailure occurinmiddleadulthood Atrialtachyarrhythmias adulthood Pulmonaryhypertension uncommon Infectiveendocarditis rarelyoccur Spontaneousclosure mostfrequentlyifASD 4mm frequentlyifASD 8mm mostlyclosedbeforeage2years 28 医药交流PPT MedicalManagement NoneedofphysicalrestrictionformostpatientsPreventionandcureofinfectiontimelyFollow upregularlyAnticongestivemeasures digitalis diuretics vasodilatorsTranscatheterclosure 经导管封堵术 29 医药交流PPT PatentDuctusArteriosus PDA 30 医药交流PPT Accountingfor15 ofCHDIncidencemaybeashighas20 60 inpreterminfantsweighing 1500gMorecommoninfemaleandtheinfantsbornathighaltitudes PatentDuctusArteriosus 31 医药交流PPT AnatomicTypes Tubulartype 80 Funneltype Windowtype 32 医药交流PPT 33 医药交流PPT RA VR PA Flow Pulmonaryhypertension AO LV expansion LA expansion DescendingaortaSmallerdiameter PeripheralarteriesDiastolicpressuredecreased HemodynamicCharacteristics Systemicbloodflow Pulmonaryartery expansion Shunt Pulmonarybloodflow 34 医药交流PPT SmallshuntAsymptomaticContinuousmachinerymurmurofgradeII IIIheardatleftsternalborderinthe2ndintercostalspaces radiatingtoinferiorleftclavicle 左锁骨下 2LSBCM o ClinicalManifestations 35 医药交流PPT Largeshunt symptoms SymptomssimilartoVSD s suchasfailuretothrive recurrentpneumonia poorcardiacfunction exceptfordifferentialcyanosis 差异性紫绀 duetoseverepulmonaryhypertension ClinicalManifestations 36 医药交流PPT Largeshunt signs 2LSBCMIII IVoDMatapexduetolargebloodflowacrossnormalmitralvalve relativemitralstenosis P2increasedwithsplitDifferentialcyanosiswithclubbingoftoes ClinicalManifestations 37 医药交流PPT Electrocardiogram Smallshunt ECGusuallynormalLargeshunt LVhypertrophywhenpulmonaryvascularresistanceisnormal BothLV RVhypertrophywhenpulmonaryhypertensionoccursduetoincreasedvascularresistance increasedflow RVhypertrophyinEisenmenger ssyndrome 38 医药交流PPT ChestX ray Smallshunt normalLargeshunt Increasedvascularmarkingsinlungs Heart chestratio 0 55 EnlargementofLA LV Dilatedmainpulmonaryarterysegment prominentaortainsize 39 医药交流PPT Echocardiogram ductalshunting 40 医药交流PPT Prognosis Complications AsymptomaticCongestiveheartfailurePulmonaryhypertensionInfectiveendocarditisspontaneousclosureofductalshunt 90 closefunctionallyby4daysafterbirth 80 closeanatomicallyin3month and95 in1yearofage 41 医药交流PPT MedicalManagement PhysicalactivitiesproperlyPreventionandcureofinfectiontimelyFollow upregularlyAnticongestivemeasures digitalis diuretics vasodilatorsTranscatheterclosure 经导管封堵术 42 医药交流PPT TetralogyofFallot TOF 43 医药交流PPT TetralogyofFallot Accountingfor10 ofCHD 44 医药交流PPT ObstructiontoRVoutflow infundibularand orvalvularlevelwithhypoplasiaofPALargeVSDAortathatoverridestheVSDHypertrophyofRV Anatomicfeatures 45 医药交流PPT HemodynamicCharacteristics 46 医药交流PPT Symptoms Owingtoanoxia Cyanosis mostlyseenfrom4monthsofageandprogressive Retardedgrowthanddevelopment easyfatigabilityanddyspneaonexcursion Squattingwhenwalking Hypoxemicspell 缺氧发作 suddenonsetofdyspnea deepeningofcyanosis irritabilityorsyncope convulsion absenceofcardiacmurmur ahallmarkofseveresituation ClinicalManifestations 47 医药交流PPT 48 医药交流PPT 49 医药交流PPT Signs Cyanosis Clubbingoffingersandtoes 3LSBSM 0 radiatingwidely P2decreased S2usuallypredominantlyaorticandsingle ClinicalManifestation 50 医药交流PPT Clubbing杵状指 51 医药交流PPT LaboratoryFindings Reponsestoanoxia Hemoglobinincreased Hematocritelevated RBCcountincreased bloodmucosityincreased 52 医药交流PPT