2022年先天性心脏病英文

1、1.Genetic factor (internalfactor) :Genetic and chromosomal aberrations2. Environmental factor (external factor): High altitude4. Inherited factor3. Other related factors: Viral infections of pregnancy , Mothers who are diabetic, alcoholics or drug addictive Drugs and metabolic factorsEtiology第一页，共四十

2、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 m

3、urmurIs 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 diseaseMajor Systolic murmur garde III or more specially with a thrillDiastolic murmurCyanosisCongestive heart failur

4、eMinor Systolic murmur less than grade III in intensity 2. Abnormal S23.Abnormal ECG4.Abnormal X-ray5.Abnormal BP第四页，共四十七页。CHDCHDAcyanotic Acyanotic CHDCHDCyanoticCyanoticCHDCHDL to R shuntsL to R shuntsASD ASD VSDVSDPDA PDA Obstructive lesions Pulmonic stenosisAortic stenosisCoarctation of aortaMit

5、ral regurgitationR to L shuntsR to L shuntsTOFTOFComplete TGAComplete TGA第五页，共四十七页。TOFPDAVSDASD Four Congenital Cardiac Anomalies in Children 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 o

6、ften 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 at

7、rial septal defect are classified on an anatomic basis: ostium secundum第二(d r)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。房间隔缺损房间隔缺损第十页，共四十七页。房间隔缺损房间隔缺损原发孔型原发孔型(k

8、n xn)位于房间隔的位于房间隔的下部，紧邻下部，紧邻(jnln)房室瓣房室瓣。第十一页，共四十七页。房间隔缺损房间隔缺损继发孔型继发孔型(kn xn)亦称中央亦称中央(zhngyng)型或型或卵圆孔型卵圆孔型第十二页，共四十七页。房间隔缺损房间隔缺损静脉静脉(jngmi)窦型窦型位置位置(wi zhi)接接近上腔静脉近上腔静脉第十三页，共四十七页。房间隔缺损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 chronicall

9、y 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(zkng) in the pulmonary arterial system, causing a wid

10、e 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-r

11、ay 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 A

12、trial 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 irrevers

13、ible plexiform arteriopathy丛状的动脉(dngmi)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

14、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 over

15、load; 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 d

16、ifficult 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

17、 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 co

18、ntraindicated 治疗(zhlio)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

19、 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房间隔缺损封堵过程(guchng)第二十六页，共四十

20、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 spontaneo

21、us 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

22、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 co

23、ntrol 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 closu

24、re 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 C

25、ardiac 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。室间隔缺损封堵伞室间隔缺损封堵伞第三十五页，共四十七页。室

26、间隔缺损封堵室间隔缺损封堵第三十六页，共四十七页。Patent Ductus ArteriosusPDA Persistence of the normal fetal vessel that joins the PA to the Aorta.Normally closes in the 1st 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 r

27、atio of 2:1Often associated w/ coarctation & VSD.第三十七页，共四十七页。动脉动脉(dngmi)导管未闭导管未闭PDA第三十八页，共四十七页。Patent Ductus ArteriosusQuestion:What TORCH infection is PDA associated with? Answer: Rubella第三十九页，共四十七页。Patent Ductus ArteriosusHemodynamicsAs a result of higher aortic pressure, blood shunts L to R t

28、hrough 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 ArteriosusHemodynamicsLarge 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 ArteriosusClinical Signs & SymptomsSmall PDAs are usually asymptomaticLarge PDAs can result in symptoms of CHF, growth