先天性心脏病(英文)

Congenitalheartdiseaseareabnormalitiesintheheart'sstructurethatarepresentatbirth.

Approximately8outofevery1,000newbornshavecongenitalheartdefects,rangingfrommildtosevere.Overview当前1页，总共50页。1.Geneticfactor(internalfactor):Geneticandchromosomalaberrations2.Environmentalfactor(externalfactor):Highaltitude4.Inheritedfactor3.Otherrelatedfactors:Viralinfectionsofpregnancy,Motherswhoarediabetic,alcoholicsordrugaddictiveDrugsandmetabolicfactorsEtiology当前2页，总共50页。Thehealthprotectionofpregnantwomanshouldbeenhanced.Highriskfactors,suchasdrugs,radiation,viralinfection,et.shouldbeavoided.SuitdosageFolicAcidshouldbefilledupinearlypregnancystage.Prevention当前3页，总共50页。Doesthechildhaveheartdisease?EvaluatingachildwithaheartmurmurIsitcongenitalheartdisease?Ifitiscongenitalheartdisease,whatisthelesion?Whatistheseverityofthelesion?当前4页，总共50页。Assessmentofachildforthepresenceofheartdisease

MajorSystolicmurmurgardeIIIormorespeciallywithathrillDiastolicmurmurCyanosisCongestiveheartfailureMinorSystolicmurmurlessthangradeIIIinintensity2.AbnormalS23.AbnormalECG4.AbnormalX-ray5.AbnormalBP当前5页，总共50页。CHDAcyanoticCHDCyanoticCHDLtoRshuntsASDVSDPDAObstructivelesionsPulmonicstenosisAorticstenosisCoarctationofaortaMitralregurgitationRtoLshuntsTOFCompleteTGA当前6页，总共50页。TOFPDAVSDASDFourCongenitalCardiacAnomaliesinChildren返回当前7页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect(ASD)ASDisthemostfrequentcongenitallesionofmajorimportanceinadults.Itisoftennotdiagnoseduntiladultlife,eveninthepresentera,becauseitrarelyproducessymptomsinchildhoodandtheassociatedphysicalsignsareeasilyconfusedwiththecardiacfindingsinnormalchildren.当前8页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectThreetypesofatrialseptaldefectareclassifiedonananatomicbasis:ostiumsecundum第二孔,sinusvenosus,andostiumprimum第一孔.Allthreetypesareassociatedwithaleft-to-rightshuntattheatriallevelandvolumeoverworkoftherightventricle.当前9页，总共50页。当前10页，总共50页。房间隔缺损当前11页，总共50页。房间隔缺损—原发孔型位于房间隔的下部，紧邻房室瓣。当前12页，总共50页。房间隔缺损—继发孔型亦称中央型或卵圆孔型当前13页，总共50页。房间隔缺损—静脉窦型位置接近上腔静脉当前14页，总共50页。房间隔缺损当前15页，总共50页。当前16页，总共50页。当前17页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Bloodischronicallyovercirculatedthroughthelungsatnormalintracardiacpressurelevels.Increasedflowthroughthepulmonaryvalveproducesacharacteristicpulmonarysystolicejectionmurmur.Thepulmonaryvalvecloseslatebecauseofthereducedimpedance阻抗inthepulmonaryarterialsystem,causingawidesplittingofthesecondheartsound,theotherclassicfindinginASD.当前18页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectThesplittingremainsrelativelyfixedinrelationtorespiration;

theaorticandpulmonarycomponentsremainaudiblysplitduringexpiration.Achestx-rayusuallyrevealsenlargementoftheheartandsignsofpulmonaryovercirculation,suchasalargepulmonarytrunkandincreasedpulmonaryvascularmarkings.Therelativeseverityoftheseconditionsreflectsthesizeoftheleft-to-rightshunt.

当前19页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectTwomajorcomplicationsofASDarepulmonaryarterialhypertensionandrightventricularfailure.Pulmonaryarterialhypertensioniscausedbyelevatedpulmonaryvascularresistance;itdevelopsafteradolescenceinabout15percentofcases.Inthemostseverecases,anirreversibleplexiformarteriopathy丛状的动脉病,similartothatseeninEisenmengersyndromeorprimarypulmonaryhypertension,ispresent.当前20页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Asaresultofpulmonaryhypertension,theleft-to-rightshuntfirstdecreases,thenbecomesbidirectional,andfinallyreverses;arightventricularpressureoverloaddevelops,pulmonarybloodflowisreduced,andthepatientbecomescyanotic.

当前21页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Rightventricularfailuredevelopsasaresultoflong-standingvolumeoverload;itusuallyaffectspatientsolderthan40years.Rightventricularfailureisusuallyassociatedwithatrialflutterorfibrillationandisoftenlinkedtotricuspidregurgitation.Eventually,asyndromeofright-andleft-sidedcongestiveheartfailuredevelops,andatthisstage,itmaybedifficulttodifferentiateclinicallybetweenASDandsuchconditionsascardiomyopathyandmitralvalvedisease.当前22页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectSurgicalclosureofASDisaverysafeandhighlyeffectiveprocedure.Prophylacticsurgeryisthereforeindicatedinanypatientinwhomtheratioofpulmonarybloodflowtosystemicbloodflowis2:1orgreater.NearlyallpatientsinwhomASDcanbeclinicallydiagnosedexhibitatleastthisdegreeofleft-to-rightshunt.当前23页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Surgeryiscontraindicated治疗或处置不当whenpulmonaryhypertensionapproachesthepressurelevelofthesystemiccirculationbecauseinsuchpatientstheoperativemortalityishighandtheelevatedpulmonaryvascularresistancedoesnotfallaftersurgery.当前24页，总共50页。CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectNonsurgicalclosureusingcardiaccatheterizationwithanumbrellalikedevicehasbeenaccomplishedinpatientswithdefectslessthan2cmindiameter,mostofwhomhavebeeninfantsorsmallchildren.

当前25页，总共50页。房间隔缺损封堵伞当前26页，总共50页。房间隔缺损封堵过程当前27页，总共50页。CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefect(VSD)VSDisthemostcommoncongenitalcardiacanomalyininfants.ItisrarelyseeninadultsbecausesubstantialVSDthatarenotcorrectedsurgicallyareassociatedwithahighmortality.Inaddition,theincidenceofspontaneousclosureofVSDisrelativelyhigh;closureoccursparticularlyoftenininfancybutalsoinlateryears.当前28页，总共50页。当前29页，总共50页。VSD当前30页，总共50页。VSD当前31页，总共50页。CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectTheVSDthatdoappearinadultsasisolatedanomaliesareusuallylessthan1cmindiameter.Becausetheopeningisquitesmall,normalsystolicpressurecanbemaintainedintherightventricleandinthepulmonaryartery.当前32页，总共50页。CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectIninfantswithalargeVSD,medicalmanagementhastwoaims:tocontrolheartfailureandtopreventthedevelopmentofpulmonaryvasculardisease.Therapeuticmeasuresareaimedatthecontrolofheartfailuresymptomsandthemaintenanceofnormalgrowth.当前33页，总共50页。CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefect

IndicationsforsurgicalclosureofVSDincludepatientsatanyagewithlargedefectsinwhomclinicalsymptomsandfailuretothrivecannotbecontrolledmedically.Infantsbetween6and12moofagewithlargedefectsassociatedwithpulmonaryhypertension,evenifsymptomsarecontrolledbymedication.当前34页，总共50页。CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectSurgicalclosureisusuallyundertakentopreventinfectiveendocarditis.Theincidenceofthiscomplicationisnotwellestablished,butsurgeryappearstobehighlyeffectiveasaprophylactic

measure.当前35页，总共50页。室间隔缺损封堵伞当前36页，总共50页。室间隔缺损封堵当前37页，总共50页。PatentDuctusArteriosusPDA–PersistenceofthenormalfetalvesselthatjoinsthePAtotheAorta.Normallyclosesinthe1stwkoflife.Accountsfor10%ofallCHD,seenin10%ofothercongenitalhrtlesionsandcanoftenplayacriticalroleinsomelesions.Female:Maleratioof2:1Oftenassociatedw/coarctation&VSD.当前38页，总共50页。动脉导管未闭PDA当前39页，总共50页。PatentDuctusArteriosusQuestion: WhatTORCHinfectionisPDAassociatedwith?•

Answer: Rubella当前40页，总共50页。PatentDuctusArteriosusHemodynamicsAsaresultofhigheraorticpressure,bloodshuntsLtoRthroughtheductusfromAortatoPA.Extentoftheshuntdependsonsizeoftheductus&PVR:SVR.SmallPDA,pressuresinPA,RV,RAarenormal.当前41页，总共50页。PatentDuctusArteriosusHemodynamicsLargePDA,PApressuresareequaltosystemicpressures.Inextremecases70%ofCOisshuntedthroughtheductustopulmonarycirculation.Leadstoincreasedpulmonaryvasculardisease.当前42页，总共50页。PatentDuctusArteriosusClinicalSigns&SymptomsSmallPDA’sareusu