先天性心脏病(英文)

Congenitalheartdiseaseareabnormalitiesintheheart'sstructurethatarepresentatbirth.

Approximately8outofevery1,000newbornshavecongenitalheartdefects,rangingfrommildtosevere.Overview现在是1页\一共有50页\编辑于星期二1.Geneticfactor(internalfactor):Geneticandchromosomalaberrations2.Environmentalfactor(externalfactor):Highaltitude4.Inheritedfactor3.Otherrelatedfactors:Viralinfectionsofpregnancy,Motherswhoarediabetic,alcoholicsordrugaddictiveDrugsandmetabolicfactorsEtiology现在是2页\一共有50页\编辑于星期二Thehealthprotectionofpregnantwomanshouldbeenhanced.Highriskfactors,suchasdrugs,radiation,viralinfection,et.shouldbeavoided.SuitdosageFolicAcidshouldbefilledupinearlypregnancystage.Prevention现在是3页\一共有50页\编辑于星期二Doesthechildhaveheartdisease?EvaluatingachildwithaheartmurmurIsitcongenitalheartdisease?Ifitiscongenitalheartdisease,whatisthelesion?Whatistheseverityofthelesion?现在是4页\一共有50页\编辑于星期二Assessmentofachildforthepresenceofheartdisease

MajorSystolicmurmurgardeIIIormorespeciallywithathrillDiastolicmurmurCyanosisCongestiveheartfailureMinorSystolicmurmurlessthangradeIIIinintensity2.AbnormalS23.AbnormalECG4.AbnormalX-ray5.AbnormalBP现在是5页\一共有50页\编辑于星期二CHDAcyanoticCHDCyanoticCHDLtoRshuntsASDVSDPDAObstructivelesionsPulmonicstenosisAorticstenosisCoarctationofaortaMitralregurgitationRtoLshuntsTOFCompleteTGA现在是6页\一共有50页\编辑于星期二TOFPDAVSDASDFourCongenitalCardiacAnomaliesinChildren返回现在是7页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect(ASD)ASDisthemostfrequentcongenitallesionofmajorimportanceinadults.Itisoftennotdiagnoseduntiladultlife,eveninthepresentera,becauseitrarelyproducessymptomsinchildhoodandtheassociatedphysicalsignsareeasilyconfusedwiththecardiacfindingsinnormalchildren.现在是8页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectThreetypesofatrialseptaldefectareclassifiedonananatomicbasis:ostiumsecundum第二孔,sinusvenosus,andostiumprimum第一孔.Allthreetypesareassociatedwithaleft-to-rightshuntattheatriallevelandvolumeoverworkoftherightventricle.现在是9页\一共有50页\编辑于星期二现在是10页\一共有50页\编辑于星期二房间隔缺损现在是11页\一共有50页\编辑于星期二房间隔缺损—原发孔型位于房间隔的下部，紧邻房室瓣。现在是12页\一共有50页\编辑于星期二房间隔缺损—继发孔型亦称中央型或卵圆孔型现在是13页\一共有50页\编辑于星期二房间隔缺损—静脉窦型位置接近上腔静脉现在是14页\一共有50页\编辑于星期二房间隔缺损现在是15页\一共有50页\编辑于星期二现在是16页\一共有50页\编辑于星期二现在是17页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Bloodischronicallyovercirculatedthroughthelungsatnormalintracardiacpressurelevels.Increasedflowthroughthepulmonaryvalveproducesacharacteristicpulmonarysystolicejectionmurmur.Thepulmonaryvalvecloseslatebecauseofthereducedimpedance阻抗inthepulmonaryarterialsystem,causingawidesplittingofthesecondheartsound,theotherclassicfindinginASD.现在是18页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectThesplittingremainsrelativelyfixedinrelationtorespiration;

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

现在是19页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectTwomajorcomplicationsofASDarepulmonaryarterialhypertensionandrightventricularfailure.Pulmonaryarterialhypertensioniscausedbyelevatedpulmonaryvascularresistance;itdevelopsafteradolescenceinabout15percentofcases.Inthemostseverecases,anirreversibleplexiformarteriopathy丛状的动脉病,similartothatseeninEisenmengersyndromeorprimarypulmonaryhypertension,ispresent.现在是20页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

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

现在是21页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Rightventricularfailuredevelopsasaresultoflong-standingvolumeoverload;itusuallyaffectspatientsolderthan40years.Rightventricularfailureisusuallyassociatedwithatrialflutterorfibrillationandisoftenlinkedtotricuspidregurgitation.Eventually,asyndromeofright-andleft-sidedcongestiveheartfailuredevelops,andatthisstage,itmaybedifficulttodifferentiateclinicallybetweenASDandsuchconditionsascardiomyopathyandmitralvalvedisease.现在是22页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectSurgicalclosureofASDisaverysafeandhighlyeffectiveprocedure.Prophylacticsurgeryisthereforeindicatedinanypatientinwhomtheratioofpulmonarybloodflowtosystemicbloodflowis2:1orgreater.NearlyallpatientsinwhomASDcanbeclinicallydiagnosedexhibitatleastthisdegreeofleft-to-rightshunt.现在是23页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Surgeryiscontraindicated治疗或处置不当whenpulmonaryhypertensionapproachesthepressurelevelofthesystemiccirculationbecauseinsuchpatientstheoperativemortalityishighandtheelevatedpulmonaryvascularresistancedoesnotfallaftersurgery.现在是24页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectNonsurgicalclosureusingcardiaccatheterizationwithanumbrellalikedevicehasbeenaccomplishedinpatientswithdefectslessthan2cmindiameter,mostofwhomhavebeeninfantsorsmallchildren.

现在是25页\一共有50页\编辑于星期二房间隔缺损封堵伞现在是26页\一共有50页\编辑于星期二房间隔缺损封堵过程现在是27页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefect(VSD)VSDisthemostcommoncongenitalcardiacanomalyininfants.ItisrarelyseeninadultsbecausesubstantialVSDthatarenotcorrectedsurgicallyareassociatedwithahighmortality.Inaddition,theincidenceofspontaneousclosureofVSDisrelativelyhigh;closureoccursparticularlyoftenininfancybutalsoinlateryears.现在是28页\一共有50页\编辑于星期二现在是29页\一共有50页\编辑于星期二VSD现在是30页\一共有50页\编辑于星期二VSD现在是31页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectTheVSDthatdoappearinadultsasisolatedanomaliesareusuallylessthan1cmindiameter.Becausetheopeningisquitesmall,normalsystolicpressurecanbemaintainedintherightventricleandinthepulmonaryartery.现在是32页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectIninfantswithalargeVSD,medicalmanagementhastwoaims:tocontrolheartfailureandtopreventthedevelopmentofpulmonaryvasculardisease.Therapeuticmeasuresareaimedatthecontrolofheartfailuresymptomsandthemaintenanceofnormalgrowth.现在是33页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefect

IndicationsforsurgicalclosureofVSDincludepatientsatanyagewithlargedefectsinwhomclinicalsymptomsandfailuretothrivecannotbecontrolledmedically.Infantsbetween6and12moofagewithlargedefectsassociatedwithpulmonaryhypertension,evenifsymptomsarecontrolledbymedication.现在是34页\一共有50页\编辑于星期二CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectSurgicalclosureisusuallyundertakentopreventinfectiveendocarditis.Theincidenceofthiscomplicationisnotwellestablished,butsurgeryappearstobehighlyeffectiveasaprophylactic

measure.现在是35页\一共有50页\编辑于星期二室间隔缺损封堵伞现在是36页\一共有50页\编辑于星期二室间隔缺损封堵现在是37页\一共有50页\编辑于星期二PatentDuctusArteriosusPDA–PersistenceofthenormalfetalvesselthatjoinsthePAtotheAorta.Normallyclosesinthe1stwkoflife.Accountsfor10%ofallCHD,seenin10%ofothercongenitalhrtlesionsandcanoftenplayacriticalroleinsomelesions.Female:Maleratioof2:1Oftenassociatedw/coarctation&VSD.现在是38页\一共有50页\编辑于星期二动脉导管未闭PDA现在是39页\一共有50页\编辑于星期二PatentDuctusArteriosusQuestion: WhatTORCHinfectionisPDAassociatedwith?•

Answer: Rubella现在是40页\一共有50页\编辑于星期二PatentDuctusArteriosusHemodynamicsAsaresultofhigheraorticpressure,bloodshuntsLtoRthroughtheductusfromAortatoPA.Extentoftheshuntdependsonsizeoftheductus&PVR:SVR.SmallPDA,pressuresinPA,RV,RAarenormal.现在是41页\一共有50页\编辑于星期二PatentDuctusArteriosusHemodynamicsLargePDA,PApressuresareequaltosystemicpressures.Inextremecases70%ofCOisshuntedthroughtheductustopulmonarycirculation.Leadstoincreasedpulmonaryvasculardisease.现在是42页\一共有50页\编辑于星期二PatentDuctusArteriosusClinicalSigns&SymptomsSmallPDA’sareusuallyasymptomaticLarge