1、先天性心臟病英文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 factorsEtiolog

2、y第一頁(yè)，共四十七頁(yè)。先天性心臟病英文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第二頁(yè)，共四十七頁(yè)。先天性心臟病英文Does the child have heart disease?Evaluatin

3、g a child with a heart murmurIs it congenital heart disease?If it is congenital heart disease, what is the lesion?What is the severity of the lesion?第三頁(yè)，共四十七頁(yè)。先天性心臟病英文Assessment of a child for the presence of heart diseaseMajor Systolic murmur garde III or more specially with a thrillDiastolic murmu

4、rCyanosisCongestive heart failureMinor Systolic murmur less than grade III in intensity 2. Abnormal S23.Abnormal ECG4.Abnormal X-ray5.Abnormal BP第四頁(yè)，共四十七頁(yè)。先天性心臟病英文CHDCHDAcyanotic Acyanotic CHDCHDCyanoticCyanoticCHDCHDL to R shuntsL to R shuntsASD ASD VSDVSDPDA PDA Obstructive lesions Pulmonic stenos

5、isAortic stenosisCoarctation of aortaMitral regurgitationR to L shuntsR to L shuntsTOFTOFComplete TGAComplete TGA第五頁(yè)，共四十七頁(yè)。先天性心臟病英文TOFPDAVSDASD Four Congenital Cardiac Anomalies in Children 第六頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect (ASD)ASD is the most frequent

6、congenital lesion of major importance in adults. It is often 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. 第七頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Card

7、iac Anomalies in Children Atrial Septal Defect Three types of atrial 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 ventric

8、le. 第八頁(yè)，共四十七頁(yè)。先天性心臟病英文第九頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損房間隔缺損第十頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損房間隔缺損原發(fā)孔型原發(fā)孔型(kn xn)位于房間隔的位于房間隔的下部，緊鄰下部，緊鄰(jnln)房室瓣房室瓣。第十一頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損房間隔缺損繼發(fā)孔型繼發(fā)孔型(kn xn)亦稱中央亦稱中央(zhngyng)型或型或卵圓孔型卵圓孔型第十二頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損房間隔缺損靜脈靜脈(jngmi)竇型竇型位置位置(wi zhi)接接近上腔靜脈近上腔靜脈第十三頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損房間隔缺損第十

9、四頁(yè)，共四十七頁(yè)。先天性心臟病英文第十五頁(yè)，共四十七頁(yè)。先天性心臟病英文第十六頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect Blood is chronically overcirculated through the lungs at normal intracardiac pressure levels. Increased flow through the pulmonary valve produces a characteristic pulmonary systolic e

10、jection murmur. The pulmonary valve closes late because of the reduced impedance阻抗(zkng) in the pulmonary arterial system, causing a wide splitting of the second heart sound, the other classic finding in ASD. 第十七頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect The splitt

11、ing remains relatively fixed in relation to respiration; the aortic and pulmonary components remain audibly split during expiration. A chest x-ray usually reveals enlargement of the heart and signs of pulmonary overcirculation, such as a large pulmonary trunk and increased pulmonary vascular marking

12、s. The relative severity of these conditions reflects the size of the left-to-right shunt. 第十八頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect Two major complications of ASD are pulmonary arterial hypertension and right ventricular failure. Pulmonary arterial hypertensio

13、n is caused by elevated pulmonary vascular resistance; it develops after adolescence in about 15 percent of cases. In the most severe cases, an irreversible plexiform arteriopathy叢狀的動(dòng)脈(dngmi)病, similar to that seen in Eisenmenger syndrome or primary pulmonary hypertension, is present. 第十九頁(yè)，共四十七頁(yè)。先天性

14、心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect As a result of pulmonary hypertension, the left-to-right shunt first decreases, then becomes bidirectional, and finally reverses; a right ventricular pressure overload develops, pulmonary blood flow is reduced, and the patient become

15、s cyanotic. 第二十頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect Right ventricular failure develops as a result of long-standing volume overload; it usually affects patients older than 40 years. Right ventricular failure is usually associated with atrial flutter or fibril

16、lation 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 difficult to differentiate clinically between ASD and such conditions as cardiomyopathy and mitral valve disease.第二十一頁(yè)，共四十七頁(yè)。先天性心臟病英文

17、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 in any patient in whom the ratio of pulmonary blood flow to systemic blood flow is 2:1 or greater. Nearly all patients in w

18、hom ASD can be clinically diagnosed exhibit at least this degree of left-to-right shunt. 第二十二頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect Surgery is contraindicated 治療(zhlio)或處置不當(dāng) when pulmonary hypertension approaches the pressure level of the systemic circulation b

19、ecause in such patients the operative mortality is high and the elevated pulmonary vascular resistance does not fall after surgery. 第二十三頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Atrial Septal Defect Nonsurgical closure using cardiac catheterization with an umbrellalike device has been

20、 accomplished in patients with defects less than 2 cm in diameter, most of whom have been infants or small children. 第二十四頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損封堵傘房間隔缺損封堵傘第二十五頁(yè)，共四十七頁(yè)。先天性心臟病英文房間隔缺損封堵過(guò)程房間隔缺損封堵過(guò)程(guchng)第二十六頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Ventricular Septal Defect (VSD)VSD is th

21、e 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 spontaneous closure of VSD is relatively high; closure occurs particularly often in infancy b

22、ut also in later years. 第二十七頁(yè)，共四十七頁(yè)。第二十八頁(yè)，共四十七頁(yè)。先天性心臟病英文VSD第二十九頁(yè)，共四十七頁(yè)。先天性心臟病英文VSD第三十頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Ventricular Septal Defect The VSD that do appear in adults as isolated anomalies are usually less than 1 cm in diameter. Because the opening is quite small, n

23、ormal systolic pressure can be maintained in the right ventricle and in the pulmonary artery. 第三十一頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Ventricular Septal Defect In infants with a large VSD, medical management has two aims: to control heart failure and to prevent the development o

24、f pulmonary vascular disease. Therapeutic measures are aimed at the control of heart failure symptoms and the maintenance of normal growth.第三十二頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Ventricular Septal Defect Indications for surgical closure of VSD include patients at any age with l

25、arge 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.第三十三頁(yè)，共四十七頁(yè)。先天性心臟病英文Congenital Cardiac Anomalies in Children Ventric

26、ular 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.第三十四頁(yè)，共四十七頁(yè)。先天性心臟病英文室間隔缺損封堵傘室間隔缺損封堵傘第三十五頁(yè)，共四十七頁(yè)。先天性心臟病英文室間隔缺損封堵室間隔缺損封堵第三十六頁(yè)，共

27、四十七頁(yè)。先天性心臟病英文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 ratio of 2:1O

28、ften associated w/ coarctation & VSD.第三十七頁(yè)，共四十七頁(yè)。先天性心臟病英文動(dòng)脈動(dòng)脈(dngmi)導(dǎo)管未閉導(dǎo)管未閉PDA第三十八頁(yè)，共四十七頁(yè)。先天性心臟病英文Patent Ductus ArteriosusQuestion:What TORCH infection is PDA associated with? Answer: Rubella第三十九頁(yè)，共四十七頁(yè)。先天性心臟病英文Patent Ductus ArteriosusHemodynamicsAs a result of higher aortic pressure, blood shu

29、nts L to R through 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.第四十頁(yè)，共四十七頁(yè)。先天性心臟病英文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.第四十一頁(yè)，共四十七頁(yè)。先天性心臟病英文Patent Ductus ArteriosusClinical Signs & SymptomsSmall PDAs are usually asymptomaticLarge PDAs can result in symptoms of CHF, growth res