先天性心臟病英文

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 factorsEtiologyThe hea

2、lth 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.PreventionDoes the child have heart disease?Evaluating a child with a heart murmurIs it congenita

3、l heart disease?If it is congenital heart disease, what is the lesion?What is the severity of the lesion?Assessment of a child for the presence of heart diseaseMajor Systolic murmur garde III or more specially with a thrillDiastolic murmurCyanosisCongestive heart failureMinorSystolic murmur less tha

4、n grade III in intensity 2. Abnormal S23.Abnormal ECG4.Abnormal X-ray5.Abnormal BPCHDAcyanotic CHDCyanoticCHDL to R shuntsASD VSDPDA Obstructive lesions Pulmonic stenosisAortic stenosisCoarctation of aortaMitral regurgitationR to L shuntsTOFComplete TGATOFPDAVSDASD Four Congenital Cardiac Anomalies

5、in Children 返回Congenital Cardiac Anomalies in Children Atrial Septal Defect (ASD)ASD is the most frequent 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

6、 signs are easily confused with the cardiac findings in normal children. Congenital Cardiac Anomalies in Children Atrial Septal Defect Three types of atrial septal defect are classified on an anatomic basis: ostium secundum第二孔, sinus venosus, and ostium primum第一孔. All three types are associated with

7、 a left-to-right shunt at the atrial level and volume overwork of the right ventricle. 房間隔缺損房間隔缺損原發(fā)孔型位于房間隔的下部，緊鄰房室瓣。房間隔缺損繼發(fā)孔型亦稱中央型或卵圓孔型房間隔缺損靜脈竇型位置接近上腔靜脈房間隔缺損Congenital Cardiac Anomalies in Children Atrial Septal Defect Blood is chronically overcirculated through the lungs at normal intracardiac pres

8、sure 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 in the pulmonary arterial system, causing a wide splitting of the second heart sound, the other classic finding in

9、ASD. 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-ray usually reveals enlargement of the heart and signs of pulmonary overcirculat

10、ion, 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. Congenital Cardiac Anomalies in Children Atrial Septal Defect Two major complications of ASD are pulmonary arterial hypertension and

11、 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 irreversible plexiform arteriopathy叢狀的動(dòng)脈病, similar to that seen in Eisenmenger syndrome or primary

12、 pulmonary hypertension, is present. 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

13、 reduced, and the patient becomes cyanotic. 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 flut

14、ter 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 difficult to differentiate clinically between ASD and such conditions as cardiomyopathy and mitral valve disease.Congeni

15、tal 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 whom ASD

16、 can be clinically diagnosed exhibit at least this degree of left-to-right shunt. Congenital Cardiac Anomalies in Children Atrial Septal Defect Surgery is contraindicated 治療或處置不當(dāng) when pulmonary hypertension approaches the pressure level of the systemic circulation because in such patients the operat

17、ive mortality is high and the elevated pulmonary vascular resistance does not fall after surgery. Congenital Cardiac Anomalies in Children Atrial Septal Defect Nonsurgical closure using cardiac catheterization with an umbrellalike device has been accomplished in patients with defects less than 2 cm

18、in diameter, most of whom have been infants or small children. 房間隔缺損封堵傘房間隔缺損封堵過程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

19、are associated with a high mortality. In addition, the incidence of spontaneous closure of VSD is relatively high; closure occurs particularly often in infancy but also in later years. VSDVSDCongenital Cardiac Anomalies in Children Ventricular Septal Defect The VSD that do appear in adults as isolat

20、ed anomalies are usually less 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. Congenital Cardiac Anomalies in Children Ventricular Septal Defect In infants with a large VSD, medical management h

21、as two aims: to control 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.Congenital Cardiac Anomalies in Children Ventricular Septal Defect Indications for surgical

22、 closure 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.Congenital Cardiac

23、 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.室間隔缺損封堵傘室間隔缺損封堵Patent Ductus ArteriosusPDA Pers

24、istence 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 2:1Often associated w/ coarctation & VSD.動(dòng)脈導(dǎo)管未閉PD

25、APatent Ductus ArteriosusQuestion:What TORCH infection is PDA associated with? Answer: RubellaPatent Ductus ArteriosusHemodynamicsAs a result of higher aortic pressure, blood shunts 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.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 dise