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ID:17964362
大小:4.38 MB
页数:58页
时间:2018-09-11
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1、VentricularSeptalDefect(VSD)1VentricularSeptalDefectThedisorderofembryologicaldevelopmentofinterventricularseptumMostcommonformofCHDinchildrenAccountingfor25%2PositionofVSD:-Membranous(60-70%):thecommonestlocationt-Subpulmonic(3-6%):riskofaorticvalveprolapse-Muscular(20-30%):occuran
2、ywhereinthemuscularpartofseptumAnatomicTypesSubpulmonicMembranousMuscular3SizeofVSD-Small:<5-Medium:5~10mm-Large:>10mm4BeforePulmonaryhypertensionRightatriumRightventricle(Flow)Pulmonaryartery(expansion)PulmonarybloodflowRightventricle(Hypertrophy)Leftatrium(Hypertrophy)Leftventri
3、cle(Hypertrophy)EjectionvolumeSystemicbloodflowShuntSystemicblood(Mixed)RightatriumLeftatriumAfterPulmonaryhypertensionLeftventriclePulmonaryhypertensionreversible(dynamic)Irreversible(pulmonaryvasculardisease)Eisenmeinger’ssyndromeShuntPulmonaryartery(expansion)Rightventricle(Hyp
4、ertrophy)HemodynamicCharacteristics5SmallVSD-asymptomatic-Pan-systolicmurmurofgradeⅡ~Ⅳheardatleftsternalborderinthe3rd~4thintercostalspaces,radiatingoverprecordium(3~4LSBSMⅡ~Ⅳo)ClinicalManifestations6Medium~LargeVSD(symptoms)Pulmonaryplethora---RecurrentchestinfectionSystemicbloodfl
5、ow--Failuretothrive(slowweightgain)Poorcardiacfunction:Cyanosiswhenright-to-leftshuntoccurs,mostlyduetoseverepulmonaryhypertensionClinicalManifestations7Medium~LargeVSDPoorcardiacfunction:-atinfancy:difficultywithfeeding,sweating,tachypnea,andhepatomegaly;-inolderchildren:dyspneaon
6、excursion,easyfatigability,palpitation,exerciseintoleranceClinicalManifestations8Medium~LargeVSD(signs)2~4LSBSMⅢ~ⅥoDMatapexduetolargebloodflowacrossnormalmitralvalve(relativemitralstenosis)P2increasedwithsplitCyanosiswithclubbinginlatestageClinicalManefestation9ElectrocardiogramSmal
7、lVSD:ECGusuallynormalMedium~large-LVhypertrophywhenpulmonaryvascularresistanceisnormal-BothLV&RVhypertrophywhenpulmonaryhypertensionoccursduetoincreasedvascularresistance&increasedflow-RVhypertrophyinEisenmenger’ssyndrome10ChestX-raySmallVSD:maybenormalMedium~largeVSD:-Increasedvasc
8、ularmarkingsinlungs
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