儿童先天性心脏病各论PPT课件

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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)PulmonarybloodflowRightventricle(Hypertrophy)Leftatrium(Hypertrophy)Leftventri

3、cle(Hypertrophy)EjectionvolumeSystemicbloodflowShuntSystemicblood（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