成人先心病（48p）

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1、AdultCongenitalHeartDisease“Common”ComplexLesionsJeffreyD.Solomon,MDNovember14&19,2008ObjectivesDescribethechangingprofileofACHDDescribethechallengesinthetransferofcarefrompediatrictoadultpractitionersReviewthedevelopmentoftheheartDescribetheanatomy,naturalhisto

2、ry,surgicalrepair,andcommonadultpresentationsoftetralogyofFallot,transpositionofthegreatarteries,andhypoplasticleftheartsyndromeACHDAgrossstructuralabnormalityoftheheartorintrathoracicgreatvesselsthatisactuallyorpotentiallyoffunctionalsignificanceOverallincidenc

3、e:75ofevery1000livebirthsACHDAgrossstructuralabnormalityoftheheartorintrathoracicgreatvesselsthatisactuallyorpotentiallyoffunctionalsignificanceOverallincidence:75ofevery1000livebirthsIncidenceofmoderateandsevereCHD:8ofevery1000livebirthsACHDAgrossstructuralabno

4、rmalityoftheheartorintrathoracicgreatvesselsthatisactuallyorpotentiallyoffunctionalsignificanceOverallincidence:75ofevery1000livebirthsIncidenceofmoderateandsevereCHD:8ofevery1000livebirthsOver90%ofchildrensurvivetoadulthood20,000operationsforCHDintheUSeachyearO

5、ver1millionadultsintheUSwithCHDTransfer/TransitionofCareChallengesComplexCHDisseldomcuredPatientshaveapoorunderstandingTimingoftransitionLackofexposureamongadultcardiologistsTransfer/TransitionofCare32ndBethesdaConference(2000)RegularevaluationatanACHDcenterHeal

6、thcarepassportStructuredtransfer/transitionplanCo-managementwithcardiologistshavingundergoneadvancedtrainingTetralogyofFallot(TOF)NamedbyEtienne-LouisArthurFallotin1888Approximately10%ofallcomplexCHDSingledevelopmentalerroroftheterminalportionofthespiraltruncoco

7、nalseptumFourdistinctcomponents:subpulmonicstenosis,VSD,overridingaorta,andRVhypertrophyOftenaccompaniedbyotheranomaliesNaturalHistoryDependsonseverityofRVOTobstructionCyanosisandexertionaldyspnea“Tetspell”profoundcyanoticepisodesecondarytoaugmentedright-to-left

8、shuntWithoutsurgicalcorrection,patientsdopoorlySurgicalRepairLongestsurgicalhistory/moststudiedoutcomesPalliativesurgicalshuntsSurgicalRepairLongestsurgicalhistory/mo