先天性心脏病个论英文稿课件

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1、Commonproblems(CHD)Atrialseptaldefect………….ASDVentricularseptaldefect……VSDPatentductusarteriosus…….PDATetralogyofFallot…………..TOFCommonproblems----1AtrialseptaldefectASDASD--historyLeornardodaVincidescribedthepatentforamenovaleintheearly1500s“Ihavefoundaperforatingchannelfromleftauricletoright

2、auricle”In1875,KarlvonRokitanskyprovidedasuperbaccountofpathologicalanatomyoftheatrialseptaldefecttogetherwithitsembryologicalbasisHeevendistinguishedbetweenprimumandsecundumdefectsASD--summaryAccountsfor20%ofCHDTwotothreetimesmorecommoninwomenUnoperatedsurvivalbeyondage40-50yisnomorethan50%

3、withasubsequentincreaseinmortalityat6%peryearafterage50yASD--classificationOstiumsecundumdefectMostcommon(60-70%)MidportionofIASIsolateddefectassociatedwithMVPOstiumPrimumdefect15-20%ofASDsInferolateralportionofIASFrequentlyassociatedwithcleftinanteriorMVleafletandMRASD--classificationSinusV

4、enosusdefect5-10%ofASDsSuperiorandposteriorinrelationtofossaovalisAlmostalwaysassociatedwithPAPVDintoRAorIVC/SVCCoronarysinusdefect<5%ofcasesLocatedinferiorandslightlyanteriortothefossaovalisCommonlyassociatedwithotherdefects(egAVSD)AlsoassociatedwithleftsidedSVC原发隔septumprimumSecondumOstium

5、Ostiumprimum继发隔SecondumseptumOvalforamenEndocardiumcushionseptumprimumOstiumprimumSecondumseptumSecondumOstium原发房隔原发孔继发房隔原发房隔继发孔继发房隔AtrialseptationASD--HemodynamicchangesIVC,SVCRAoverloadRVdialatedPAdialatedPulmonarycongestionPulmonaryveinsLALVvolumedecreasedAorticvolumedecreasedSystemicvolu

6、medecreasedASDHemodynamicchangesinASDLRshuntPulmonarycirculationSystemiccirculation2.CardiacvolumeRA,RV3.PulmonaryHypertensionEisenmengersyndromeASDLVRVLARAWhytheleftatriumisnoenlargewithASD？ASDclinicalmanifestationClinicalsymptoms：Lightly：asymptomaticPulmonarycirculationhyperemia：repeatpulm

7、onaryinfectionSystemiccirculationhyporemia：anergy、hidrosistachypneaaftermovement、delayedgrowthPotentialcyanotic：cryingorheartfailureinfectiveendocarditis：fewASDclinicalmanifestationSignsInspection：bulge—precordialregionPalpation：goodturn—apexbeatPe