小儿心脏病的治疗

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1、ApproachtochildwithheartdiseasePushpaRajSharmaProfessorofChildHealthInstituteofMedicineDiseasesofheartPericardiumMyocardiumEndocardiumBloodvesselsPrevalenceCongenitalCyanotic:22%Acyanotic:68%VSD25%ASD6%PDA6%TOF5%PS5%AS5%AcquiredKawasakidiseaseRheumaticTubercularColla

2、genCeylonMedJ2001Sep;46(3):96-8;IndianJPediatr.2001Aug;68(8):757-7Nelson’sTextbookofpediatrics;17ed.CommonacyanoticlesionsVentricularseptaldefectsAtrialseptaldefectsAtrio-ventricularseptaldefectsPatentductusarteriosusTruncusarteriosusPulmonarystenosisAorticstenosisMi

3、tralstenosis/incompetenceCoarctationofaortaTricuspidregurgitationCommonCyanoticLesionsDecreasedflow1.TetralogyofFallot2.TricuspidAtresia3.SeverePulmonicStenosis4.Ebstein’sanamolyIncreasedFlow5.Transpositionofgreatvessles6.VSDwithpulmonaryatresiaCommonLesionsproducing

4、cyanosis7.TruncusArteriosus8.Hypoplasticleftheart9.Singleventricle10.TAPVRwithinfradiaphragmaticobstructionPresentingcomplaints/signsFailuretothriveExerciseintolerenceEasyfatigabilityChestindrawingSweatingduringfeedingBluishspellsFeverwithrigorPalpitationConvulsionFa

5、stbreathingOedemaHepatomegaly,spleenomegalyClubbingCyanosisFocalneurologicallesionOtherorgandefectsChromosomalanomaliesCyanosis:isitacardiaccauseorlungcauseHyperoxiatestNeonateswithcyanoticcongenitalheartdiseaseusuallydonothavesignificantlyraisedarterialPao2duringadm

6、inistrationof100%oxygen.VentricularDefectSmallVSDAsymptomaticAloud,harsh,orblowingholosystolicmurmur.LargeVSDdyspnea,feedingdifficulties,poorgrowth,profuseperspiration,recurrentpulmonaryinfections,andcardiacfailureinearlyinfancy.80%Syndromesassociatedwiththisconditio

7、nVSD:ECGisnormalbutmayshowrightventricularhypertrophy,ifpresentindicatesdefectislargeandpresenceofpulmonaryhypertensionorpulmonrystenosisVentricularSeptalDefect(VSD)LargeVSD:Thepresenceofrightventricularhypertrophy,olegeimiclungfields(pulmonaryhypertensionoranassocia

8、tedpulmonicstenosis),grosscardiomegalywithprominenceofbothventricles,theleftatrium.SmallVSDs,thechestradiographisusuallynormalVentr