医学课件先心病室间隔缺损

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1、AtrialSeptalDefectKendraMarsh,MDDivisionofCardiology,UICFellowEmbryologyGestationalWeek4GestationalWeek4-6•Athin,crescentshapedwedgeoftissueof(septumprimum)growstowardsandfuseswithendocardialcushions.Theremainingopeningiscalledtheostuimprimum.•Asthese

2、ptumprimumisgrowingdown,theendocardialcushionsfuseandtheostiumprimumiseventuallyobliterated.EmbryologyTheinteratrialseptumformsduringthefirstandsecondmonthsoffetaldevelopment.StageIistheformationoftheseptumprimum.Theseptumprimumwallsoffacrescent-shape

3、dportionoftheholebetweentherightandleftatria.Foramenprimum(alsocalledtheostiumprimum)staysopenTheremainingpartoftheopeningbetweentherightandleftatriaisclosedbytheseptumsecundum.The2tissuelayersoverlaplikeaflap,allowingbloodflowtocontinueduringfetallif

4、e.Changesincirculationatbirth,closestheflappermanently.AnatomyandPhysiologyExtendsfromcavo-atrialjunctionwithsuperiorandinferiorvenacavaeEndsneartheatrio-ventricularcanalnearthetricuspidvalveOstiumSecundumMostcommontypeofASDCenteroftheseptumbetweenthe

5、rightandleftatriumVariantofthistypeofASDiscalledaPatentForamenOvale(PFO)whichisverysmall.OstiumPrimumNextmostcommontypeLocatedinthelowerportionoftheatrialseptum.Willoftenhaveamitralvalvedefectassociatedwithitcalledamitralvalvecleft.Amitralvalvecleftis

6、aslit-likeorelongatedholeusuallyinvolvestheanteriorleafletofthemitralvalve.SinusVenosusLeastcommontypeofASDLocatedintheupperportionoftheatrialseptum.AssociationwithanabnormalpulmonaryveinconnectionFourpulmonaryveins,twofromtherightlungandtwofromthelef

7、tlung,normallyreturnredbloodtotheleftatrium.UsuallywithasinusvenosusASD,apulmonaryveinfromtherightlungwillbeabnormallyconnectedtotherightatriuminsteadoftheleftatrium.Thisiscalledananomalouspulmonaryvein...asd-veno.jpgForamenOvaleRemnantoffetalcircula

8、tionBehaveslikeflapvalveOpensduringincreasedintra-thoracicpressureIncidenceandPrevalenceoneofthemostcommoncongenitalheartdefectsseeninpediatriccardiology7-10%ofallpatientswithcongenitalheartdiseaseTwiceasfrequentinfemalesthanmalesPresentationF