（儿童先天性心脏病各论）ppt课件

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1、VentricularSeptalDefect（VSD）VentricularSeptalDefectThedisorderofembryologicaldevelopmentofinterventricularseptumMostcommonformofCHDinchildrenAccountingfor25％PositionofVSD：－Membranous(60-70%):thecommonestlocationt－Subpulmonic(3-6%):riskofaorticvalvepro

2、lapse－Muscular(20-30%):occuranywhereinthemuscularpartofseptumAnatomicTypesSubpulmonicMembranousMuscularSizeofVSD－Small:<5－Medium:5～10mm－Large:>10mmBeforePulmonaryhypertensionRightatriumRightventricle(Flow)Pulmonaryartery(expansion)Pulmonarybloodflow

3、Rightventricle(Hypertrophy)Leftatrium(Hypertrophy)Leftventricle(Hypertrophy)EjectionvolumeSystemicbloodflowShuntSystemicblood（Mixed）RightatriumLeftatriumAfterPulmonaryhypertensionLeftventriclePulmonaryhypertensionreversible(dynamic)Irreversible(pulm

4、onaryvasculardisease)Eisenmeinger’ssyndromeShuntPulmonaryartery(expansion)Rightventricle(Hypertrophy)HemodynamicCharacteristicsMedium～LargeVSDPoorcardiacfunction:－atinfancy：difficultywithfeeding,sweating,tachypnea,andhepatomegaly;－inolderchildren：dysp

5、neaonexcursion,easyfatigability,palpitation,exerciseintoleranceClinicalManifestationsMedium～LargeVSD(signs)2～4LSBSMⅢ~ⅥoDMatapexduetolargebloodflowacrossnormalmitralvalve(relativemitralstenosis)P2increasedwithsplitCyanosiswithclubbinginlatestageClinica

6、lManefestationElectrocardiogramSmallVSD:ECGusuallynormalMedium~large－LVhypertrophywhenpulmonaryvascularresistanceisnormal－BothLV&RVhypertrophywhenpulmonaryhypertensionoccursduetoincreasedvascularresistance&increasedflow－RVhypertrophyinEisenmenger’ssyn

7、dromeChestX-raySmallVSD:maybenormalMedium~largeVSD:－Increasedvascularmarkingsinlungs－Heart/chestratio:>0.55－EnlargementofLVand/orRV－Dilatedmainpulmonaryarterysegment－SmalleraortainsizeEchocardiogramDisplaypositionandsizeofthedefectDisplayshuntingMeasu

8、repressuregradientDisplaysizeofchambersandvessels:－EnlargedLA,LVand/orRVEchocardiogram2DE&CDEdisplaysVSDPrognosis&ComplicationsAsymptomatic30~50％closespontaneouslyby2yearsofageCongestiveheartfailurePulmonaryhypertensionInfundibulumstenosis(漏斗部