chds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%):riskofaorticvalveprolapse－Muscular(20-30%):occuranyw

2、hereinthemuscularpartofseptumAnatomicTypesSubpulmonicMembranousMuscularSizeofVSD－Small:<5－Medium:5～10mm－Large:>10mmBeforePulmonaryhypertensionRightatriumRightventricle(Flow)Pulmonaryartery(expansion)PulmonarybloodflowRightventricle(Hypertrophy)Leftatrium(Hypertrophy)Leftventricle(

3、Hypertrophy)EjectionvolumeSystemicbloodflowShuntSystemicblood（Mixed）RightatriumLeftatriumAfterPulmonaryhypertensionLeftventriclePulmonaryhypertensionreversible(dynamic)Irreversible(pulmonaryvasculardisease)Eisenmeinger’ssyndromeShuntPulmonaryartery(expansion)Rightventricle(Hypertr

4、ophy)HemodynamicCharacteristicsSmallVSD－asymptomatic－Pan-systolicmurmurofgradeⅡ~Ⅳheardatleftsternalborderinthe3rd~4thintercostalspaces,radiatingoverprecordium(3~4LSBSMⅡ~Ⅳo)ClinicalManifestationsMedium～LargeVSD(symptoms)Pulmonaryplethora---RecurrentchestinfectionSystemicbloodflow--F

5、ailuretothrive(slowweightgain）Poorcardiacfunction:Cyanosiswhenright-to-leftshuntoccurs,mostlyduetoseverepulmonaryhypertensionClinicalManifestationsMedium～LargeVSDPoorcardiacfunction:－atinfancy：difficultywithfeeding,sweating,tachypnea,andhepatomegaly;－inolderchildren：dyspneaonexcursi

6、on,easyfatigability,palpitation,exerciseintoleranceClinicalManifestationsMedium～LargeVSD(signs)2～4LSBSMⅢ~ⅥoDMatapexduetolargebloodflowacrossnormalmitralvalve(relativemitralstenosis)P2increasedwithsplitCyanosiswithclubbinginlatestageClinicalManefestationElectrocardiogramSmallVSD:ECGu

7、suallynormalMedium~large－LVhypertrophywhenpulmonaryvascularresistanceisnormal－BothLV&RVhypertrophywhenpulmonaryhypertensionoccursduetoincreasedvascularresistance&increasedflow－RVhypertrophyinEisenmenger’ssyndromeChestX-raySmallVSD:maybenormalMedium~largeVSD:－Increasedvascularmarking

8、sinlungs－Heart/ches