先天性心脏病y.pptxVIP

先天性心脏病y第1页/共36页 Congenital Heart Disease(CHD)Shengjing HospitalPediatricsYu Xuexin第2页/共36页 IntroductionCHD is defined as an abnormality in circulatory structure or function that is present at birth, even if it is discovered much later. Incidence: 6.9 ‰ in alive neonatal.150,000 neonatal suffer from CHD in China per year.New treatments：catheterization、 development of operation, etc. 第3页/共36页 Object and RequestFamiliar with the etiology and classification of CHD.Master the hemodynamics 、clinical menifestation and diagnosis of common complications in VSD, ASD, PDA and TOF.第4页/共36页 EtiologyInternal factors： gene mutation or chromosome aberration.External factors: intraureteral infection 、ray、drug、metabolic diseases、intraureteral hypoxia.第5页/共36页 Classificationleft-to-right shunts Cyanosis maybe VSD、PDA、ASD right-to-left shunts non-shuntsCyanosis TOF、dislocation of main arteryPulmonary artery stenosis、aortic stenosisBased on shunt between right and left heart第6页/共36页 Patent ductus arteriosus PDACommon CHD in ClinicAtrial septal defect ASDVentricular septal defect VSDTetralogy of Fallot TOF1234第7页/共36页 Ventricular Septal Defect（VSD）1、membrane defect 85%2、muscular defect3、funnel defect 10%20-50％ VSD can close up without treatment.1、minor defect2、media defect3、major defectAnatomyMost common，30% in CHD。第8页/共36页 PathobiologyRV blood↑,pulmonary hypertension,persistent cyanosis(Eisenmenger syndrome)LV blood↓,body circulation ↓第9页/共36页 HemodynamicsBefore pulmonary hypertension RARV（blood↑）Pulmonary artery(dilation)Pulmonary circlation (congestion)RV(dilation)LA(hypertrophy)LV(hypertrophy)（射血量减少）body circulationBlood volume↓shunt第10页/共36页 HemodynamicsBody circulation（mixed blood）RALAPulmonary Artery dilationRV（Dilation)After pulmonary hypertensionLVDynamic PulmonaryhypertesionObstructive pulmonary hypertesionshunt第11页/共36页 Clinical Manifestation症状：分流量大时：生长迟缓、体重不增、消瘦、喂养困难、活动后乏力、气短、多汗、反复呼吸道感染、心衰。声音嘶哑（肺动脉压迫喉返神经）。体征：胸骨左缘3、4肋间Ⅲ-Ⅳ粗糙的全收缩期杂音，向四周传导，伴有震颤。 肺动脉第二音亢进。 二尖瓣