循环外科课件：先天性心脏病

1、心外科心外科 田海田海Cardiovascular Surgery TIAN HAoctor_Congenital Heart Disease先天性心脏病先天性心脏病 Congenital heart diseases1 Introduction of CHD2Introduction of CHDRatio of embryo abnormality is no less than 12 % .Ratio of congenital heart disease is about 0.8 %.Etiology When embryo heart is growing,

2、 any factors affect the growth of heart and lead to the pause or abnormity of the heart growth are the reason of CHD. in a word, etiology of congenital heart disease is the interaction of environment and genetic.Intrauterine infectionIntrauterine hypoxiaOverdose radiationfolate deficiency of pregnan

3、t womenChronic metabolic disease drugsSymptomsSymptoms For severe hypoxia patients, they always be syncope when feeding, crying and excrement;For cyanotic patients, they will be growth retardation and prefer to squat;For mild patients, they do not have any symptoms;For severe patients, they are diff

4、icult to be fed. Emesis and sweaty;If the enlarged left atrium compress recurrent laryngeal nerve, the patients will be hoarseness, short breath and cough;Physical SignsPhysical SignsAuscultation area cardiac murmur。auscultation Growth retardation, cyanotic or not；inspectionTremor of precardium；touc

5、h Enlargement of heart using；percussAccessory examinationAccessory examinationX rayX ray；Electrocardiogram (ECG)；Ultrasonic cardiogram (UCG);Laboratory examinationsBlood gas analysis, blood routine examination, urine routine test, biochemical series, etc.TreatmentTreatmentSurgical therapy Surgical t

6、herapy Interventional therapyDrug therapyCongenital heart diseasesSimple Classification of CHDSimple Classification of CHDCyanotic CHD TOF, DORV etc.Non-cyanotic CHDASD, VSD, etc.123Complex cyanotic defects (“mixing defects”)4Pure obstructive lesionsSimple L-R shuntR-L shunt (Cyanotic defects with d

7、ecreased PBF)Classification of Congenital Heart Diseases1Pulmonary stenosis (PS)Mitral stenosis (MS)23Left ventricular outflow tract obstruction (LVOTO)Coarctation of aorta (CoA)45Interrupted aortic arch (IAA)Pure Obstructive LesionsPulmonary Stenosis (PS)v A form of RV outflow obstruction in which

8、stenosis is usually valvar or both valvar & infundibular or only infundibularv Indications of intervention Critical PS in neonate : indicated with diagnosis PS in infants and children : indicated with signs & pressure gradient over 50mmHg Surgical treatment is not indicated with mild stenosi

9、s.Pulmoary StenosisPS membranous typePoststenotic dilatation1Patent ductus arteriosus (PDA)Atrial septal defect (ASD)23Ventricular septal defect (VSD)Atrioventricular septal defect (AVSD)45Aortopulmonary window (AP window)Simple L-R ShuntPatent Ductus Arteriosus (PDA)v Open communication usually bet

10、ween upper descending aorta and proximal portion of LPAv Surgical indications Significant PDA : indicated after 1st month Prophylactic closure : 6 -12 monthsPDAPDA LigationAtrial Septal Defect (ASD)q A hole of variable size in the atrial septum and is most common cardiac malformation with various lo

11、cation of defect: fossa ovalis, ostium primum, ostium secundum, coronary sinus, subcaval, postcavalq Indication: ASD with RV volume overload (Qp/Qs1.5 or 2.0) Optimal age: 1-2 years to avoid RV volume overloadASD - Surgical AnatomyPatch Closure of Secundum ASDVentricular Septal Defect (VSD)v A hole

12、(or multiple holes) between L & R ventriclev Surgical Indication Symptomatic large VSD : indication of operation Moderate sized VSDs (Qp/Qs 3.0) with few signs: observation in infancy Small VSDs (Qp/Qs 1.5) : not indicated, risk of bacterial endocarditis Subarterial type : early repair before ch

13、ildhoodTypes of VSDVSD Patch Closure1Tetralogy of Fallot (TOF)TOF with Pulmonary Atresia (PA)23PA with intact ventricular septum (IVS)Ebsteins anomaly45Tricuspid atresia (TA)R-L ShuntTetralogy of Fallot (TOF)v Characterized by underdevelopment of RV infundibulum with anterior and left-ward displacem

14、ent of conal (supracristal) septumv Diagnosis is an indication of operation Symptomatic complicated in early life : Early total correction or initial shunt (1-2 mo) & total correction (1 year) Asymptomatic uncomplicated : Total correction at 3-24 moTOFAortaPulmonaryArteryVentricular SeptumTOF RV

15、OT Patch Widening1Double outlet right ventricle (DORV)Univentricular heart23Transposition of great arteries (TGA)Total anomalous pulmonary venous connection (TAPVC)45Truncus arteriosusComplex Cyanotic LesionsHypoplastic left heart syndrome (HLHS)6Double Outlet Right Ventricle (DORV)v A congenital ca

16、rdiac anomalies in which both great arteries rise wholly or in large part from the RV. v Diagnosis is an indication of operationv Surgical options Simple DORV with subaortic VSD : repair by 6 mo DORV with subpulmonic VSD (Taussig-Bing heart) : Arterial switch operation within 1 mo DORV with PS : REV or Rastelli op. at 3-5 years DORV with noncommitted VSD : VSD enlargement & intraventricular tunnel Fontan operationTypes of DORVDORV with PS REV O