先天性心脏病英文

先天性心脏病英文第1页，课件共47页，创作于2023年2月1.Geneticfactor(internalfactor):Geneticandchromosomalaberrations2.Environmentalfactor(externalfactor):Highaltitude4.Inheritedfactor3.Otherrelatedfactors:Viralinfectionsofpregnancy,Motherswhoarediabetic,alcoholicsordrugaddictiveDrugsandmetabolicfactorsEtiology第2页，课件共47页，创作于2023年2月Thehealthprotectionofpregnantwomanshouldbeenhanced.Highriskfactors,suchasdrugs,radiation,viralinfection,et.shouldbeavoided.SuitdosageFolicAcidshouldbefilledupinearlypregnancystage.Prevention第3页，课件共47页，创作于2023年2月Doesthechildhaveheartdisease?EvaluatingachildwithaheartmurmurIsitcongenitalheartdisease?Ifitiscongenitalheartdisease,whatisthelesion?Whatistheseverityofthelesion?第4页，课件共47页，创作于2023年2月Assessmentofachildforthepresenceofheartdisease

MajorSystolicmurmurgardeIIIormorespeciallywithathrillDiastolicmurmurCyanosisCongestiveheartfailureMinorSystolicmurmurlessthangradeIIIinintensity2.AbnormalS23.AbnormalECG4.AbnormalX-ray5.AbnormalBP第5页，课件共47页，创作于2023年2月CHDAcyanoticCHDCyanoticCHDLtoRshuntsASDVSDPDAObstructivelesionsPulmonicstenosisAorticstenosisCoarctationofaortaMitralregurgitationRtoLshuntsTOFCompleteTGA第6页，课件共47页，创作于2023年2月TOFPDAVSDASDFourCongenitalCardiacAnomaliesinChildren返回第7页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect(ASD)ASDisthemostfrequentcongenitallesionofmajorimportanceinadults.Itisoftennotdiagnoseduntiladultlife,eveninthepresentera,becauseitrarelyproducessymptomsinchildhoodandtheassociatedphysicalsignsareeasilyconfusedwiththecardiacfindingsinnormalchildren.第8页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectThreetypesofatrialseptaldefectareclassifiedonananatomicbasis:ostiumsecundum第二孔,sinusvenosus,andostiumprimum第一孔.Allthreetypesareassociatedwithaleft-to-rightshuntattheatriallevelandvolumeoverworkoftherightventricle.第9页，课件共47页，创作于2023年2月第10页，课件共47页，创作于2023年2月房间隔缺损第11页，课件共47页，创作于2023年2月房间隔缺损—原发孔型位于房间隔的下部，紧邻房室瓣。第12页，课件共47页，创作于2023年2月房间隔缺损—继发孔型亦称中央型或卵圆孔型第13页，课件共47页，创作于2023年2月房间隔缺损—静脉窦型位置接近上腔静脉第14页，课件共47页，创作于2023年2月房间隔缺损第15页，课件共47页，创作于2023年2月第16页，课件共47页，创作于2023年2月第17页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Bloodischronicallyovercirculatedthroughthelungsatnormalintracardiacpressurelevels.Increasedflowthroughthepulmonaryvalveproducesacharacteristicpulmonarysystolicejectionmurmur.Thepulmonaryvalvecloseslatebecauseofthereducedimpedance阻抗

inthepulmonaryarterialsystem,causingawidesplittingofthesecondheartsound,theotherclassicfindinginASD.第18页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectThesplittingremainsrelativelyfixedinrelationtorespiration;

theaorticandpulmonarycomponentsremainaudiblysplitduringexpiration.Achestx-rayusuallyrevealsenlargementoftheheartandsignsofpulmonaryovercirculation,suchasalargepulmonarytrunkandincreasedpulmonaryvascularmarkings.Therelativeseverityoftheseconditionsreflectsthesizeoftheleft-to-rightshunt.

第19页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectTwomajorcomplicationsofASDarepulmonaryarterialhypertensionandrightventricularfailure.Pulmonaryarterialhypertensioniscausedbyelevatedpulmonaryvascularresistance;itdevelopsafteradolescenceinabout15percentofcases.Inthemostseverecases,anirreversibleplexiformarteriopathy丛状的动脉病,similartothatseeninEisenmengersyndromeorprimarypulmonaryhypertension,ispresent.第20页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Asaresultofpulmonaryhypertension,theleft-to-rightshuntfirstdecreases,thenbecomesbidirectional,andfinallyreverses;arightventricularpressureoverloaddevelops,pulmonarybloodflowisreduced,andthepatientbecomescyanotic.

第21页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Rightventricularfailuredevelopsasaresultoflong-standingvolumeoverload;itusuallyaffectspatientsolderthan40years.Rightventricularfailureisusuallyassociatedwithatrialflutterorfibrillationandisoftenlinkedtotricuspidregurgitation.Eventually,asyndromeofright-andleft-sidedcongestiveheartfailuredevelops,andatthisstage,itmaybedifficulttodifferentiateclinicallybetweenASDandsuchconditionsascardiomyopathyandmitralvalvedisease.第22页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectSurgicalclosureofASDisaverysafeandhighlyeffectiveprocedure.Prophylacticsurgeryisthereforeindicatedinanypatientinwhomtheratioofpulmonarybloodflowtosystemicbloodflowis2:1orgreater.NearlyallpatientsinwhomASDcanbeclinicallydiagnosedexhibitatleastthisdegreeofleft-to-rightshunt.第23页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefect

Surgeryiscontraindicated治疗或处置不当whenpulmonaryhypertensionapproachesthepressurelevelofthesystemiccirculationbecauseinsuchpatientstheoperativemortalityishighandtheelevatedpulmonaryvascularresistancedoesnotfallaftersurgery.第24页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenAtrialSeptalDefectNonsurgicalclosureusingcardiaccatheterizationwithanumbrellalikedevicehasbeenaccomplishedinpatientswithdefectslessthan2cmindiameter,mostofwhomhavebeeninfantsorsmallchildren.

第25页，课件共47页，创作于2023年2月房间隔缺损封堵伞第26页，课件共47页，创作于2023年2月房间隔缺损封堵过程第27页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefect(VSD)VSDisthemostcommoncongenitalcardiacanomalyininfants.ItisrarelyseeninadultsbecausesubstantialVSDthatarenotcorrectedsurgicallyareassociatedwithahighmortality.Inaddition,theincidenceofspontaneousclosureofVSDisrelativelyhigh;closureoccursparticularlyoftenininfancybutalsoinlateryears.第28页，课件共47页，创作于2023年2月第29页，课件共47页，创作于2023年2月VSD第30页，课件共47页，创作于2023年2月VSD第31页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectTheVSDthatdoappearinadultsasisolatedanomaliesareusuallylessthan1cmindiameter.Becausetheopeningisquitesmall,normalsystolicpressurecanbemaintainedintherightventricleandinthepulmonaryartery.第32页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectIninfantswithalargeVSD,medicalmanagementhastwoaims:tocontrolheartfailureandtopreventthedevelopmentofpulmonaryvasculardisease.Therapeuticmeasuresareaimedatthecontrolofheartfailuresymptomsandthemaintenanceofnormalgrowth.第33页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefect

IndicationsforsurgicalclosureofVSDincludepatientsatanyagewithlargedefectsinwhomclinicalsymptomsandfailuretothrivecannotbecontrolledmedically.Infantsbetween6and12moofagewithlargedefectsassociatedwithpulmonaryhypertension,evenifsymptomsarecontrolledbymedication.第34页，课件共47页，创作于2023年2月CongenitalCardiacAnomaliesinChildrenVentricularSeptalDefectSurgicalclosureisusuallyundertakentopreventinfectiveendocarditis.Theincidenceofthiscomplicationisnotwellestablished,butsurgeryappearstobehighlyeffectiveasaprophylactic

measure.第35页，课件共47页，创作于2023年2月室间隔缺损封堵伞第36页，课件共47页，创作于2023年2月室间隔缺损封堵第37页，课件共47页，创作于2023年2月PatentDuctusArteriosusPDA–PersistenceofthenormalfetalvesselthatjoinsthePAtotheAorta.Normallyclosesinthe1stwkoflife.Accountsfor10%ofallCHD,seenin10%ofothercongenitalhrtlesionsandcanoftenplayacriticalroleinsomelesions.Female:Maleratioof2:1Oftenassociatedw/coarctation&VSD.第38页，课件共47页，创作于2023年2月动脉导管未闭PDA第39页，课件共47页，创作于2023年2月PatentDuctusArteriosusQuestion: WhatTORCHinfectionisPDAassociatedwith?•

Answer: Rubella第40页，课件共47页，创作于2023年2月PatentDuctusArteriosusHemodynamicsAsaresultofhigheraorticpressure,bloodshuntsLtoRthroughtheductusfromAortatoPA.Extentoftheshuntdependsonsizeoftheductus&PVR:SVR.SmallPDA,pressuresinPA,RV,RAarenormal.第41页，课件共47页，创作于2023年2月PatentDuctusArteriosusHemodynamicsLargePDA,PApressuresareequaltosystemicpressures.Inextremecases70%ofCOisshuntedthroughtheductustopulmonarycirculation.Leadstoincreasedpulmonaryvasculardisease.第42页，课件共47页，创作于2023年2月PatentD