先天性心脏病个论英文稿.ppt

Common problems(CHD) Atrial septal defect………….ASD Ventricular septal defect……VSD Patent ductus arteriosus…….PDA Tetralogy of Fallot…………..TOF Common problems----1 Atrial septal defect ASD ASD--history Leornardo da Vinci described the patent foramen ovale in the early 1500s “I have found a perforating channel from left auricle to right auricle” In 1875, Karl von Rokitansky provided a superb account of pathological anatomy of the atrial septal defect together with its embryological basis He even distinguished between primum and secundum defects ASD--summary Accounts for 20% of CHD Two to three times more common in women Unoperated survival beyond age 40-50y is no more than 50% with a subsequent increase in mortality at 6% per year after age 50y ASD-- classification Ostium secundum defect Most common (60-70%) Mid portion of IAS Isolated defect associated with MVP Ostium Primum defect 15-20% of ASDs Inferolateral portion of IAS Frequently associated with cleft in anterior MV leaflet and MR ASD-- classification Sinus Venosus defect 5-10% of ASDs Superior and posterior in relation to fossa ovalis Almost always associated with PAPVD into RA or IVC/SVC Coronary sinus defect 5% of cases Located inferior and slightly anterior to the fossa ovalis Commonly associated with other defects (eg AVSD) Also associated with left sided SVC 原发隔septum primum septum primum ASD-- Hemodynamic changes ASD clinical manifestation Clinical symptoms： Lightly： asymptomatic Pulmonary circulation hyperemia：repeat pulmonary infection Systemic circulation hyporemia ：anergy、hidrosis tachypnea after movement、 delayed growth Potential cyanotic：crying or heart failure infective endocarditis：few ASD clinical manifestation Signs Inspection：bulge — precordial region Palpation：good turn—apex beat Percussion：expand —border of cardiac dullness Auscultation：next Clinical presentations-auscultation Grade II-Ⅲ systolic ejection murmur at le