先天性心脏病教材幻灯片.pptVIP

2006/4/4 兒童心臟科 張文王醫師 * Congenital Heart Disease 先天性心臟病 行政院衛生署 彰化醫院 兒童心臟科 Congenital Heart Disease Acyanotic congenital heart disease The Left-to-Right shunt lesions ASD, PAPVR, ECD, VSD, PDA, AP window defect, Coronary A-V fistula… The Obstructive lesions PS with IVS, DCRV with PS, PPS, AS, CoA, Congenital MS, Regurgitant lesions PV insufficiency, MR, TR Congenital Heart Disease Cyanotic Congenital Heart Disease Lesions associated with decreased pulmonary blood flow TOF, PA with/without VSD, TA, DORV with PS, TGA with VSD, Ebstein anomaly… Lesions associated with increased pulmonary blood flow d-TGA, l-TGA, DORV without PS, TAPVR, Truncus Arteriosus, single ventricle, Hypoplastic Left Hear syndrome, asplenia/polysplenia syndrome… Congenital Heart Disease---VSD VSD is the most common cardiac malformation and accounts for 25% of congenital heart disease. Membranous type : most , anterior to the septal leaflet of the TV Supracristal type : superior to the crista supraventricularis , less common but may impinge on an aortic sinus caused AR Subpulmonary type : between the crista and papillary muscle of the conus , associated with PS Muscular type : in the midportion or apical region of septum, single or multiple (Swiss cheese septum) Congenital Heart Disease---VSD Congenital Heart Disease---VSD Pathophysiology Determine the L-to-R shunt magnitude Qp/Qs: The size of the VSD : restrictive VSD ( 0.5 cm2), nonrestrictive VSD (1.0 cm2) – RV and LV pressure equlized The level of the ratio of pul to systemic vascular resistance : after birth, PVR remain higher. Because of normal involution of the media of small pulmonary arterioles, the size of shunt increases. Qp/Qs 1.75:1 shunt is small, but 2:1 left side volume overload occurs, as dose RV and PAH Congenital Heart Disease---VSD Congenital Heart Disease---VSD Clinical Manifestations Vary according to the size of the defect and pulmonary blood flow and pressure Small : asymptomatic, PE revealed a loud harsh or blowing