(精选)先心病 (57p)教学课件.pptVIP

Part I Fetal Circulation, ASD, VSD ;Fetal Circulation (Pulmonary);Fetal Circulation (Pulmonary);Fetal Circulation(Pulmonary);Fetal Circulation (Systemic);Problems with shunts;Atrial Septal Defect;Atrial Septal Defect;Atrial Septal Defect;Atrial Septal Defect;Atrial Septum ;Atrial Septum;Symptoms;Signs;CXR;Ostium Secundum ASD;Atrial Septal Defect;Calculation for PVR;Calculation for SVR;Shunt Calculation;ASD;Atrial Septal Defect: CCS Consensus Conference 2001;The initial workup at a minimum should include: A through clinical assessment ECG CXR TTE/Doppler evaluation TEE to prove the existence of ASD, better define location, shape and size, assess pulmonary venous connections, and evaluate cardiac valves (if not provided by TTE). TEE is essential for determination of suitability for device closure Resting oxygen saturations;The diasgnostic workup may require: Right heart Cath (PAP and PVR determination, to assess pulmonary vascular reactivity or to delineate APVC) Coronary angio (in high risk pts or in pts 40 y if surgical repair is planned) MRI to prove existence of ASD or to assess pulmonary venous connections if doubt remains after other imaging modalities. Also can calculate Qp:Qs Oxygen saturation with exercise if there is any suggestion of PHTN. Do not exercise if there is severe PHTN or resting oxygen Sat is 85% Open lung Bx should be considered when the reversibility of PHTN is uncertain from hemodynamic data;Indications for intervention: In presence of PHTN (PAP2/3 SABP, or PVR2/3 SVR), and a net L to R shunt of 1.5 or greater, or evidence of PA reactivity when challenged with a pulmonary vasodilator (eg NO, prostaglandins), or lung Bx evidence that PA changes are potentially reversible (Heath Edwards grade II-III or less) A cryptogenic CVA/TIA in presence of small ASD or PFO, and a R to L shunting demonstrated on contrast echo (softer indication) Closure should be done before age 25 for mortality benefit and before age 40 for arrhythmia benefit;Heath-Edwards