先心病(39p).pptVIP

Case Presentation cont’d * * * * * Hyperoxia test- Cardiac or Pulmonary? 50-150mm Hg Truncus Arteriosus ( No restricted pulmonary blood flow)? 50 mm Hg Tetralogy of Fallot, Tricuspid Atresia ( Reduced pulmonary flow)? 150 mm Hg Cardiac disease or PPHN (SHUNT) 150mm Hg Pulmonary disease (V/Q mismatch)? On 100% oxygen paO2 Case Presentation Case Presentation History: 6 week old male with 2 days of clear, nasal congestion, no fever Gets bluish after feeding or crying Previously well, full-term baby The family history was negative Case Presentation cont’d Physical: Vigorous male, growing appropriately HR = 135, RR = 30, normal BP, no fever Clear nasal discharge Lungs clear to auscultation b/l, no wheezes, ronchi, rales Purplish lips, hands and feet Grade III/VI systolic murmur loudest at lower left sternal border Liver was 1.5 cm below right costal margin and a normal spleen Peripheral pulses equal in upper/lower extremities, 1.5 sec cap refill Work Up: Case Presentation cont’d PaO2 of 38mm Hg and a hyperoxia test showed increase to 48mm Hg Electrocardiogram showed RVH Chest X-ray: WHATS THE DIAGNOSIS? Case Presentation cont’d Tetralogy of Fallot IV antibiotics b/c of age and possible sepsis Echocardiogram Cardiac Catheterization and plan surgery * * * * * * * * * * * * * * * * * * * * * * * Cyanotic Heart Disease Casey Wong MS III Overview Specific Cyanotic Congenital Heart Diseases Evaluation of Cyanosis Case Presentation Epidemiology of Congenital Heart Disease Incidence of congenital heart disease is 1 in 100 live births Critical Congenital Heart Disease 1 in 400 live births Of these, 1/3 have cyanotic heart disease Etiology of Congenital Heart Disease % of All Lesion OBSTRUCTIVE LESIONS (Coarctation, aortic/pulmonic stenosis)? ACYANOTIC LESIONS (VSD 30-35, ASD, PDA)? CYANOTIC LESIONS