先心病(42p).pptVIP

Congenital Heart Disease Classification Acyanotic Interrupted Aortic Arch Aortic Stenosis Ventricular Septal Defect Atrial Septal Defect Cyanotic Defects Hypoplastic Ventricle Pulmonary Stenosis Tetralogy of Fallot D transposition of the great vessels Tricuspid atresia Plan We will discuss few topics that are important from the anesthesiologist point of view Septal Defects Atrial Septal Defects Patent Ductus Arteriosus Interrupted Aortic Arch Tetralogy of Fallot Single ventricle The Cyanotic Neonate Ductus Arteriosus closes within 6 hours of birth so any congenital heart disease that relies on it for perfusion of oxygenated blood will present early To prevent death from inadequate oxygenation, the duct has to be maintained open with prostaglandines Any neonate with a congenital heart disorder that relies on an open ductus arteriosus for oxygenation will deteriorate rapidly and requires immediate transfer to a specialty center Ventricular Septal Defect I Defect in the septum separating the left and right ventricles Most common type of congenital heart disease accounting for 21% of all cases Can occur singly or in multiples anywhere along the ventricular septum Small defects often close spontaneously in the first 2 years of life while large defects require surgical repair within the 1st year Ventricular Septal Defect II Prevalence equal between boys and girls Due to increased pressures in the left ventricle, left to right shunting of oxygenated blood occurs With the increased pulmonary blood flow, pulmonary hypertension can occur with large defects Ventricular Septal Defect III Symptoms of Ventricular Septal Defects Rapid breathing Irritability Excessive Sweating Poor weight gain Congestive Heart Failure, usually within 6 to 8 weeks of life if defect is large Pulmonary Hypertension if defect is large Treatments for Ventricular Septal Defects Lasix and Aldactone to decrease symptoms of CHF Digoxin to increase effectiveness of myocardial function If surgery needed,