先心病(48p).pptVIP

ANATOMY (CON’T) ULTIMATELY, THE DUCTUS FIBROSES AND BECOMES THE LIGAMENTUM ARTERIOSUM WHEN IT DOESN’T CLOSE IT IS CALLED A PATENT DUCTUS ARTERIOSUS(REDUNDANT) HEMODYNAMICS OF PDA HEMODYNAMICS OF PDA HIGH PRESSURE AORTA COMMUNICATES WITH LOW PRESSURE PULMONARY ARTERY INCREASES VOLUME IN LUNGS AND SUBSEQUENTLY INTO LV SIMILAR TO VSD HEMODYNAMICS RA, RV NO CHANGE MAIN PA, PULM VESSELS, LA, LV AND AORTA DILATE CLILNICAL APPLICATION OCCURS EARLY IN LIFE INITIALLY MURMUR IS SYSTOLIC, BUT AS DIASTOLIC EQUILIBRATION OCCURS, MURMUR BECOMES A CLASSIC TO AND FRO OR CONTINUOUS MURMUR OCCURS. PHYSICAL EXAM OF PDA CONTINUOUS MURMUR LEFT OF STERNUM AT 2ND OR 3RD INTERSPACE COURSES ALONG STERNUM AND ALONG PULMONARY ARTERY DISPLACE APEX DUE TO INCRESED VOLUME WITH A THRUST CLINICAL APPLICATION BIRTH-NORMAL 2-6 WEEKS-FLOW BEGINS AND SYSTOLIC MUMRUR IS HEARD AS LA AND LV SIZE INCREASE, CHF DEVELOPES MURMUR BECOMES CONTINUOUS AS PA AND LV DIASTOLIC PRESSURES EQUAL COARCTATION OF THE AORTA COARCTATION 5TH AND 7TH WEEKS OF GESTATION, THE AORTIC ARCH DEVELOPS AT AREA OF PATENT DUCTUS, AORTA DEVELOPS IMPROPERLY, LEAVING A RESTRCTED LUMEN. LOCATION:PROXIMAL , AT , OR DISTAL TO INSERTIN OF DUCTUS. COARCTATION MORE COMMON IN MALES RIB NOTCHING OCCURS DUE TO PHYSICAL ERROSION OF THE UNDERSURFACE OF THE RIBS AS A RESULT OF INTERCOSTAL COLLATERAL CIRCULATION ASSOCIATED WITH BICUSPID AORTIC VALVE TETRALOGY OF FALLOT TETRALOGY OF FALLOT 3RD TO 4TH WEEK, THE COMMON TRUNK DIVIDES INTO THE PULMONARY ARTERY AND THE AORTA. 4TH AND 8TH WEEK, THE VENTRICLE DIVIDES INTO TWO TETRALOGY DEFINED BY FOUR FINDINGS 1) INFUNDIBULAR STENOSIS 2) VENTRICULAR SEPTAL DEFECT 3) RIGHT VENTRICULAR HYPERTROPHY 4) OVERRIDING OF THE AORTA HEMODYNAMICS DIMINISHED BLOOD FLOW TO THE LUNGS AND INCREASED BLOOD FLOW TO THE BODY. DUE TO THE STENOSIS OF THE INFUNDIBULUM, PULMONARY FLOW IS DIMINISHED. THE OVERRIDING AORTA ACCEPTS MOST OF THE RV BLOOD. CLINICAL APPLICATION THIS PRODUCES A RIGHT TO LEFT SHUNT AND THEREFORE PRODUCE