先心病(49p).pptVIP

Congenital Heart Disease Thoracic Conference Frank Nami, M.D. The Heart Congenial Heart Disease Obstructive Congenital Heart Lesions Congenital Heart Lesions that INCREASE Pulmonary Arterial Blood Flow Congenital Heart Lesions that DECREASE Pulmonary Arterial Blood Flow Obstructive Congenital Heart Lesions Impede the forward flow of blood and increase ventricular afterloads. Pulmonary Stenosis Aortic Stenosis Coarctation of the Aorta Pulmonary Stenosis No symptoms in mild or moderately severe lesions. Cyanosis and right-sided heart failure in patients with severe lesions. High pitched systolic ejection murmur maximal in second left interspace. Ejection click often present. Pulmonary Stenosis Aortic Stenosis Valvular Aortic Stenosis Subaortic Stenosis Supravalvular Aortic Stenosis Asymmetric Septal Hypertrophy (Idiopathic Hypertrophic Subaortic Stenosis) Valvular Aortic Stenosis Most common type, usually asymptomatic in children. May cause severe heart failure in infants. Prominent left ventricular impulse, narrow pulse pressure. Harsh systolic murmur and thrill along left sternal border, systolic ejection click. Valvular Aortic Stenosis Predominantly in males Thickened, fibrotic, malformed aortic leaflets. Fused commissures Bicuspid aortic valve. Valvular Aortic Stenosis Coarctation of the Aorta Absent or weak femoral pulses. Systolic pressure higher in upper extremities than in lower extremities; diastolic pressures are similar. Harsh systolic murmur heard in the back. Coarctation of the Aorta Males twice as frequently as females. 98% of all coarctations at segment of aorta adjacent to ductus arteriosus. Produced by both an external narrowing and an intraluminal membrane. Blood flow to the lower body maintained through collateral vessels. Coarctation of the Aorta Congenital Heart Lesions that INCREASE Pulmonary Arterial Blood Flow Atrial Septal Defect Complete Atrioventricular Canal Ventricular Septal Defect Patent Ductus Arteriosis Total Anomalous Pul