先心病(57p).pptVIP

Part I Fetal Circulation, ASD, VSD Fetal Circulation (Pulmonary) Gas exchange occurs in placenta Pulmonary blood flow is low, supplying nutritional requirements for lung growth and allowing lungs to serve a metabolic or paraendocrine fx The flow is low despite dominance of RV (in fetus ejects 60-65% of total CO) Most of RV output is diverted away from the lungs via ductus arteriosus Fetal Circulation (Pulmonary) Pattern of pulmonary blood flow: 0.5 gestation 3-4% of total CO 0.8 gestation 6% Term 8-10% Fetal mean PAP increases with gestation and is ~50 mmHg @ term This exceeds the mean aortic pressure by 1-2 mmHg Total PVR early in gestation is extremely high relative to that in infant or adults Total PVR decreases progressively over last half of gestation This is due to growth of new arteries and an overall increase in cross-sectional area However PVR per unit of lung tends to increase in late gestation Fetal Circulation(Pulmonary) At birth PVR decreases rapidly This is associated with 8-10 fold increase in pulmonary blood flow By 24 hours of age mean PAP is only half of systemic After an initial rapid decrease in PVR and PAP there is a slow progressive decrease with adult levels achieved after 2-6 weeks With the large increase in pulmonary blood flow, the increase in pulmonary venous return into LA reverses the pressure difference The greater LAP now closes the valve of FO In addition the DA constricts and closes functionally within several hours after birth (largely in response to increased oxygen tension) These events result in effective separation of systemic and pulmonary circulation after birth Fetal Circulation (Systemic) For the central venous circulation to allow the ventricles to perform their tasks efficiently, the least saturated venous blood should return to RV and most saturated to the LV Blood returns from the upper body via SVC and from the myocardium via CS The leftward and superior course of the Eustachian valve directs 95% of blood away f