先心病(58p).pptVIP

How To Look To Patient Data History Taking Growth Exercise Intolerance Recurrent Chest Infection Syncopal Attacks Squatting ECG , Echo Cardiac Cath. Systolic Diastolic Dysfunction Reduced Fractional Shortening Systolic Dysfunction Diastolic Dysfunction Ventricular Hypertrophy Obstructive Volume Before Repair e.g valvular outflow obst. After Repair e.g Homograft conduit Before Repair e.g Lt . to Rt. shunt After Repair e.g Pulmonary valve regurge ( F4 ) MV repair Concentric Eccentric Anaesthetic considerations : Consider determinants of coronary perfusion myocardial oxygen balance Heart rate changes Hypotension Myocardial contractility Anaesthetic considerations increase wall thickness coronary filling becomes diastolic coronary perfusion depends on bl. p. hr Maintain heart rate to decrease regurgitant fraction Syst. Dysfunction In Dialted type RV LV anaesthetic myocardial depression Decrease driving filling pressure of coronary arteries Coronary ischemia Diast. Dysfunction In Hypertrophic restrictive type Residual Shunts : Occasionally present after repair of ASD , VSD F4 Small patch leaks are hemodynamically benign Dysrhythmias : Atrial ventricular types increase mortality and morbidity Arrhythmias Associated With Specific Surgical Procedures Ostium secondum ASD : P-R interval is prolonged in 20-30% of patients AF , atrial flutter with advancing age VSD : RBBB Atrial ectopic , junctional beats , premature ventricular beat Late onset of complete heart block or ventricular arrhythmias are rare Repair of F4 : RBBB complete heart block Mustard or Senning operation : Sinus nodal dysfunction Bradycardia A-V block , AF Severity of hypertension of base line PAH correlated with the incidence of major complications ( pulmonary hypertensive crisis or cardiac arrest ) Pulmonary hypertension Cardiovascular risk of PAH Major perioperative hemodynamic deterioration mainly pulmonary hypertensive crisis and acute rig