小儿心脏病的治疗.pptVIP

Approach to child with heart disease Pushpa Raj Sharma Professor of Child Health Institute of Medicine Diseases of heart Prevalence Congenital Cyanotic: 22% Acyanotic: 68% VSD 25% ASD 6% PDA 6% TOF 5% PS 5% AS 5% Acquired Kawasaki disease Rheumatic Tubercular Collagen Common acyanotic lesions Ventricular septal defects Atrial septal defects Atrio-ventricular septal defects Patent ductus arteriosus Truncus arteriosus Pulmonary stenosis Aortic stenosis Mitral stenosis/incompetence Coarctation of aorta Tricuspid regurgitation Common Cyanotic Lesions Decreased flow 1. Tetralogy of Fallot 2. Tricuspid Atresia 3. Severe Pulmonic Stenosis 4. Ebstein’s anamoly Increased Flow 5. Transposition of great vessles 6. VSD with pulmonary atresia Common Lesions producing cyanosis 7. Truncus Arteriosus 8. Hypoplastic left heart 9. Single ventricle 10. TAPVR with infradiaphragmatic obstruction Presenting complaints/signs Failure to thrive Exercise intolerence Easy fatigability Chest indrawing Sweating during feeding Bluish spells Fever with rigor Palpitation Convulsion Fast breathing Oedema Hepatomegaly, spleenomegaly Clubbing Cyanosis Focal neurological lesion Other organ defects Chromosomal anomalies Cyanosis: is it a cardiac cause or lung cause Hyperoxia test Neonates with cyanotic congenital heart disease usually do not have significantly raised arterial Pao2 during administration of 100% oxygen. Ventricular Defect Small VSD Asymptomatic A loud, harsh, or blowing holosystolic murmur. Large VSD dyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary infections, and cardiac failure in early infancy. Ventricular Septal Defect (VSD) Ventricular Septal defects 30–50% of small defects close spontaneously, most frequently during the 1st 2 yr of life. Small muscular VSDs are more likely to close (up to 80%) than membranous VSDs are (up to 35%). infants with large defects have repeated episodes of respiratory infection and heart failu