儿科学精品教学（重庆医科大学）07.CHD（先天性心脏病）.pptVIP

Congenital Heart Disease(CHD) Introduction CHD,the most common cardiac disease in children Critical time of embryotic cardiac development: second to eighth week of gestation Incidence:7～8/1000 Etiology CHD result from interaction between genetic and environmental factors Genetic factors: single mutant genes/chromosomal abnormalities/multifactorial gene factors Environmental factors: fetal environment/viral infection Classification According to Hemodynamics: left-to-right shunts (without cyanosis) eg VSD,ASD,PDA,et al right-to-left shunts (with cyanosis) eg TOF,TGA,et al no shunt at all (without cyanosis) eg PS,AS,et al Ventricular Septal Defect(VSD) Atria Septal Defect(ASD) Patent Ductus Arteriosus(PDA) Tetralogy of Fallot(TOF)  Outline Incidence and rate of natural closure Pathological anatomy Pathophysiology and Hemodynamics Clinical Manifestations Assistant Examinationes Electrocardiogram/X-ray/ Echocardiography/ Cardiac Catheterization and Angiocardiography Complications Treatment Incidence and rate of natural closure VSD is the most common of all CHD, accounting for approximately 30 to 60% of all full-term newborn with CHD. Most tiny muscular and perimembranous defects（＜0.5cm）have high chance of spontaneous closure within 6 to 12 months after birth. Pathological anatomy Supracristal perimembranous：60-70% Muscular defect： Pathophysiology and Hemodynamics Moderate defect(0.5～1.0cm)，left to right shunt,pulmonary flow increased，LA、LV enlargement ,or double ventricle enlargement hypertension in RV, PA Pathophysiology and Hemodynamics LA,LV enlargement and hypertrophy RV flow increased、enlargement、hypertrophy Pulmonary circulation flow increased Systemic circulation flow insufficiency Clinical Manifestations Two determinants for clinical manifestation of isolated VSD size of defect volume of shunt Clinical Manifestations Small VSD: no obvious symptoms Moderate VSD: Symptoms:shortness of breath after crying or su