Congenital Heart Diseases - Khyber Medical University：先天性心脏病-开伯尔医学大学.pptVIP

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Congenital Heart Diseases - Khyber Medical University：先天性心脏病-开伯尔医学大学.ppt

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Congenital Heart Diseases - Khyber Medical University：先天性心脏病-开伯尔医学大学

Pathophysiology of ventricular septal defect. The defect results in a left-to-right shunt at the ventricular level, resulting in increased volume and pressure in the right ventricle, the magnitude of which depends on the size of the defect. The right ventricle undergoes hypertrophy because of volume and pressure overload. The left ventricle, which must handle the shunted blood in addition to the normal output into the aorta, also undergoes hypertrophy and dilation. Pulmonary arterial pressure may increase with time as a result of changes occurring in the pulmonary vasculature. This causes a progressive decrease in shunt volume and, if severe enough, may result in shunt reversal. * Pathophysiology of patent ductus arteriosus. Blood is shunted from the aorta to the main pulmonary artery via the patent ductus. This results in increased pressure and volume in the pulmonary artery, the magnitude of which depends on the size of the shunt. Pulmonary hypertension causes right ventricular hypertrophy. The left ventricle, which pumps a volume equal to the shunt plus the systemic output, also undergoes hypertrophy. Increasing pulmonary hypertension due to secondary pulmonary vascular changes may result in shunt reversal. * Tetralogy of Fallot. The marked narrowing of the pulmonary outflow tract results in a right-to-left shunt through the ventricular septal defect, resulting in central cyanosis. The right ventricle is hypertrophied. * * * * * * * * * * * * * * * * * * * * * * * * * Morphology The heart is large and boot shaped in tetralogy of Fallot as a result of; right ventricular hypertrophy; the proximal aorta is typically larger than normal, with a diminished pulmonary trunk. The left-sided cardiac chambers are normal sized, while the right ventricular wall is markedly thickened and may even exceed that of the left. The VSD lies in the vicinity of the membranous portion of the interventricular septum, and the aortic valve lies immediately over the VSD The pulmonary