chds(儿童先天性心脏病各论).pptxVIP

Ventricular Septal Defect（VSD）;Ventricular Septal Defect ;Position of VSD： －Membranous(60-70%): the commonest locationt －Subpulmonic(3-6%): risk of aortic valve prolapse －Muscular(20-30%) : occur anywhere in the muscular part of septum ;Size of VSD;Before Pulmonary hypertension;Small VSD －asymptomatic －Pan-systolic murmur of grade Ⅱ~Ⅳ heard at left sternal border in the 3rd~4th intercostal spaces, radiating over precordium ( 3~4 LSB SM Ⅱ~Ⅳo);Medium～Large VSD (symptoms) Pulmonary plethora---Recurrent chest infection Systemic blood flow ? --Failure to thrive (slow weight gain ） Poor cardiac function: Cyanosis when right-to-left shunt occurs, mostly due to severe pulmonary hypertension ;Medium～Large VSD Poor cardiac function: － at infancy：difficulty with feeding, sweating, tachypnea, and hepatomegaly; － in older children：dyspnea on excursion, easy fatigability, palpitation, exercise intolerance;Medium～Large VSD (signs) 2～4 LSB SM Ⅲ~Ⅵo DM at apex due to large blood flow across normal mitral valve (relative mitral stenosis) P2 increased with split Cyanosis with clubbing in late stage;Electrocardiogram;Chest X-ray;Echocardiogram;Echocardiogram;Prognosis Complications;Medical Management;Indications for Surgical Repair;Atrial Septal Defect（ASD）;Atrial Septal Defect;上腔静脉;Hemodynamic Characteristics;Symptoms are similar to VSD’s －such as poor growth and development, recurrent pneumonia, poor cardiac function －but occur less frequently in infants －Some patients even remain asymptomatic through life ;Signs： －2,3LSB SM Ⅱ~Ⅲo The murmur is caused by increased flow across pulmonic valves (i.e. relative pulmonary stenosis) －4LSB DM can often be heard (relative tricuspid stenosis) －P2 increased with fixed split (固定分裂）;Electrocardiogram ;Chest X-ray ;Echocardiogram;Echocardiogram;Prognosis Complications;Medical Management;Patent Ductus Arteriosus（PDA）;Accounting for 15％ of CHD Incidence may be as high as 20~60% in preterm infa