先心双语广西医科大学医学医药.pptVIP

第二节 小儿先天性心脏病概述 概念：CHD是胎儿期心脏及大血管发育异常而致心血管畸形，是小儿最常见心脏病 发病率:6～8‰，上海6.87‰ 我国每年出生15万CHD 诊治研究取得很大进展，预后大为改观 病 因 内因：与遗传有关，染色体异常或基因突变。 外因： （1）早期宫内感染：风疹、流感、腮腺炎、柯萨奇病毒等。 （2）孕母接触大量放射线服用药物史（抗癌药、抗癫痫药) （3）代谢性疾病:糖尿病、高钙血症 （4）宫内慢性缺氧 （5）妊娠早期酗酒、吸食毒品 环境因素＋遗传因素 Categories of congenital heart disease The left-to-right shunt type (ASD VSD PDA) Acyanotic early Pulmonary blood increased Systemic blood decreased Pulmonary hypertension Eisenmenger syndrome: cyanotic lately due to right-to-left shunts The right-to-left shunt type Tetralogy of Fallot ( TOF), transposition of the great arteries (TGA) Cyanotic early Cyanotic lesions with increased pulmonary blood flow Cyanotic lesions with decreased pulmonary blood flow The systemic circulation is hypoxemia No-shunt lesions Pulmonary stenosis (PS), Coarctation of the aorta (Coa) Acyanotic Hypertrophy resulting in increased pressure load Normal cardiothoracic imaging landmarks, PA view Anterior radiographic view of cardiac anatomy X-ray 你X线诊断分别是什么？ The sequence of ECG: rate, rhythm, P wave, PR interval, QRS complex ( axis, amplitude, and duration), QT interval, ST segment, and T wave. Assess atrioventricular hypertrophy Diagnosis of dysrhythmias Electrocardiogram, ECG Normal ECG A powerful noninvasive method: M-mode, two and three dimensional, color and Doppler Evaluate cardiac structure Estimate intracardiac pressure and gradient across stenotic valves and vessels Quantitate cardiac contractile function Determine the direction of flow across a defect Examine the integrity of the coronary arteries Evaluate endocarditis, pericardiac fluid, cardiac tumors, or chamber thrombi. Echocardiography M-mode ECHO Long-axis view for LV 2-D ECHO Four-chamber view at apex 2-D ECHO Short-axis view at the great artery 2-D color ECHO (four-chamber view) 2-D color Doppler ECHO 3-D Reconstruction SVC IVC RV Cardiac Catheterization Estimate Cardiac output according to Oxygen content and saturation, pulm