儿科学 先天性心脏病 先天性心脏病.ppt

Simple VSD is the single most common congenital heart malformation. Between the right and left ventricle there is a defects in the ventricular septum. Patients with small or moderate left-to-right shunts usually have no cardiovascular symptoms. Patients with large left-to-right shunts are usually ill early in infancy. Such patients have frequent respiratory infections. They grow slowly, with very poor weight again. Dyspnea, exercise intolerance, and fatigue are quite common. Congestive heart failure develops between 1 and 6 months. A grade Ⅱ-Ⅳ/Ⅵ class, medium-to-high pitched , harsh pansystolic murmur is heard best at the left sternal border (LSB) in the third and fourth intercostal spaces. There is radiation over the entire precordium. A thrill may be present at the lower left sternal border. ? An increase intensity of the pulmonary component of the second heart sound (P2). ? A diastolic murmur indicate VSD combine with aortic regurgitation. An ASD is an opening in the atrial septum permitting the shunting of blood between the two atria. There are two major types: The ostium secundum type is the most common and is in the middle of the septum in the region of the foramen ovale. The ostium primum type is low in position. Symptoms of ASD are similar with that of VSD. ? A grade Ⅰ-Ⅲ/Ⅵ class ejection systolic murmur is heard best at the left sternal border in the second intercostal space. The murmur is caused by increased flow across the pulmonary valve. No murmur is heard from the flow across the ASD. ? S2 at the pulmonary area is widely split and often fixed. ? The pulmonary component of S2 is accentuation in intensity. ? A mid-diastolic murmur can often be heard in the fourth intercostal space at the left sternal border. This murmur is caused by increase flow across the tricuspid valve during diastole. PDA is the persistence of the normal fetal vessel that joins the pulmonary artery trunk to the descending aorta. It is a common abnormality in C