先心病(30p)
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Most common category of congenital structural malformation
Commonly divided into noncyanotic (L R) and cyanotic (R L) categories based on direction of shunting
Three major types Small, hemodynamically
insignificant
Between 80% and 85% of all VSDs < 3 mm in diameter All close spontanously
50% by 2 years 90% by 6 years 10% during school years
Previously surgical; now often closed interventionally
Atrial Septal Defect
Ventricular Septal Defect
Single most common congenital heart malformation, accounting for almost 30% of all CHD
months
Ventricular Septal Defects
Clinical findings
Grade II-IV/VI, medium- to highpitched, harsh pansystolic murmur heard best at the left sternal border with radiation over the entire precordium
Atrial Septal Defect
Treatment
Closure generally recommended when ratio of pulmonary to systemic blood flow (qP/qS) is > 2:1
Operation performed electively between ages 1 and 3 years
25-30 6-8 6-8 5-7 5-7 5-7 4-7 3-5 1-3 1-3 1-2 1-2 1-2 1-2 5-10
Baidu Nhomakorabea
Atrial Septal Defect
Atrial Septal Defect
Three major types
Ostium secundum
most common In the middle of the septum in the region of the foramen
hypertension, may be followed until spontaneous closure occurs
Ventricular Septal Defect
Large VSDs with normal PVR
6-10 mm in diameter Usually requires surgery, otherwise… Will develop CHF and FTT by age 3-6
Relative Frequency of Lesions
Ventricular septal defect Atrial septal defect (secundum) Patent ductus arteriosus Coarctation of aorta Tetralogy of Fallot Pulmonary valve stenosis Aortic valve stenosis Transposition of great arteries Hypoplastic left ventricle Hypoplastic right ventricle Truncus arteriosus Total anomalous pulm venous return Tricuspid atresia Double-outlet right ventricle Others
Ventricular Septal Defect
Treatment
Indicated for closure of a VSD associated
with CHF and FTT or pulmonary
hypertension Patients with cardiomegaly, poor growth,
Muscular close sooner than membranous
Ventricular Septal Defect
Moderate VSDs
3-5 mm in diameter Least common group of children (3-5%) Without evidence of CHF or pulmonary
ovale
Ostium primum
Low position Form of AV septal defect
Sinus venosus
Least common Positioed high in the atrial septum Frequently associated with PAPVR
Defects can occur in both the membranous portion of the septum (most common) and the muscular portion
Ventricular Septal Defect
Ventricular Septal Defect
A Quick Tour of Congenital Heart Disease
Chris Longhurst, MD Wednesday, October 21, 2020
Introduction
Present in 0.8% of North American and European children
Commonly divided into noncyanotic (L R) and cyanotic (R L) categories based on direction of shunting
Three major types Small, hemodynamically
insignificant
Between 80% and 85% of all VSDs < 3 mm in diameter All close spontanously
50% by 2 years 90% by 6 years 10% during school years
Previously surgical; now often closed interventionally
Atrial Septal Defect
Ventricular Septal Defect
Single most common congenital heart malformation, accounting for almost 30% of all CHD
months
Ventricular Septal Defects
Clinical findings
Grade II-IV/VI, medium- to highpitched, harsh pansystolic murmur heard best at the left sternal border with radiation over the entire precordium
Atrial Septal Defect
Treatment
Closure generally recommended when ratio of pulmonary to systemic blood flow (qP/qS) is > 2:1
Operation performed electively between ages 1 and 3 years
25-30 6-8 6-8 5-7 5-7 5-7 4-7 3-5 1-3 1-3 1-2 1-2 1-2 1-2 5-10
Baidu Nhomakorabea
Atrial Septal Defect
Atrial Septal Defect
Three major types
Ostium secundum
most common In the middle of the septum in the region of the foramen
hypertension, may be followed until spontaneous closure occurs
Ventricular Septal Defect
Large VSDs with normal PVR
6-10 mm in diameter Usually requires surgery, otherwise… Will develop CHF and FTT by age 3-6
Relative Frequency of Lesions
Ventricular septal defect Atrial septal defect (secundum) Patent ductus arteriosus Coarctation of aorta Tetralogy of Fallot Pulmonary valve stenosis Aortic valve stenosis Transposition of great arteries Hypoplastic left ventricle Hypoplastic right ventricle Truncus arteriosus Total anomalous pulm venous return Tricuspid atresia Double-outlet right ventricle Others
Ventricular Septal Defect
Treatment
Indicated for closure of a VSD associated
with CHF and FTT or pulmonary
hypertension Patients with cardiomegaly, poor growth,
Muscular close sooner than membranous
Ventricular Septal Defect
Moderate VSDs
3-5 mm in diameter Least common group of children (3-5%) Without evidence of CHF or pulmonary
ovale
Ostium primum
Low position Form of AV septal defect
Sinus venosus
Least common Positioed high in the atrial septum Frequently associated with PAPVR
Defects can occur in both the membranous portion of the septum (most common) and the muscular portion
Ventricular Septal Defect
Ventricular Septal Defect
A Quick Tour of Congenital Heart Disease
Chris Longhurst, MD Wednesday, October 21, 2020
Introduction
Present in 0.8% of North American and European children