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CongenitalHeartDisease(CHD)ShengjingHospitalPediatricsYuXuexinPediatrics,ShengjingHospitalIntroductionIntroduction•CHDisdefinedasanabnormalityincirculatorystructureorfunctionthatispresentatbirth,evenifitisdiscoveredmuchlater.•Incidence:6.9‰inaliveneonatal.•150,000neonatalsufferfromCHDinChinaperyear.•Newtreatments：catheterization、developmentofoperation,etc.Pediatrics,ShengjingHospitalObjectandRequestObjectandRequest•FamiliarwiththeetiologyandclassificationofCHD.•Masterthehemodynamics、clinicalmenifestationanddiagnosisofcommoncomplicationsinVSD,ASD,PDAandTOF.Pediatrics,ShengjingHospitalEtiologyEtiology•Internalfactors：genemutationorchromosomeaberration.•Externalfactors:intraureteralinfection、ray、drug、metabolicdiseases、intraureteralhypoxia.Pediatrics,ShengjingHospitalClassificationClassificationleft-to-rightshunts•Cyanosismaybe•VSD、PDA、ASDright-to-leftshuntsnon-shunts•Cyanosis•TOF、dislocationofmainartery•Pulmonaryarterystenosis、aorticstenosisBasedonshuntbetweenrightandleftheartPediatrics,ShengjingHospitalPatentductusarteriosusPDAPatentductusarteriosusPDACommonCHDinClinicCommonCHDinClinicAtrialseptaldefectASDAtrialseptaldefectASDVentricularseptaldefectVSDVentricularseptaldefectVSDTetralogyofFallotTOFTetralogyofFallotTOF11223344Pediatrics,ShengjingHospitalVentricularSeptalDefect（VSD）1、membranedefect85%2、musculardefect3、funneldefect10%20-50％VSDcancloseupwithouttreatment.1、minordefect2、mediadefect3、majordefectAnatomyMostcommon，30%inCHD。Pediatrics,ShengjingHospitalPathobiologyPathobiologyRVblood↑,pulmonaryhypertension,persistentcyanosis(Eisenmengersyndrome)LVblood↓,bodycirculation↓Pediatrics,ShengjingHospitalHemodynamicsHemodynamicsBeforepulmonaryhypertensionRARV（blood↑）Pulmonaryartery(dilation)Pulmonarycirclation(congestion)RV(dilation)LA(hypertrophy)LV(hypertrophy)（射血量减少）bodycirculationBloodvolume↓shuntPediatrics,ShengjingHospitalHemodynamicsHemodynamicsBodycirculation（mixedblood）RALAPulmonaryArterydilationRV（Dilation)AfterpulmonaryhypertensionLVDynamicPulmonaryhypertesionObstructivepulmonaryhypertesionshuntPediatrics,ShengjingHospitalClinicalManifestationClinicalManifestation•症状：分流量大时：生长迟缓、体重不增、消瘦、喂养困难、活动后乏力、气短、多汗、反复呼吸道感染、心衰。声音嘶哑（肺动脉压迫喉返神经）。•体征：胸骨左缘3、4肋间Ⅲ-Ⅳ粗糙的全收缩期杂音，向四周传导，伴有震颤。肺动脉第二音亢进。二尖瓣相对狭窄的较柔和舒张中期杂音Pediatrics,ShengjingHospitalExaminationExamination•X线：左、右心室增大，以左室增大为主，主动脉弓影较小，肺动脉段突出，肺野充血。艾森曼格综合征：肺动脉主支增粗，肺外周血管影很少，宛如枯萎的枯枝。•心电图•USPediatrics,ShengjingHospitalComplicationsandtreatmentComplicationsandtreatment•合并症支气管肺炎、心衰、肺水肿、亚急性细菌性心内膜炎•治疗小型缺损：不一定手术治疗。中型缺损：5-6岁做手术。大型缺损并反复心衰者：可在6月-2岁内做手术。介入治疗Pediatrics,ShengjingHospitalAtrialAtrialSeptalDefectASDAtrialAtrialSeptalDefectASD•5-10%•病理解剖：1.原发孔型：约占15%，缺损位于心内膜垫与房间隔交界处。2.继发孔型：中央型，最常见，约占75%，缺损位于房间隔中心卵圆窝。3.静脉窦型：约占5%，分为上腔型和下腔型。4.冠状静脉窦型：约占2%，缺损位于冠状静脉窦上端与左心房间。Pediatrics,ShengjingHospitalAtrialAtrialSeptalDefectASDAtrialAtrialSeptalDefectASDHemodynamicsHemodynamicsPediatrics,ShengjingHospitalHemodynamicChangeHe...