1、1.Genetic factor(internalfactor):Genetic and chromosomal aberrations,2.Environmental factor(external factor):High altitude,4.Inherited factor,3.Other related factors:Viral infections of pregnancy,Mothers who are diabetic,alcoholics or drug addictive Drugs and metabolic factors,Etiology,第一页，共四十七页。,Th
2、e health protection of pregnant woman should be enhanced.High risk factors,such as drugs,radiation,viral infection,et.should be avoided.Suit dosage Folic Acid should be filled up in early pregnancy stage.,Prevention,第二页，共四十七页。,Does the child have heart disease?,Evaluating a child with a heart murmur
3、,Is it congenital heart disease?,If it is congenital heart disease,what is the lesion?,What is the severity of the lesion?,第三页，共四十七页。,Assessment of a child for the presence of heart disease,Major Systolic murmur garde III or more specially with a thrillDiastolic murmurCyanosisCongestive heart failur
4、e,Minor,Systolic murmur less than grade III in intensity,2.Abnormal S2,3.Abnormal ECG,4.Abnormal X-ray,5.Abnormal BP,第四页，共四十七页。,第五页，共四十七页。,TOF,PDA,VSD,ASD,Four Congenital Cardiac Anomalies in Children,返回(fnhu),第六页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect(ASD)ASD is the mo
5、st frequent congenital lesion of major importance in adults.It is often not diagnosed until adult life,even in the present era,because it rarely produces symptoms in childhood and the associated physical signs are easily confused with the cardiac findings in normal children.,第七页，共四十七页。,Congenital Ca
6、rdiac Anomalies in Children,Atrial Septal Defect Three types of atrial septal defect are classified on an anatomic basis:ostium secundum第二(d r)孔,sinus venosus,and ostium primum第一孔.All three types are associated with a left-to-right shunt at the atrial level and volume overwork of the right ventricle
7、.,第八页，共四十七页。,第九页，共四十七页。,房间隔缺损,第十页，共四十七页。,房间隔缺损原发孔型(kn xn),位于房间隔的下部，紧邻(jnln)房室瓣。,第十一页，共四十七页。,房间隔缺损继发孔型(kn xn),亦称中央(zhngyng)型或卵圆孔型,第十二页，共四十七页。,房间隔缺损静脉(jngmi)窦型,位置(wi zhi)接近上腔静脉,第十三页，共四十七页。,房间隔缺损,第十四页，共四十七页。,第十五页，共四十七页。,第十六页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect Blood is
8、chronically overcirculated through the lungs at normal intracardiac pressure levels.Increased flow through the pulmonary valve produces a characteristic pulmonary systolic ejection murmur.The pulmonary valve closes late because of the reduced impedance阻抗(zkng)in the pulmonary arterial system,causing
9、 a wide splitting of the second heart sound,the other classic finding in ASD.,第十七页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect The splitting remains relatively fixed in relation to respiration;the aortic and pulmonary components remain audibly split during expiration.A chest
10、 x-ray usually reveals enlargement of the heart and signs of pulmonary overcirculation,such as a large pulmonary trunk and increased pulmonary vascular markings.The relative severity of these conditions reflects the size of the left-to-right shunt.,第十八页，共四十七页。,Congenital Cardiac Anomalies in Childre
11、n,Atrial Septal Defect Two major complications of ASD are pulmonary arterial hypertension and right ventricular failure.Pulmonary arterial hypertension is caused by elevated pulmonary vascular resistance;it develops after adolescence in about 15 percent of cases.In the most severe cases,an irreversi
12、ble plexiform arteriopathy丛状的动脉(dngmi)病,similar to that seen in Eisenmenger syndrome or primary pulmonary hypertension,is present.,第十九页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect As a result of pulmonary hypertension,the left-to-right shunt first decreases,then becomes bidi
13、rectional,and finally reverses;a right ventricular pressure overload develops,pulmonary blood flow is reduced,and the patient becomes cyanotic.,第二十页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect Right ventricular failure develops as a result of long-standing volume overload;it
14、 usually affects patients older than 40 years.Right ventricular failure is usually associated with atrial flutter or fibrillation and is often linked to tricuspid regurgitation.Eventually,a syndrome of right-and left-sided congestive heart failure develops,and at this stage,it may be difficult to di
15、fferentiate clinically between ASD and such conditions as cardiomyopathy and mitral valve disease.,第二十一页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect Surgical closure of ASD is a very safe and highly effective procedure.Prophylactic surgery is therefore indicated in any patie
16、nt in whom the ratio of pulmonary blood flow to systemic blood flow is 2:1 or greater.Nearly all patients in whom ASD can be clinically diagnosed exhibit at least this degree of left-to-right shunt.,第二十二页，共四十七页。,Congenital Cardiac Anomalies in Children,Atrial Septal Defect Surgery is contraindicated 治疗(zhlio)或处置不当 when pulmonary hypertension approaches the pressure level of the systemic circulation because in such patients the operative mortality is high and the elevated pulmonary vascular resis