,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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,The 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,Does the child have heart disease?,Evaluating a child with a heart murmur,Is it congenital heart disease?,If it is congenital heart disease,what is the lesion?,What is the severity of the lesion?,Assessment of a child for the presence of heart disease,Major,Systolic murmur garde III or more specially with a thrill,Diastolic murmur,Cyanosis,Congestive heart failure,Minor,Systolic murmur less than grade III in intensity,2.Abnormal S2,3.Abnormal ECG,4.Abnormal X-ray,5.Abnormal BP,CHD,Acyanotic,CHD,Cyanotic,CHD,L to R shunts,ASD,VSD,PDA,Obstructive lesions,Pulmonic stenosis,Aortic stenosis,Coarctation of aorta,Mitral regurgitation,R to L shunts,TOF,Complete TGA,TOF,PDA,VSD,ASD,Four Congenital Cardiac Anomalies in Children,返回,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,(ASD),ASD is the most 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.,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Three types of atrial septal defect are classified on an anatomic basis:ostium secundum其次孔,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.,房间隔缺损,房间隔缺损原发孔型,位于房间隔的下部，紧邻房室瓣,。,房间隔缺损继发孔型,亦称中心型或卵圆孔型,房间隔缺损静脉窦型,位置接近上腔静脉,房间隔缺损,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Blood is 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,in the pulmonary arterial system,causing a wide splitting of the second heart sound,the other classic finding in ASD.,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 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.,Congenital Cardiac Anomalies in Children,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 irreversible plexiform arteriopathy,丛状的动脉病,similar to that seen in Eisenmenger syndrome or primary pulmonary hypertension,is present.,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,As a result of pulmonary hypertension,the left-to-right shunt first decreases,then becomes bidirectional,and finally reverses;a right ventricular pressure overload develops,pulmonary blood flow is reduced,and the patient becomes cyanotic.,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Right ventricular failure develops as a result of long-standing volume overload;it 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,differentiate clinically between,ASD and such conditions as cardiomyopathy and mitral valve disease.,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 patient 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.,Congenital Cardiac Anomalies in Children,Atrial Septal Defect,Surgery is contraindicated,治疗或处置不当,when pulmonary hypertension approaches the pressure level of the systemic circulation because in such patients the operative mortality is h