《先心病-(ASD)课件.ppt》由会员分享，可在线阅读，更多相关《先心病-(ASD)课件.ppt（36页珍藏版）》请在taowenge.com淘文阁网|工程机械CAD图纸|机械工程制图|CAD装配图下载|SolidWorks_CaTia_CAD_UG_PROE_设计图分享下载上搜索。
1、Atrial Septal Defects ASDPresentedbyDr.MaysaAbdulHaqDirectedbyDr.AliHalabiJordanHospital11-9-2005Background:Anatrialseptaldefect(ASD)isadeficiencyoftheatrialseptum.ASDsaccountforabout10-15%ofallcongenitalcardiacanomalies.Types of ASDs:1-Ostiumsecundumdefect70%ofASDs.2-Ostumprimumdefect20%ofASDs.3-si
2、nusvenosusdefect.10%ofASDs.4-coronarysinusseptaldefect1%ofASDs.Normal heart for comparison.Cardiac Development:Cardiactissuesarefirstdetectableonthe18thor19thdayoffetallife.Cardiacdevelopmentcontinuesforthenextseveralweeks.Theatrialseptumbeginstoformduringthefourthweekandiscompletebytheendofthefifth
3、week.Age of presentation:ASD,ispresentatbirth;however,inmostcases,amurmurisnotaudibleuntilthechildisafewmonthsold.SymptomsusuallydonotoccurinindividualswithASDuntillatechildhood,adolescence,oradulthood.Secundumtype,sinusvenosus,andunroofedcoronarysinusdefectssometimesarenotdiagnoseduntilthethirddeca
4、deoflife.OstiumprimumASDsusuallyarediagnosedinthefirstfewyearsoflifebecauseofthepresenceofamitralregurgitationmurmur.Ostium Secundum:AdefectintheregionofthefossaovalisThemostcommonformofASDAssociatedwithstructurallynormalAVvalves.Itmaybesingleormultiple(fenestratedatrialseptum)Female:male3:1incidenc
5、e.Associatedlesions:partiallyanomalouspulmonaryvenousreturn.&Holt-Oram-syndrome.Ostium secundum ASD is the most common type of ASD.It occurs in the center of the septum between the right and left atrium.A variant of this type of ASD is called a patent foramen ovale(PFO)and is very smallContinueHeart
6、defects:ThemostcommonlesionisasecundumASD.Othersincludeventriculoseptaldefect(VSD),atrioventricular(AV)block,pulmonicstenosis(includingperipheralarterial),andmitralvalveprolapse.Continuerighthandofa6-month-oldinfantwithHolt-Oramsyndrome,showinghypoplasticrightthumb.ContLargebloodflowthroughtherights
7、ideoftheheartcauseenlargementofrightatriumandventricle,dilatationofthepulmonaryarterybutpulmonaryatrialBPisusuallynormal(absenceofhighpressurecommunicationbetweenPulm.andSys.Circulation.)PVRmayincreaseinadulthoodandresultinrighttoleftshunt.Continue4-Systolicejectionmurmuratmiddleandupperleftsternalb
8、order.3-Middiastolicrumblingmurmuratthelowerleftsternalborder.ThesefindingsindicateQp:Qsratioatleast2:1.Diagnosis:ChestX-Ray:shows*variabledegreesofrightventricleandatrialenlargement.*Enlargementofpulmonaryartery.*Increasepulmonaryvascularity.2-ECG:signsofrightventriclevolumeoverload.Rightaxisdeviat
9、ionRightventricularconductiondelay(rsR).3-Echocardiogram:Increasedrightventricularenddiastolicdimensions.AbnormalmotionofventricularseptumLocationandsizeofASDConfirmationoftheshunt.4-CardiacCatheterization:confirmationofthedefectMeasuringoftheshuntandPVP.(itsofconsiderablevolumewhenifmorethanorequal
10、s20/min/m2.Note:inthecaseofclassicalfeaturesofASDonphysicalexamination,CXRandECHOwhichIdentifyisolatedseccundumASD,thereisnoneedforthecardiancathbeforesurgery.Continue.Note:inthecaseofclassicalfeaturesofASDonphysicalexamination,CXR,andECHOwhichIdentifyisolatedsecundumASD,thereisnoneedforthecardiacca
11、thbeforesurgery.left-to-rightshunt,isofconsiderablevolumewhenifmorethanorequals20L/min/m2.Prognosis&Complications:15%ostiumsecunduminterminfantsclosespontaneously.Symptomsdontusuallyappearuntilthethirddecadeinlifeorlater:Pulmonaryhypertension,atrialdysrhythmias,AVvalveinsufficiency,andheartfailure,i
12、nitiallyappearsduringvolumeoverloadinpregnancy.InfectiveEndocarditisisextremelyrareandthereisnoneedforantibioticprophylaxis.Treatment:Surgeryortranscatheterdeviceclosure.Indications:1-allsymptomaticpatients.2-asymptomaticpatientswithQP:QSratioofatleast2:1.Timing:electiveclosureafteroneyearandbeforee
13、ntryofschool.ContinuePostOpcomplications:(HF,AF)Theriskisgreaterifdoneafter20yearsofage.PostOpprognosis:1-symptomsdisappearrapidly.2-enhancedphysicaldevelopmentandactivity.3-Heartsizedecreasestonormal.Ostium primum:Anostiumprimumatrialseptaldefect(ASD)islocatedinthemostanteriorandinferioraspectofthe
14、atrialseptum.Cleftofanteriorleafletofthemitralvalveisnoticed.Tricuspidvalveisusuallyfunctionallynormal.Development:Duringfetaldevelopment,therudimentaryatriumisdividedbytheseptumprimum,exceptforananteriorandinferiorspacethatistheostiumprimum.Theostiumprimumissealedbyfusionofthesuperiorandinferiorend
15、ocardialcushionsaroundthefifthweekofgestation.FailuretodosoresultsinanostiumprimumASD.OstiumprimumASDsaremostcommonlyassociatedwithDownsyndrome(trisomy21).ContinueSex:Themale-to-femaleratiois1:1.Age:Patientswithsmallerdefectsandlittleornomitralregurgitationmaypresentatanyagewithamurmurand/oranabnorm
16、alelectrocardiogram(ECG).ThosewithmoreseveremitralregurgitationtypicallypresentwithCHFinthefirst1-2yearsoflife.Pathophysiology:Shuntingispredominantlyleft-to-rightintheabsenceofpulmonaryvasculardiseaseorsignificantrightventricularoutflowtractobstruction.Thisresultsinvolumeoverloadoftherightatriumand
17、ventricleandpulmonaryovercirculation.Ifthemitralvalvecleftcausessignificantmitralregurgitation,theleftsideoftheheartbecomesvolumeoverloaded.Aleftventricletorightatriumshuntcanbepresent,whichfurtheroverloadsboththerightandleftheart.Treatment:theprimumformofASDisnotamenabletodeviceclosureinthecardiacc
18、atheterizationlaboratory.Thedeviceisunabletobeadequatelyseatedsecondarytoaninadequateinferiorrimofatrialseptaltissue.DefinitivemanagementofhemodynamicallysignificantprimumASDsandpartialAVcanaldefectsisoperativerepair.ContinueTiming:PatientswithanisolatedostiumprimumASDusuallyarereferredforelectivere
19、pairwhenaged3-5years.repairmayberecommendedatanearlieragebecauseofsignificantCHForbecauseoffailuretothrive,allpatientswithdocumentedmitralregurgitationbereferreduponpresentation,asonceregurgitationdevelops,makingrepairlesssuccessful.Sinus venosus:SituatedintheupperpartofAS,incloserelationtoentryofSV
20、C.SinusvenosusASDsaccountforonly10%ofASDsalwaysassociatedwithanomalouspulmonaryvenousdrainageoftherightupperpulmonaryveinintotheSVC.A sinus venosusdefectistheleastcommontypeofASDandislocatedintheupperportionoftheatrialseptum.AsinusvenosusASDoftenhasanabnormalpulmonaryveinconnectionassociatedwithit.F
21、ourpulmonaryveins,twofromtherightlungandtwofromtheleftlung,normallyreturnredbloodtotheleftatrium.UsuallywithasinusvenosusASD,apulmonaryveinfromtherightlungwillbeabnormallyconnectedtotherightatriuminsteadoftheleftatrium.Thisiscalledananomalouspulmonaryvein.ContinueAlmostallpatientswithsinusvenosusASD
22、becomsymptomaticwhentheyareyoungerthan40years.Thehaemodynamicdisturbance,clinicalpicture;ECG;C-Xrayaresimillertoostiumsecundum.DiagnosisbyEchocardiography&cardiaccath.Anatomicalcorrection:theinsertionofapatchtoclosethedefect.excellentsurgicalresultswithamortalityratenear0%canbeexpected.Ifrepairdoneb
23、eforeage15years.Coronary sinus:TheleastcommontypeofASDistermedanunroofedcoronarysinusorcoronarysinusseptaldefect.Aportionoftheroofofthecoronarysinusismissing,allowingshuntingofbloodfromtheleftatriumintothecoronarysinusandsubsequentlyintotherightatrium.usuallyassociatedwithotherformsofcongenitalheartdisease(eg.persistantLSVC.alsomaybeassociatedwithotherformsofASD,suchasthesecundumorprimumtypes,ContinuePatientsusuallypresentwithsymptomstypicalofotherASDsorwithsymptomsrelatedtotheirconcomitantdefects.InthepresenceofaLSVC,thesefenestrationscanresultinahistoryofbrainabscessorcerebralembolism.