Congenital Heart Disease Children's Hospital Zhejiang University School of Medicine THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Congenital Heart Disease Children’s Hospital Zhejiang University School of Medicine
Cardiovascular Development Key periods:the 2nd ~8th week As early as 20-22 days,the embryonic heart begins to contract At the end of 8 weeks,4 chamber heart is formed THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Cardiovascular Development Key periods: the 2nd ~8th week As early as 20-22 days, the embryonic heart begins to contract At the end of 8 weeks, 4 chamber heart is formed
Fetal gulation Head In the fetus,the placenta provides Arm for gas and metabolite exchange. The lung do not provide gas Ductus arteriosus Lun exchange,and vessels in the ung pulmonary circulation are Liver vasoconstricted Foramen ovale Ductus venosus Umbilical vein Three cardiovascular structures Gut unique to the fetus are important Placenta for maintaining this circulation: the ductus venosus,foramen ovale, Umbilical artery and ductus arteriosus Legs A THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Fetal Circulation In the fetus, the placenta provides for gas and metabolite exchange. The lung do not provide gas exchange, and vessels in the pulmonary circulation are vasoconstricted Three cardiovascular structures unique to the fetus are important for maintaining this circulation: the ductus venosus, foramen ovale, and ductus arteriosus
Post-Nataculation At birth,mechanical expansion of the lungs and an increase in arterial PO2 result in a rapid decrease in pulmonary Postnatal circulation vascular resistance Ligamentum arteriosus The output from the right ventricle Pulmonary flows entirely into the pulmonary artery circulation Pulmonary vein The increased volume of pulmonary blood flow returning to the left atrium increases left atrial volume and pressure sufficiently to close the foramen ovale functionally Ligamentum teres) the high arterial PO,signals constriction of the ductus arteriosus and it closes THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Post-NatalCirculation At birth, mechanical expansion of the lungs and an increase in arterial PO2 result in a rapid decrease in pulmonary vascular resistance The output from the right ventricle flows entirely into the pulmonary circulation The increased volume of pulmonary blood flow returning to the left atrium increases left atrial volume and pressure sufficiently to close the foramen ovale functionally the high arterial PO 2 signals constriction of the ductus arteriosus and it closes
Physiological Changes in the circulation after Birth Changes in the pulmonary circulation Closure of the ductus arteriosus Closure of foramen ovale Arrest of circulation through the placent THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Physiological Changes in the Circulation After Birth Changes in the pulmonary circulation Closure of the ductus arteriosus Closure of foramen ovale Arrest of circulation through the placenta
Epidemiology of Congenital Heart Disease Congenital heart disease occurs in approximately 8 of 1000 live births About 2-3 out of 1000 total newborn infants will be symptomatic with heart disease in the 1st yr of life THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Epidemiology of Congenital Heart Disease Congenital heart disease occurs in approximately 8 of 1000 live births About 2-3 out of 1000 total newborn infants will be symptomatic with heart disease in the 1st yr of life
Etiology Congenital heart disease originates from a combination of genetic and environmental causes.The cause of most specific congenital heart defects is still unknown THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Etiology Congenital heart disease originates from a combination of genetic and environmental causes. The cause of most specific congenital heart defects is still unknown
Genetic Factors: (1)single gene mutation or multifactorial inheritance pattern (2) certain types of VSD (supracristal)are more common in children of Asian background (3) the recurrence risk of congenital heart disease increases from 0.8%to about 2-6%if a 1st degree relative is affected. (4) approximately 3%of patients with congenital heart disease have an identifiable single gene defect,such as Marfan or Noonan syndrome (5)5-8%of patients with congenital heart disease have an associated chromosomal abnormality:90%of trisomy 18, 50%of trisomy 21,40%of Turner syndrome THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Genetic Factors: (1) single gene mutation or multifactorial inheritance pattern (2) certain types of VSD (supracristal) are more common in children of Asian background (3) the recurrence risk of congenital heart disease increases from 0.8% to about 2-6% if a 1st degree relative is affected. (4) approximately 3% of patients with congenital heart disease have an identifiable single gene defect, such as Marfan or Noonan syndrome (5) 5-8% of patients with congenital heart disease have an associated chromosomal abnormality: 90% of trisomy 18, 50% of trisomy 21, 40% of Turner syndrome
Infective Factors: congenital rubella syndrome,congenital CMV infection Environmental Factors: physical and chemical factors Drug Factors Maternal Diseases: Diabetes mellitus,SLE THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Infective Factors: congenital rubella syndrome, congenital CMV infection Environmental Factors: physical and chemical factors Drug Factors Maternal Diseases: Diabetes mellitus, SLE
Diagnos methods History and Physical Examination ECG changes in P waves,QRS and T-wave morphologic features are indicative of atrial enlargement or ventricle hypertropy Chest X-ray cardiac size and shape(cardiothoracic ratio) pulmonary blood flow Echocardiography cardiade structure,intracardiac pressure and gradient across stenotic valves and vessels,quantitate cardiac function THE CHILDREN'S HOSPITAL ZHEJIANG UNIVERSITY SCHOOL OF MEDICINE 浙江大学医学院附属儿童医院
Diagnostic Methods History and Physical Examination ECG changes in P waves, QRS and T-wave morphologic features are indicative of atrial enlargement or ventricle hypertropy Chest X-ray cardiac size and shape (cardiothoracic ratio) pulmonary blood flow Echocardiography cardiadc structure, intracardiac pressure and gradient across stenotic valves and vessels, quantitate cardiac function