儿童先天性心脏病cardiovascular_diseases in children(英文课件)

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1、CongenitalHeartDiseasesinChildren（GeneralIntroduction）Dr.LiuChonghaiCardiovascularDiseasesinChildrenCongenitalheartdiseasesViralmyocarditisRheumaticheartdiseaseCardiomyopathyKawasakiDiseaseArrhythmiaCongestiveheartfailurePericarditisInfectiveendocarditisEtc….Congeni

2、talHeartDiseasesDefinition：CardiovascularmalformationspresentduringembryonicstagesCHDaccountsfornearly1/3ofallmajorcongenitalanomalies.25%arelifethreateningandrequireearlyintervention.TheprevalenceofCHDininfancyisestimatedat6-8per1000livebirths.(Indian)－7~8/1000newb

3、orns（reporteddata）(China)－6.87/1000newbornsinShanghai（Epidemiologicsurveyduring1989～1991）PrevalenceEtiologicConsiderationsHereditaryfactors(Associatedwith15%CHD)Trisomiesofchromosome21,18,15,13Deletionofchromosome22q11Genedefects：－DefectsofElastininWilliam’ssyndrome

4、－MutationsofFibrillininMarfan’ssyndrome－MutationsofTbx5inHolt-Oramsyndrome－MutationsofCx43inhypoplasticleftheartEtiologicConsiderationsEnvironmentalfactorsExposedtothefollowingfactorsduringthefirsttrimesterofpregnancy－Viralinfections:rubella,influenza,enterovirus,pa

5、rotitis－Physicalandchemicalfactors:drugs,radiation,alcohol,tobacco－Maternitydiseases:diabetes,connectivetissueproblems,hypertensionsyndromePathogenesisHypostasis：－Heartdevelopmentisaverycomplexprocessinvolvingmanycoordinatedsteps－Abnormalembryologicaldevelopmentofth

6、eheartleadstoCHDMechanism：－GeneticbasisinteractedwiththeenvironmentalfactorsplayrolepossiblyinmostcasesFetalHeartDevelopmentFormationofprimitivehearttubeLoopingofprimitivehearttubeFormationofendocardialcushionFormationofinteratrialseptumFormationofinterventricularse

7、ptumSeptationofaorticandpulmonaryarteriesFormationandLoopingofPrimitiveHeartTube3weeksofintrauterinelife4weeksofintrauterinelife5-6weeksofintrauterinelife7-8weeksofintrauterinelife11FetalCirculation&ChangesafterBirthafterbirthbeforebirthDifferencesbetweenthefetalan

8、dpostnatalcirculationPresenceofplacentalcirculation,whichprovidesgasexchangeforthefetus.Absenceofgasflowofbloodtothelungsandthuslittlepulm