26619169-Malformatii-cardiace-congenitale

7/30/2019 26619169-Malformatii-cardiace-congenitale

1/44

MALADII CONGENITALE

CARDIACE


2/44

MCC CIANOGENE

Tetralogia Fallot (trilogie, pentalogie) Atrezia de tricuspid

Hipoplazia de cord stng Trunchiul arterial comun Transpoziia de vase mari (D- sau L-)

Maladia Ebstein Drenajul venos aberant


3/44

TETRALOGIA FALLOT

10% din MCC 35-75% din MCCC Anomalii stenoza pulmonar (infundibul)

- DSV- dextropoziia aortei- HVD

Presiuni sistolice egale VS, VD, Ao Clinic Radiologic cord n sabot


4/44

AD

VS


5/44


6/44

TETRALOGIA FALLOT

ECG deviere axial dr, HVD Ecocardiografia


7/44


8/44

TRILOGIA FALLOT

5%

Anomalii stenoz pulmonar (valvular) -DSA ostium secundum - HVD

Clinic Radiologic

ECG

Ecocardiografic


9/44


10/44

PENTALOGIE FALLOT

Anomalii stenoza arterei pulmonare- DSA- DSV- dextropoziia aortei- HVD


11/44


12/44

ATREZIA TRICUSPIDIAN

2-5% Anomalii - absena-imperforaia valvei

- HAD

- AS mrire progresiv- DSA- VD hipoplazic

- DSV- artera pulmonar - hipoplazie- PCA


13/44

ATREZIA TRICUSPIDIAN

Clinic Radiologic

ECG axa la stnga, HAD, HVS Ecocardiografic


14/44


15/44

HIPOPLAZIA DE CORD STNG

3% - mai ales la Anomaliivalve aortice atrezie-

hipoplazie - aorta hipoplazic- valva mitral atrezie-hipoplazie - DSA ostiumsecundum - PCA

- DSV- HVD


16/44

AD VS


17/44

HIPOPLAZIA DE CORD STNG

Clinic Radiologic

ECG Ecocardiografic


18/44


19/44

TRANSPOZIIA DE VASE MARI (D-)

15-20% - primele 2 luni Anomalii Ao din VD

- AP din VS- DSV- stenoz pulmonar- PCA

- Foramen ovale permeabil


20/44

ADVS


21/44

TRANSPOZIIA DE VASE MARI (D-)

Clinic Radiologic pensarea pediculului

vascular - ou culcat pediafragm

ECG axa hiperdeviat la dreapta

Ecocardiografia


22/44


23/44

TRANSPOZIIA CORECTAT (L-)

Inversiune ventricular concomitent Anatomic AD valv mitral VS AP

- AS valv tricuspid VD Ao- artere coronare inversate- n asociere cu alte anomalii

Clinic Radiologic 2 arcuri convexe ECG Q n precordiale drepte, bloc AV


24/44

TRUNCHI ARTERIAL COMUN

1-4% Anomalii o valv semilunar comun - un

vas de calibru mare - se ramific Ao,AP, Acoronare - DSV - foramenovale persistent

Calibrul AP tetralogie Fallot -

transpoziie de vase mari


25/44

AD

VS


26/44


27/44

TRUNCHI ARTERIAL COMUN

Clinic semne de shunt stg-dr- cianoz- pulsul foarte amplu

Radiologic cord n sabot- cord ovoid

ECG Ecocardiografic


28/44


29/44

MALADIA EBSTEIN

0,5-1% Anomalie de inserie a valvei tricuspide Reducere a VD Asocieri DSA,stenoz-atrezie pulmonar Clinic Radiologic bombarea arcului drept ECG BRD, tulburri de ritm Ecocardiografic


30/44

MALADIA EBSTEIN

AD VS


31/44


32/44

DRENAJ VENOS PULMONAR ANORMAL

2% - total Anomalii vene pulmonare AD

(supracardiac - 55%,

retrocardiac 25%,infracardiac 15%)- DSA obligatoriu

Clinic Radiologic om de zpad ECG HAD marcat, BRD


33/44


34/44


35/44

COARCTAIA AORTEI

7-10% - n sd. Turner Reducerea - lumenului cu 50%

- diametrului cu 80% Preductal tip infantil Postductal tip adult

Circulaie colateral Asociere - PCA


36/44

COARCTAIA AORTEI

Consecine HTA n amonte- hipoTA n aval- HVS

La sugar puls la femurale absent- gradient peste 20 mm Hg

(absent dac se asociaz PCA)

La copilul mare complicaii


37/44

COARCTAIA AORTEI

Clinic Radiologic

ECG Ecocardiografie


38/44


39/44


40/44

Complicaiile MCC

Insuficiena cardiac dreapt- stng

Crizele hipoxice Infecioase endocardit

- abces cerebral

Stroke HTA- Hipervscozitate


41/44

TRATAMENT

Medical Digoxin- Diuretice- PgE2

- Indometacin Chirurgical corector

- paleativ

Intervenii prin cateterism


42/44

CHIRURGIE PALEATIV

SHUNT AP-Ao - Blalock-Taussig -- Potts Aod-APs- Waterston Aoa-APd

Mrirea DSA Rashkind- Blalock-Hanlon


43/44


44/44

CHIRURGIE - CORECIE

DSA, PCA intervenii prin cateterism Intervenii pe cord deschis

- TVM (D-) Jatene arterial- Mustard atrial -

- Hipoplazia de cord stng- Norwood VD-Ao

- Ao-AP

Documents

26619169-Malformatii-cardiace-congenitale