BAIBAOCAO HB1 English Congenital heart disease ASEAN Congress

BAIBAOCAO HB1 English Congenital heart disease ASEAN Congress tài liệu, giáo án, bài giảng , luận văn, luận án, đồ án, b...

T he spectrum of congenital malformations of the heart is diverse and ranges from mild cardiac changes without substantial hemodynamic relevance to severe congenital heart disease, from cardiac conditions that do not require surgery to severe, inoperable conditions. Consequently, the physical exercise capability in children with congenital heart conditions varies widely. In mild, uncomplicated cardiac malformations, exercise capability remains normal. Where the congenital heart conditions are serious, however, exercise capability is clearly reduced (1, e1, 2, e2, 3, e3, 4, 5, 6). However, it is not only these children who show limitations. In some children with mild or completely corrected malformations, reduced exercise capability is probably predominantly related to overprotection and the resulting lack of exercise; this can be balanced by suitable exercise training (7). Even doctors often advise restrictions quite unnecessarily in this setting. Sports for children covers a wide range of activities that place very different demands on the body: from swimming for infants, gymnastics for mothers and children, leisure time play/exercise, sports in schools, sports in clubs, to competitive sports. Thus far, only few, mostly small, studies have dealt with the effects of sport on children with congenital heart problems. Without exception, these show the positive effects of sports on psychomotor development and physical exercise capacity in such children. None of the studies reported any deterioration of the hemodynamic function and/or increased health risks to the children. Larger, randomized controlled trials are urgently needed in this area. This article aims to provide doctors practising in their own practices with information that might help them assess the exercise capacity of children with cardiovascular conditions and provide targeted recommendations about their fitness to exercise. Dtsch Arztebl 2007; 104(9): A 563–9 ⏐⏐ www.aerzteblatt.de 1 MEDICINE SUMMARY Introduction: Children with congenital heart disease (CHD) can participate in sport on an individualized basis, if their exercise capability is formally tested. Methods: Selective review of the literature on sport in children with CHD, and analysis of the authors' own findings. Results: Few studies have addressed the effects of regular sporting activities on children with CHD. The available literature confirms that regular sport has a positive effect on exercise capacity and psychomotor development in this group of children, without any negative hemodynamic effects or additional risks. Discussion: The current internationally accepted recommendations on physical activity and sport for children with CHD are almost entirely based on diagnosis. It may however be more appropriate to classify children in terms of their current hemodynamic status. Children have a basic need for physical activity which is an integral aspect of normal somatic, motor, emotional, psychosocial and cognitive development. The majority of children with CHD following corrective surgery or definitive palliation may participate in normal sporting activities in an unrestricted fashion. Recommendations concerning sport should also be based on a hemodynamic classification, taking into account the nature of the condition, disease severity, and potential risks. Dtsch Arztebl 2007; 104(9): A 563–9. Key words: congenital heart disease, psycho-motor development, physical activity, physical performance Klinik und Poliklinik VIETNAM HEART INSTITUTE HANOI MEDICAL UNIVERSITY Echocardiography guides for congenital heart disease intervention Truong Thanh Huong, MD, PhD INTRODUCTION Interventional therapeutic catheterization procedures for CHD have replaced cardiac surgery in many types of defects Echocardiography is being used to diagnose CHD, guide, evaluate immediate and late results of these interventional procedures In this presentation, we will detail the role of echocardiography in closure of ASD, VSD, PDA, congenital coronary artery fistulas; balloon dilation of PVS ATRIAL SEPTAL DEFECT DEFINITION - An ASD is a hole in atrial septum that separates the right and left atria - ASDs account for between and 10% of all cases of CHD and are twice as prevalent among girls and boys ANATOMICAL CLASSIFICATION Ostium Secundum Defect: 70% Ostium Primum Defect: 15-20% Sinus Venosus Defect: 5-10% Coronary sinus Defect: rare Schematic drawing showing the different types of ASD Ostium secundum defect The typical findings in a secundum ASD The present of the defect is confirmed by color flow mapping Pulse-wave Doppler recording of the velocity across a ASD with left-toright shunting during both systole and diastole Sinus venosus defect Defect was seen in the upper atrial wall Coronary sinus defect Fenestrated ASDs : holes Subcostal view illustrating color Doppler flow images of a fenestrated atrial septum with left-to-right shunting through two defects Amplatzer Septal Occluder Indication - Secundum type ASDs, diameter ≤ 34 mm - SVC, IVC, AV valve and RUPV rims are at least mm - Significant left-to-right shunt: Qp/Qs > 1.5 and right heart chamber enlargement - Small ASD or PFO with atrial arrythmia or paradoxal embolism Transpulmonic valvar gradient INDICATION OF BALLOON VALVULOPLASTY  Isolated valvular pulmonary stenosis with transpulmonic valve gradient > 50 mmHg  Infundibular pulmonic stenosis or dysplastic pulmonary valves: valvuloplasty only for pts being operated or impossible surgically corrected CHD)  Tetralogy Fallot, CHD with cyanose: Balloon dilation is for pts with severe cyanose or for pts being completely corrected by surgery Echocardiography in the cath.lab Echocardiography can identify if the catheters centered across pulmonary valves before inflating the balloon Residual obstruction and insufficiency caused by balloon dilation procedure The cusp perforation or avulsion Echocardiography after procedure - RV and LV dimensions, RV systolic pressure, thickness of RV wall - Septal mouvement - Diameter of PA - Transpulmonic and transinfundibular gradients - Pulmonary regurgitation CONGENITAL CORONARY ARTERY FISTULA DEFINITION  Anomalous connection of a coronary artery with a cardiac chamber or major thoracic vessel  Rare malformation: 1/ 50.000 of all CHD ECHOCARDIOGRAPHIC CONSIDERATIONS ORIGIN OF CORONARY ARTERY FISTULAS: Dilation of the coronary artery, its diameter exceeds mm TRAJECTORY : Tortuous, dilated; +/- aneurysmal dilatation in the region of the fistula DRAINAGE SITE: disturbed continuous flow in Color Doppler mapping FUNCTIONAL CONSEQUENCES: The chamber or vessel into which the fistula drains is dilated The potential ischemic effects of a coronary steal: evaluate global and regional wall motion ORIGIN OF CORONARY ARTERY FISTULAS The proximal right coronary artery is markedly dilated TRAJECTORY OF CORONARY INVOLVED Coronary involved is tortuous and dilated TRAJECTORY OF CORONARY INVOLVED Color flow mapping shows turbulent flow (arrow) in the RA (drainage of the right coronary fistula) ECHOCARDIOGRAPHY POST CATETHERIZATION OTHER MALFORMATIONS ECHOCARDIOGRAPHY IS CRUCIAL IN Balloon dilation and stent management of stenotic BT bypass, restrictive PDA in tetralogy, branch pulmonary artery stenosis, coarctation of the aorta, Balloon dilation of aortic stenosis, LA membranous stenosis in cor triatriatum ECHOCARDIOGRAPHY IS CRUCIAL IN Percutaneous transluminal septal myocardial ablation in HOCM  Occlusion of arteriovenous pulmonary fistulas  Balloon atrial septostomy in transposition great artery, pulmonry atresia, total anomalous pulmonary venous connection 116 Asian Nursing Research ❖ September 2007 ❖ Vol 1 ❖ No 2 ORIGINAL ARTICLE INTRODUCTION Approximately 2–3 of 1000 infants are born with congenital heart disease (CHD) in Korea (Lee, Kim, Jung, Kim, & Choi, 2001). As a result of dramatic advances in the medical and surgical management of CHD, 85% of infants with CHD are now expected to survive to adulthood, and CHD is regarded as a chronic disease rather than a terminal one (Lee, 2001). However, the management of CHD involves repeated invasive procedures, hospitalization, and often prognostic uncertainty. All of these can be stressful for children and their families (Peterson & Harbaugh, 1995). Accordingly, parents continue to have concerns about how their child’s illness and treatment affect their child’s daily functioning, devel- opment, and overall wellbeing (Van Horn, DeMaso, Gonzalez-Heydrich, & Ericson, 2001). DeMaso, Beardslee, Silbert, and Fyle (1990) reported that the behavioral adjustment of children with CHD was significantly related to the level of parenting stress. The poor psychological adjustment Parenting Stress in Mothers of Children with Congenital Heart Disease Sunhee Lee 1 *, RN, MSN, Ji-Soo Yoo 2 , RN, PhD, Il-Young Yoo 2 , RN, PhD 1 PhD Candidate, College of Nursing, Yonsei University, Seoul, Korea 2 Professor, College of Nursing, Yonsei University, Seoul, Korea Purpose The main purposes of this study were to examine the relationships among uncertainty, social support and parenting stress in mothers of children with congenital heart disease (CHD) and to identify the factors related to parenting stress. Methods This was a survey study using a questionnaire. Fifty-one mothers of children with CHD were recruited at the pediatric cardiac outpatient clinic at one university-affiliated hospital in Seoul between July 14th and September 25th, 2006. Abidin’s Parenting Stress Index–Short Form, Mishel’s Parents’ Perception Uncer- tainty in Illness Scale, and Brandt and Weinert’s Personal Resource Questionnaire were used to collect data. Results The results of bivariate analysis showed that parenting stress was significantly related to social support, ambiguity, lack of clarity, and lack of information, but was not related to unpredictability, one of the subconcepts of uncertainty. Multiple regression analysis showed that parenting stress was significantly related to social support and Internet information. Conclusion Mothers who reported they had more social support and less uncertainty showed lower parent- ing stress. Also, the Internet could be an effective method to obtain information and to share child-rearing experiences with other mothers of children with CHD. [Asian Nursing Research 2007;1(2):116–124] Key Words congenital heart disease, parenting, stress, uncertainty *Correspondence to: Sunhee Lee, RN, MSN, College of Nursing, Yonsei University, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. E-mail: sunhee418@yahoo.co.kr 117 and anxiety of children with CHD were related more to maternal anxiety and pampering than to the degree of incapacity or severity of disease (Linde, Rasof, Dunn, & Rabb, 1966). Mattie-Luksic, Javornisky, and DiMario (2000) reported that the factors that helped mothers to cope with their children’s disease were having information about the disease, communicating with knowledgeable professionals, understanding cause/treatment, and participating in a support group. One of the most significant difficulties encoun- tered by the parents of children Nomenclature and Classification of Congenital Heart Disease Jeffrey P. Jacobs, M.D. The Congenital Heart Institute of Florida (CHIF) All Children’s Hospital Children’s Hospital of Tampa University of South Florida Cardiac Surgical Associates of Florida (CSAoF) Saint Petersburg and Tampa, Florida, United States of America Thoracic Surgery Directors Association (TSDA) Curriculum for Congenital Heart Surgery January, 2011 Cardiac Description 1. the segmental anatomy of the heart 2. the classification of the cardiac lesion 3. the description of the cardiac lesion Left and Right For cardiac chambers: ‘‘left’’ refers to morphologically left and ‘‘right’’ refers to morphologically right. Cardiac Relations and Cardiac Connections Cardiac relations describe the broad interspatial relations between the various cardiac structures. Cardiac connections describe the specific mechanism by which two cardiac structures connect to each other regardless of their interspatial relations. Segmental Approach Van Praagh & Vlad 1. the sidedness of the atrial chambers, or, in other words, the atrial “situs”, 2. the ventricular topology, in other words, the ventricular “loop”, and 3. the relationships of the arterial trunks in space Atrial ‘‘situs’’ (the sidedness of the atrial chambers) • The viscera and atria: The types of visceroatrial situs – S solitus (otherwise known as normal arrangement) – I inversus (or the mirror-imaged arrangement) – A ambiguus ‘‘Situs ambiguus is defined as an abnormality in which there are components of situs solitus and situs inversus in the same person. Situs ambiguus, therefore, can be considered to be present when the thoracic and abdominal organs are positioned in such a way with respect to each other as to be not clearly lateralized and thus have neither the usual, or normal, nor the mirror-imaged arrangements.’’ Visceral Situs William T. Mahle, MD Associate Professor of Pediatrics Emory University School of Medicine Norman H Silverman Stanford University Lucile Packard Children’s Hospital Ventricular Topology (Ventricular Loop) • The viscera and atria: The types of visceroatrial situs – S solitus – I inversus – A ambiguus • The ventricular topology – D D-loop ventricles, – L L-loop ventricles Morphologically Right Ventricle Robert Anderson [...]... position of the heart and the orientation of its apex Cardiac Description 1 the segmental anatomy of the heart 2 the classification of the cardiac lesion 3 the description of the cardiac lesion • • • • • • • • • • • • • • • • • • Ventricular septal defect Atrial septal defect Patent ductus arteriosus Aortic coarctation Congenital aortic stenosis Tetralogy of Fallot Pulmonary stenosis Transposition of the... Aiello VD, The nomenclature, definition and classification of cardiac structures in the setting of heterotaxy Béland MJ, Colan SD, Gaynor JW, Krogmann ON, Abnormal Brain Development in Newborns with Congenital Heart Disease original article T h e ne w e ngl a nd j o u r n a l o f m e d icine n engl j med 357;19 www.nejm.org november 8, 2007 1928 Abnormal Brain Development in Newborns with Congenital Heart Disease Steven P. Miller, M.D., C.M., Patrick S. McQuillen, M.D., Shannon Hamrick, M.D., Duan Xu, Ph.D., David V. Glidden, Ph.D., Natalie Charlton, B.S., Tom Karl, M.D., Anthony Azakie, M.D., Donna M. Ferriero, M.D., A. James Barkovich, M.D., and Daniel B. Vigneron, Ph.D. From the Departments of Neurology (S.P.M., D.M.F., A.J.B.), Pediatrics (P.S.M., D.M.F., A.J.B.), Radiology (D.X., N.C., A.J.B., D.B.V.), Epidemiology and Biosta- tistics (D.V.G.), and Surgery (T.K., A.A.), University of California at San Francisco, San Francisco; the Department of Pediat- rics, University of British Columbia, Van- couver, Canada (S.P.M.); and the Depart- ment of Pediatrics, Emory University, Atlanta (S.H.). Address reprint requests to Dr. Miller at the Division of Neurology, BC Children’s Hospital, K3-180, 4480 Oak St., Vancouver, BC V6H 3V4, Canada, or at smiller6@cw.bc.ca. N Engl J Med 2007;357:1928-38. Copyright © 2007 Massachusetts Medical Society. A b s t r a c t Background Congenital heart disease in newborns is associated with global impairment in devel- opment. We characterized brain metabolism and microstructure, as measures of brain maturation, in newborns with congenital heart disease before they underwent heart surgery. Methods We studied 41 term newborns with congenital heart disease — 29 who had trans- position of the great arteries and 12 who had single-ventricle physiology — with the use of magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and diffusion tensor imaging (DTI) before cardiac surgery. We calculated the ratio of N-acetylaspartate to choline (which increases with brain maturation), the ratio of lactate to choline (which decreases with maturation), average diffusivity (which decreases with maturation), and fractional anisotropy of white-matter tracts (which increases with maturation). We compared these findings with those in 16 control newborns of a similar gestational age. Results As compared with control newborns, those with congenital heart disease had a de- crease of 10% in the ratio of N-acetylaspartate to choline (P = 0.003), an increase of 28% in the ratio of lactate to choline (P = 0.08), an increase of 4% in average diffusiv- ity (P<0.001), and a decrease of 12% in white-matter fractional anisotropy (P<0.001). Preoperative brain injury, as seen on MRI, was not significantly associated with find- ings on MRS or DTI. White-matter injury was observed in 13 newborns with con- genital heart disease (32%) and in no control newborns. Conclusions Term newborns with congenital heart disease have widespread brain abnormalities before they undergo cardiac surgery. The imaging findings in such newborns are similar to those in premature newborns and may reflect abnormal brain develop- ment in utero. Downloaded from www.nejm.org on February 18, 2008 . Copyright © 2007 Massachusetts Medical Society. All rights reserved. Br ain Development in Newbor ns with Congenital Heart Dise ase n engl j med 357;19 www.nejm.org november 8, 2007 1929 I n the united states, severe congeni- tal heart disease is a common cause of child- hood CONGENITAL HEART DISEASE – SELECTED ASPECTS Edited by P. Syamasundar Rao Congenital Heart Disease – Selected Aspects Edited by P. Syamasundar Rao Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Marina Jozipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team Image Copyright Nixx Photography, 2011. Used under license from Shutterstock.com First published December, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Congenital Heart Disease – Selected Aspects, Edited by P. Syamasundar Rao p. cm. ISBN 978-953-307-472-6 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Overview of Congenital Hear Defects 1 Chapter 1 Congenital Heart Defects – A Review 3 P. Syamasundar Rao Part 2 Prevalence and Etiology 45 Chapter 2 Epidemiology and Etiology of Congenital Heart Diseases 47 Jarun Sayasathid, Kanchapan Sukonpan and Naraporn Somboonna Chapter 3 Recent Advances Concerning the Molecular Mechanism of Patent Ductus Arteriosus 85 Susumu Minamisawa and Utako Yokoyama Chapter 4 Bone Morphogenetic Protein Signaling Pathways in Heart Development and Disease 97 Cristina Harmelink and Kai Jiao Chapter 5 Molecular Mechanisms of Congenital Heart Disease 121 Jing-bin Huang and Jian Liang Chapter 6 Drosophila Model of Congenital Heart Diseases 141 Georg Vogler, Rolf Bodmer and Takeshi Akasaka Part 3 Individual Heart Defects 159 Chapter 7 Congenitally Corrected Transposition of the Great Arteries 161 English C. Flack and Thomas P. Graham VI Contents Chapter 8 Proximal Anomalous Connections of Coronary Arteries in Adults 183 Pierre Aubry, Xavier Halna du Fretay, Patrick A. Calvert, Patrick Dupouy, Fabien Hyafil, Jean-Pierre Laissy and Jean-Michel Juliard Part 4 Management of Congenital Heart Disease 231 Chapter 9 Evaluation and Emergency Treatment of Criticlly Ill Neonate with Cyanosis and Respiratory Distress 233 Emina Hadzimuratovic and Admir Hadzimuratovic Chapter 10 Fontan Surgery: Experience of One Cardiovacular Center 253 Monica Guzman, Juan Marcos Guzman and Miguel Ruz Part 5 International Issues 261 Chapter 11 Challenges in ... In this presentation, we will detail the role of echocardiography in closure of ASD, VSD, PDA, congenital coronary artery fistulas; balloon dilation of PVS ATRIAL SEPTAL DEFECT DEFINITION - An... AV valve and RUPV rims are at least mm - Significant left-to-right shunt: Qp/Qs > 1.5 and right heart chamber enlargement - Small ASD or PFO with atrial arrythmia or paradoxal embolism ECHOCARDIOGRAPHIC