type

reason

type

reason

pulmonary artery stenosis

aortic stenosis

Left-to-right shunt (early after birth → left and right ventricular thicknesses are similar → not much shunt volume) (with age → pulmonary vascular resistance/right ventricular pressure decrease → right ventricle is thinner than left ventricle) (left heart strength > right heart → defect When blood flows from the left heart to the right) → the blood volume of the right heart is greatly increased than before → compensatory hypertrophy of the right heart → increased blood volume of the pulmonary circulation → in the later stage, thickening and stenosis of the pulmonary arteriole muscle layer → obstructive pulmonary hypertension

A grade 2-3 systolic ejection murmur can be heard in the 2-3 intercostal spaces on the left sternal border (right ventricular enlargement → stenosis through the pulmonary valve)

Hyperactive first heart sound

Fixed split (increased right heart volume → prolonged systolic time → pulmonary valve closing time > aortic valve) ★ not related to breathing

Small conduction range

Enhanced second heart sound in pulmonary artery

★Principle of murmur: relative pulmonary valve stenosis (a large amount of blood flow passes through the normal pulmonary valve causing relative pulmonary valve stenosis)

x-ray performance

Electrocardiogram (because of passive right ventricular enlargement)

cardiac catheterization

left atrium blood → left ventricle

small defect

medium defect

large defect

usually split

x-ray examination

Echocardiogram (first test)

★Surgery contraindications (Eisenmenger syndrome, pulmonary hypertension)

The opening of the ductus arteriosus in the fetus is an important channel for blood circulation.

15 hours after birth

The aorta exceeds the pulmonary artery in both systole and diastole → therefore the ductus arteriosus shunts from left to right → left atrium and left ventricle ascending aortic blood flow increases → long-term large blood flow impacts the pulmonary circulation → pulmonary hypertension → right heart hypertrophy or even failure

★When pulmonary artery pressure > aortic pressure → left-to-right shunt decreases/stops → pulmonary artery blood flow counterflows into the descending aorta → the child may be differentially cyanotic

Continuous mechanical murmur above the left sternal border → the murmur is conducted toward the left subclavian, neck, and back

Enhanced second heart sound in pulmonic valve area

There may be peripheral vascular disease → water pulse, shooting sound, capillary pulsation sign

Arterial systolic blood pressure remains unchanged, diastolic blood pressure decreases → peripheral vascular sign

Increased pulse pressure (reduced systemic circulation and increased pulmonary circulation) → decreased diastolic blood pressure → increased pulse pressure difference

When there is significant pulmonary hypertension → cyanosis of the lower body may occur (at this time the pulmonary artery → aorta → a large amount of venous blood flows into the systemic circulation)

X-ray shows → enlarged aortic arch (high blood flow, mitral stenosis)

Interventional treatment of choice

Indomethacin can be used in most premature infants with patent systasis

Pulmonary valve stenosis → passive increase in right ventricular systolic pressure (because there is no defect in the ventricular septum, so in severe stenosis → right ventricular pressure > left ventricle → right heart failure)

The right ventricular lifting pulse can be palpated on the left parasternal side.

An ejection murmur can be heard in the 2/3 intercostal space on the left sternal border

First heart sound normal

Split second heart sound Second heart sound weakened

jugular venous distention

Severe stenosis may cause clubbing and bruising

The noise is: click sound

Right ventricular hypertrophy and strain

Right ventricular outflow tract obstruction (mainly pulmonary artery stenosis malformation)

ventricular septal defect

aortic straddling

right ventricular hypertrophy

In the presence of ventricular septum, pulmonary artery stenosis is mild → left-to-right shunt (no cyanosis)

Under ventricular septum, severe pulmonary artery stenosis → right-to-left shunt (obvious cyanosis)

Right ventricular outflow tract obstruction → increased right ventricular afterload → compensatory right ventricular hypertrophy

The aorta rides over both ventricles → the aorta receives blood from the left ventricle and the right ventricle → sends it to the whole body → bruises

Bruising (earliest appearance) → More common in superficial areas with rich capillaries (lips, nail beds, conjunctiva)★ Bruising after activity

Symptoms of squatting (active squatting during walking games → squatting and flexion → reduced venous return to the heart → reduced heart load)

Clubbing of fingers (cyanosis lasting for more than six months → clubbing of fingers) → long-term hypoxia → telangiectasia, proliferation and hypertrophy

Paroxysmal hypoxic attacks (mainly pulmonary infundibular spasm)

x-ray examination

Head down and legs up position