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Congenital diaphragmatic defect (pleuroperitoneal/parasternal foramen developmental defect) often with congenital diaphragmatic hernia; respiratory distress.
心胸外科Valvular aortic stenosis is most common congenital aortic outlet stenosis; 60%. Bicuspid 70%; tricuspid 30%; unicuspid/quadricuspid rare. Post-30: turbulent flow → thickening/calcification/regurgitation.
心胸外科Normal aortic valve area >3.0cm2; mild 1.5; moderate 1.0; severe <1.0. Causes: rheumatic/congenital/senile calcification. Congenital: progressive fibrosis/calcification; post-stenotic dilation; death within 1 year. Acquired: rheumatic valve disease.
心胸外科Aortic dissection is intimal/medial rupture with blood entering media; true/false lumen. Coady: 8-15% without intimal tear = intramural hematoma.
心胸外科Aortopulmonary septal defect (AP window) is rare great vessel anomaly; Stansel 1977 <100 cases reported. Between ascending aorta and main PA; physiology like PDA. Semilunar valves normal.
心胸外科Spontaneous hemothorax is non-traumatic; young males; tall thin body; bullae rupture/pleural adhesion tear; exertion/cough/straining trigger. Varies with blood volume/speed.
心胸外科Hypoplastic left heart syndrome (HLHS) is rare complex CHD; 1-27/100,000; 16/100,000 live births; 1.4% CHD. Underdeveloped ascending aorta/aortic valve/LV/mitral valve; requires PDA to survive. Asians lower incidence.
心胸外科Ventricular septal defect (VSD) is common CHD; 20% CHD; isolated or part of TOF/AVCD/DORV/TGA/PA. Left-to-right shunt; 0.1-3cm; membranous most common. Small restrictive asymptomatic; large causes CHF/growth retardation.
心胸外科Ruptured sinus of Valsalva aneurysm is rare CHD; M>F; congenital weakness of sinus base; progressive aneurysmal dilation then rupture. Right coronary sinus most common → RV; then non-coronary.
心胸外科Patent ductus arteriosus (PDA) is failure of ductus arteriosus to close after birth; left-to-right shunt from descending aorta to PA; CHF; growth retardation; recurrent pneumonia.
心胸外科Congenital aortic coarctation is 5% CHD; Western countries common. Morgagni 1760; Crafoord 1945 surgery; Calodney 1950 infant resection. 95% at isthmus near ductus. Infantile (preductal) / adult (postductal).
心胸外科Left ventricular aneurysm after MI: 10-38% transmural MI → fibrous scar; thin wall, dyskinesia; 85% anteroapical. Surgery for CHF/angina/VT/systemic embolism. LAD occlusion common.
心胸外科Pericardial cyst is congenital mediastinal mesothelial cyst; right cardiophrenic angle most common; serous fluid; benign; rarely compressive. If pedunculated communicating with pericardial cavity = pericardial diverticulum.
心胸外科Ventricular septal rupture after MI is 10% of cardiac ruptures; 1.3-2% of MI deaths. Latham 1847; Cooley 1957 repair. Usually 2 weeks post MI (24h-23d). Harsh holosystolic murmur at lower left sternal border; 50% thrill.
心胸外科Aortic dissection is intimal/medial rupture with blood entering media; true/false lumen. Sennertus 1542, Morgagni 1761, Laennec 1819. Acute <14d, subacute 14-90d, chronic >90d.
心胸外科Complete TGA: aorta from anatomic RV, pulmonary artery from anatomic LV; two parallel circulations. D-TGA: aorta right anterior to PA. Intact septum / VSD. Associated ASD/VSD/PDA/PS.
心胸外科Total anomalous pulmonary venous return (TAPVR) is all pulmonary veins not draining to LA; to RA/systemic venous system via vertical vein; 1.5-2% CHD. Types: intracardiac/supracardiac/infracardiac/mixed; with/without obstruction. Requires ASD/PFO.
心胸外科Tricuspid atresia is cyanotic CHD; 1-5% CHD; third after TOF/TGA. No tricuspid valve/TV orifice; no RA-RV communication; ASD/PFO, LV dilation, RV hypoplasia. Single left ventricular inlet.
心胸外科Acquired tricuspid regurgitation is relative (RV dilation/annular dilation in severe rheumatic MS/MR) or organic (rheumatic; leaflet thickening/retraction, chordae shortening, annulus dilation). Carcinoid syndrome causes TR.
心胸外科Anomalous origin of coronary artery from PA/aorta; left main from PA most common; bilateral PA origin dies days after birth. LCA from PA: 1/300,000 live births; 0.26% CHD.
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