tailieunhanh - Examination of the Newborn - part 8

X-quang ngực cho thấy một biên giới trái tim lõm gắn với các lĩnh vực phổi oligaemic. Con yêu cầu khẩn cấp giới thiệu đến tim mạch. Điều trị thường là phẫu thuật, nhưng co thắt có thể được ngăn chặn bằng cách sử dụng của propranolol. | ABNORMAL FINDINGS AND CONGENITAL ABNORMALITIES 145 FIGURE Fallot s tetralogy A chest radiograph shows a concave left heart border in association with oligaemic lung fields. The baby requires urgent referral to the cardiologists. Treatment is usually surgical but spasm may be prevented by the use of propranolol. TOTAL ANOMALOUS PULMONARY VENOUS DRAINAGE TAPVD This is a rare but it can be mistaken for lung disease in a neonate. Abnormal drainage of the pulmonary veins to one of several places results in obstruction of the vessel s with subsequent pulmonary venous congestion. The baby is tachypnoeic and cyanosed. There may be a loud pulmonary second sound because of the pulmonary hypertension that develops as a result of the congestion. Sometimes the chest X-ray is diagnostic but the opinion of a cardiologist is usually required to confirm the diagnosis. EBSTEIN S ANOMALY In this rare condition the baby may present with neonatal cyanosis. The right atrium is enlarged at the cost of the size of the 146 EXAMINATION OF THE NEWBORN right ventricle. The tricuspid valve is also abnormal and incompetent. The baby is cyanosed and there are additional heart sounds as well as the systolic murmur of tricuspid incompetence. A chest radiograph shows a large globular wall-to-wall heart with right atrial enlargement and oligaemic lung fields. An ECG shows tall P waves. The opinion of a cardiologist is usually required to confirm the diagnosis. Acyanotic congenital heart disease VENTRICULAR SEPTAL DEFECT FIGURE This is the commonest of all congenital heart defects. It may be associated with other cardiac anomalies. It can occur in the membranous portion of the septum or in the muscular part. In the neonatal period these defects may be asymptomatic and there may not even be an audible murmur. In the larger defects as the pulmonary vascular resistance falls the flow across the defect from left to right increases the lower left sternal pansystolic murmur develops and heart .

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