Saenz R B, Beebe D K, Triplett L C
Department of Family Medicine, University of Mississippi Medical Center, Jackson 39216, USA.
Am Fam Physician. 1999 Apr 1;59(7):1857-68.
Congenital heart defects are classified into two broad categories: acyanotic and cyanotic lesions. The most common acyanotic lesions are ventricular septal defect, atrial septal defect, atrioventricular canal, pulmonary stenosis, patent ductus arteriosus, aortic stenosis and coarctation of the aorta. Congestive heart failure is the primary concern in infants with acyanotic lesions. The most common cyanotic lesions are tetralogy of Fallot and transposition of the great arteries. In infants with cyanotic lesions, hypoxia is more of a problem than congestive heart failure. Suspicion of a congenital heart defect should be raised by the presence of feeding difficulties in association with tachypnea, sweating and subcostal recession, or severe growth impairment. Follow-up of infants with congenital heart disease should follow the schedule of routine care for healthy babies with some modifications, such as administration of influenza and pneumococcal vaccines. More frequent follow-up is required if congestive heart failure is present. Family psychosocial issues should also be addressed. One of the main roles for the family physician is to help the parents put the diagnosis in perspective by clarifying expectations and misconceptions, and answering specific questions.
非青紫型和青紫型病变。最常见的非青紫型病变是室间隔缺损、房间隔缺损、房室通道、肺动脉狭窄、动脉导管未闭、主动脉狭窄和主动脉缩窄。充血性心力衰竭是患有非青紫型病变婴儿的主要问题。最常见的青紫型病变是法洛四联症和大动脉转位。在患有青紫型病变的婴儿中，缺氧比充血性心力衰竭更是一个问题。喂养困难伴呼吸急促、出汗和肋下凹陷，或严重生长发育迟缓，应引起对先天性心脏病的怀疑。患有先天性心脏病的婴儿的随访应遵循健康婴儿常规护理的时间表，并做一些调整，如接种流感疫苗和肺炎球菌疫苗。如果存在充血性心力衰竭，则需要更频繁的随访。家庭心理社会问题也应得到解决。家庭医生的主要作用之一是通过澄清期望和误解以及回答具体问题，帮助父母正确看待诊断。
