Congenital heart disease (CHD) is a malformed condition caused by abnormal cardiovascular development during the embryonic period and is a common heart disease in children. The exact etiology is not well understood, but recent studies suggest that it is associated with genetics, especially chromosomal abnormalities (trisomy 21, trisomy 13, 15), intrauterine infections (e.g., rubella, toxoplasmosis), exposure to radiation, nutritional deficiencies (e.g., folic acid deficiency), drug effects (e.g., use of anticancer drugs, methylglyoxal), metabolic disorders (diabetes mellitus, hypercalcemia, phenylpropionic acid ketonuria), and intrauterine chronic Chronic diseases such as hypoxia are related. It is generally believed that any of these factors can affect the development of the embryonic heart during the third to eighth week of embryonic development, causing the development of a part of the heart to stop or develop abnormally, resulting in various types of congenital heart disease. The incidence of each type of heart disease is in the order of ventricular septal defect, patent ductus arteriosus, atrial septal defect, and tetralogy of Fallot. Ancillary tests include echocardiography, electrocardiogram, X-ray, and cardiac catheterization. Hong Xuan, Department of Thoracic Surgery, Shanghai Oriental Hospital Congenital heart disease is very complex and often has combined malformations. With the development of cardiothoracic surgery, practice has confirmed that many intracardiac malformations cannot be completely diagnosed clearly before surgery by physical examination and 2D color Doppler fan scan in all cases. Diagnosis must be done with caution and extra vigilance. For children with congenital heart disease, all factors that can cause accelerated heart rate in children should be avoided, such as crying, noise, heat and cold, agitation, etc. It is also necessary to prevent diseases such as cold, fever and respiratory distress. I. Atrial septal defect ASD The defect on the left and right atrial septum is called atrial septal defect (ASD), which accounts for about 1/10-20 of congenital heart disease, and the murmur of atrial defect is light and is often found only during physical examination. The atrial defect is located at the site of the foramen ovale, which is the central type or II foramen type; located at the lower part connected with the mitral and tricuspid annulus, which is called the primary foramen type or I foramen type; located at the location where the superior and inferior vena cava enters the right atrium, which is called the vena cava sinus type; located at the coronary sinus, which is called the coronary sinus type. Diagnostic points 1. Symptoms: Small defect diameter and small blood flow can be completely asymptomatic. If the defect is large, the left-to-right flow will affect the growth and development of the child, appearing weakness, excessive sweating, wasting, shortness of breath after activity, and easy to suffer from lower respiratory tract infection. 2. Signs: If the defect is small and the flow is low, only a grade II systolic murmur can be heard at the left border of the sternum, and the second heart sound (P2) in the pulmonary valve area is split. In large defects, there may be an anterior elevation of the precordial region, diffuse apical pulsation, and a grade II-III jet systolic murmur can be heard at the third intercostal space on the left sternal border, with hyperactive and fixed splitting of the second heart sound in the pulmonary valve region. When the left-to-right shunt flow is high, a mid-diastolic rumble-like murmur can be heard at the lower left sternal border. 3. The progressive development of ASD may be manifested as right bundle branch conduction block on electrocardiogram, and chest X-ray shows more pulmonary blood, enlarged cardiac shadow, and enlarged right atrium and right ventricle, and most atrial defects can be clearly diagnosed by echocardiography or with the help of acoustic imaging and esophageal ultrasound. Treatment principles 1. The overall natural closure rate of atrial septal secondary foramen ovale defects is 87%; 100% of atrial septal defects with defects <3mm diagnosed before 3 months of age can be spontaneously closed within 1.5 years of age; more than 80% of atrial septal defects with defects between 3-8mm can be spontaneously closed within 1.5 years of age; few of those with defects above 8mm can be spontaneously closed. In general, ASDs are rarely symptomatic in the early stages, and small ASDs can be left unoperated for life. By adult age, if there is recurrent cerebral infarction, small emboli of its venous system, through atrial defect into the left heart, to the small arteries of the brain and cause cerebral infarction. In recent years, the type and number of minimally invasive interventional treatment methods through pediatric internal medicine instead of surgical treatment have increased rapidly, and most of the secondary foramen type atrial septal defects can already be treated by interventional methods. 2. Primary foramen ovale defects have mild symptoms in infancy and are prone to pulmonary hypertension in childhood. Repair surgery is usually performed before school age (4-5 years). Those with combined mitral regurgitation for which drug treatment is ineffective should undergo surgery. Complete atrioventricular access is also within the scope of endocardial cushion defect, and children often have respiratory infection, pulmonary hypertension or heart failure, which can be surgically repaired within 1 year of age. 3, secondary hole defect fractional flow is very small and no pulmonary hypertension, there is no indication for surgery. In a few cases, the defect flow is large or heart failure occurs, drug treatment is effective, and most of them can be postponed to 4-5 years old for repair, because the tolerance of children at this age is greater than that of small babies. 4, atrial septal defect catheter interventional closure: since 1972, the trial of ASD closure via catheter intervention began, the earliest application of single umbrella method, later improved to double umbrella method, and in recent years improved to button double disc device to close ASD. some domestic hospitals have begun to trial. Some scholars have proposed that interventional treatment can be considered for patients with small atrial defects and unclosed foramen ovale, which can be closed by introducing a double-sided umbrella method with catheters without direct intracardiac surgery. There are several methods of catheter closure of atrial defects, most of which require atrial defects less than 2 cm. medium to large atrial defects require surgical repair treatment, and the results are very satisfactory. Currently, cardiac surgery is performed with small incisions or non-stop heart repair to reduce the complications of surgery. If the atrial defect is accompanied by severe pulmonary hypertension, the surgical result is poor. 1. Symptoms: small defects can be asymptomatic; medium-sized defects are prone to lower respiratory tract infections and occasional heart failure; large defects often suffer from repeated respiratory tract infections and pneumonia, poor growth and development, wasting, weakness, shortness of breath after activity, and prone to heart failure. 2, signs: small defects can be heard in the left sternum like 3, 4 intercostal interval III-IV rough systolic murmur, the second sound of pulmonary valve (P2) is not hyperactive, can be felt tremor. In medium-sized defects, the left precordial area can be elevated, and a grade III-IV rough all-systolic murmur can be heard between the left image of the sternum and the third and fourth ribs, and the second pulmonary valve sound (P2) is not hyperactive, and tremor can be felt. In large ventricular septal defect, there is obvious elevation in the precordial region, diffuse apical pulsation, grade II-IV rough all-systolic murmurs can be heard between the 4th and 5th ribs outside the midclavicular line and between the 3rd and 4th ribs of the left image of the sternum, and tremors can be mostly felt, mid-diastolic rumble-like murmurs can be heard in the apical region, and P2 hyperactivity is obvious. Hong Xuan, Department of Thoracic Surgery, Shanghai Oriental Hospital Treatment principles 1, membrane ventricular septal defect (VSD), the chance of self-closing in children within 6 months is about 25%, but it is difficult to close after 6 months. If the defect is small and the growth and development are normal, surgery is generally unnecessary for the time being. In medium to large VSDs with large left-to-right shunt flow and pulmonary hypertension, repair surgery should be considered at the age of 1-1/2 years. If the pulmonary artery pressure is normal or mildly elevated, and the pulmonary blood flow (Qp) is two times of the systemic blood flow (Qs), surgery is usually performed at the age of 4-6 years. 2.Large VSD is prone to congestive heart failure and recurrent respiratory infections, and the growth and development of the child can be significantly affected. If anti-cardiac failure treatment is ineffective, surgery can be considered at any age. 3, although there is pulmonary hypertension but no right-to-left shunt can be repaired, but the mortality rate is high. Once a right-to-left shunt occurs, the clinical appearance of cyanosis indicates the development of Eisenmenger's syndrome, which is a contraindication to surgery, and the child has lost the opportunity for surgery. 4, cardiac catheter intervention to close the VSD: because there is not much mature experience, foreign trial in the apical myocardial defect may have superior ah. 3, the end of the arterial catheter closure PDA Diagnostic points 1, symptoms: catheter caliber fine, the clinical can be asymptomatic. If the catheter is thick and the flow is large, the child has palpitations, shortness of breath, weakness, sweating and other symptoms. 2, physical examination: the left sternum can be elevated. A loud and rough continuous machine-like murmur (throughout systole and diastole) can be heard between the 2 ribs at the left edge of the sternum and is transmitted to the left subclavian and neck. Tremor can be detected at the loudest part of the murmur. In the presence of heart failure or pulmonary hypertension, only the systolic murmur is often heard. In cases of high fractional flow, a diastolic rumble-like murmur can be heard in the apical region. The second sound in the pulmonary valve area is hyperactive but is mostly masked by the murmur. The pulse pressure is widened, capillary pulsations in the nail bed are seen, and there is a water-rush pulse. The lower half of the body is cyanotic and may have pestle-like fingers if the pulmonary artery pressure is significantly increased. Hong Xuan, Thoracic Surgery Department, Shanghai Oriental Hospital Treatment principles 1. Surgical ligation or cutting of the ductus arteriosus can be performed before school age to avoid affecting the growth and development of children. If the condition requires, surgery can be performed at any age. 2. Arteriovenous ductus arteriosus in preterm infants can be treated with anti-inflammatory pain. The first time 0.2mg/kg, such as the age of <2 days, the second and third time for 0.1mg/kg, the age of 2-7 days, the second and third time for 0.2mg/kg, >8 days, the second and third time for 0.25mg/kg. every 12 hours, a total of 3 times, intravenous slow and uniform drip; can also use 0.1mg / (kg? times), a total of 6 days, the total dose of drugs remain unchanged, PDA closure rate of 90% The PDA closure rate was 90%, while the former was only 77%. And the former 6 days after the relapse rate of 40%, the latter is 21%. 3, in recent years the development of some non-open surgery to treat PDA new treatment, such as Rashkind method (miniature spring umbrella) or Partsmann method (special plastic plug) blocking the arterial catheter. Coil method (miniature spring ring blocking arterial catheter), easy to operate, good results, easy to promote.