There are two ways to classify congenital heart disease, one is to roughly divide the congenital heart disease into two categories, non-cyanotic and cyanotic, according to whether the patient has cyanosis; the other is to divide the blood into left-to-right shunt type, right-to-left shunt type and no shunt type according to the direction of blood shunt. At present, it is considered that the classification is better by combining pathological anatomy and pathophysiology through hemodynamic examination.
1.Left-to-right shunt type
(1) The shunt occurs at the atrial level: such as atrial septal defect, partial pulmonary venous malformation drainage, etc;
(2) Shunt occurs at the ventricular level: such as ventricular septal defect (including left ventricular-right atrial communication), etc;
(3) Shunts occur at the level of the great arteries: e.g., ductus arteriosus, aortic-pulmonary septal defect, etc;
(4) The shunt occurs between the aorta and its branches and the right heart: e.g., aortic sinus aneurysm rupture into the right heart, coronary right ventricular fistula, left coronary artery anomaly originating from the pulmonary artery, etc;
(5) The shunt occurs at multiple levels: endocardial cushion defect, combined atrioventricular defect, ventricular septal defect with arteriovenous catheter failure, etc.
2.Right-to-left shunt type
(1) Reduced pulmonary blood flow and reduced pulmonary artery pressure: such as tetralogy of Fallot, large vessel misalignment with pulmonary artery stenosis, right ventricular double outlet with pulmonary artery stenosis, single ventricle with pulmonary artery stenosis, permanent aortic trunk with small pulmonary artery, tricuspid atresia, tricuspid valve subluxation malformation with atrial septal defect, pulmonary valve atresia, etc;
(2) Increased pulmonary blood flow: such as large vessel misalignment, right ventricular double outlet with ventricular septal defect, aortic trunk immortality with large pulmonary artery, complete pulmonary venous malformation drainage, single ventricle with low pulmonary resistance, single atrium, tricuspid atresia with large ventricular septal defect, ventricular septal defect with vena cava drainage to the left atrium, etc;
(3) Increased pulmonary artery pressure: Eisenmenger syndrome, right ventricular double outlet with increased pulmonary artery resistance, aortic atresia, mitral atresia, aortic arch dissection, large vessel dislocation with pulmonary hypertension, single ventricle with increased pulmonary artery resistance, complete pulmonary venous malformation with increased pulmonary artery resistance, etc.
3.No shunt type
(1)Malformations occurring in the right heart: such as simple pulmonary artery stenosis, pulmonary valve insufficiency, primary pulmonary hypertension, other pulmonary artery malformations (pulmonary artery agenesis, left pulmonary artery anomaly originating from the right pulmonary artery, etc.), inferior vena cava draining into the odd vein system, etc;
(2) Malformations occurring in the left heart: such as aortic stenosis, aortic valve insufficiency, bilobed aortic valve, aortic constriction, mitral stenosis, mitral valve insufficiency, triatrial heart, malformation of the aortic arch and its branches, etc;
(3) Others are: right-sided heart, ectopic heart, etc., all of which can be combined with other precordial diseases.
However, there are relatively fixed diagnostic procedures for all precordial diseases.
(1) history taking: i.e. whether the patient presents with the above clinical symptoms;
(2) Physical examination: the patient’s development, the size of the cloudy heart, whether the precordial region is elevated, whether there is cyanosis and pestle-like fingers (toes), blood pressure and pulse changes, and so on. However, the most important thing is the cardiac auscultation, whether the heart has pathological murmur, whether it is systolic, diastolic or continuous murmur, what is its nature, in which direction it is conducted, etc;
(3) Blood tests: such as routine blood, blood biochemistry, electrolytes, etc;
(4) General auxiliary examinations: chest X-ray, electrocardiogram, cardiac ultrasound, which are routine clinical examinations for the diagnosis of precordial disease, through which information can be obtained on the cardiothoracic ratio, atrial and ventricular size, the amount of pulmonary blood, whether there are arrhythmias and what kind of cardiovascular malformations, etc., which can generally clarify whether the patient has precordial disease and the type of precordial disease;
(5) special tests: such as MRI, ultra-high-speed CT, radionuclide examination and cardiac catheterization, cardiovascular angiography, etc. These are not routine tests for the diagnosis of precordial disease, but are only selectively used when the lesion is complex, the extracardiac structures are not clearly shown, and the diagnosis is not clear through routine tests. In addition, in addition to clear diagnosis, cardiac catheterization also has an important role in measuring pressure, especially pulmonary artery pressure, which plays a vital role in deciding whether surgery is indicated and what type of surgery to take.