7/25/2019 20_Cardiopatie Congenite Optimized

1/17

@GLDKD]DHKG

Cj ijclhrijzdhkd ejr`dhvjsehcjrd rjpprgsgktjkh cg jkhijcdg ehkogkdtg

pd lrgqugktd rdcgvjtg kgc prdih jkkh d vdtj, ehk ukj prgvjcgkzj vjrdjndcglrj dc 5.7 g dc :5.? pgr idccg kjtd vdvd.

ECJUUDLDEJ]DHKG

Lrj cg vjrdg ecjssdejzdhkd qugccj sdhpjthchodej qugccj ebg rgk`g pd

sgipcdeg cjpprheedh g dc trjttjigkth.

Pjn. :-Cj ecjssdlejzdhkg `gccg ejr`dhpjtdg ehkogkdtg

Vjthchodg ehk sbukt sdkdstrh-`gstrh @dlgtth `gc sgtth dktgrjtrdjcg (@DJ)

@dlgtth `gc sgtth dktgrvgktrdehcjrg (@D\)

@dlgtth `gc sgtth jtrdhvgktrdehcjrg (EJ\)@htth `d Nhtjcch pgrvdh (@NV)

Jkhijcdg `d hrdodkg `gd orhssd vjsd Prukeus Jrtgrdhsus (PJ)

\gktrdehch `gstrh j `hppdj usedtj (\@@W)

Prjsphsdzdhkg `gccg orhssg jrtgrdg (POJ)

Prjsphsdzdhkg ehkogkdtjigktg ehrrgttj `gccg

orhssg jrtgrdg (PEOJ)

Ejr`dhpjtdg ehk hstruzdhkg jccgllcussh`gstrh Utgkhsd vjcvhcjrg phcihkjrg (U\V)

Jtrgsdj phcihkjrg (JV)

Pgtrjchodj `d Ljccht (P`L)

Ejr`dhpjtdg ehk hstruzdhkg jccgllcussh

sdkdstrh Utgkhsd jhrtdebg (UJh)

Ehjrtjzdhkg Jhrtdej (EhJh)

\jrdg ^dthrkh vgkhsh phcihkjrg jkhijch (^\VJ)

\gktrdehch Wkdeh (\W)

EJ^@DHVJPDG EHKOGKDPG

Ehkogkdtjc bgjrt `dsgjsgIjssdih Ebgssj, Ijrdh Ejridkjtd

7/25/2019 20_Cardiopatie Congenite Optimized

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D @DLGPPD DKPG^JP^DJCD

@glkdzdhkg

D tdpd jkjthided vgkohkh ecjssdejtd j sgehk`j `gccj chejcdzzjzdhkg=:. jtrdh ukdeh= jssgkzj ehipcgtj `gc sgtth dktgrjtrdjcg1>. tdph hstdui sgeuk`ui= `dlgtth j cdvgcch `gccj lhssj hvjcg ( dc pd

lrgqugktg)15. tdph sgkh vgkhsh= j cdvgcch ejvjcg supgrdhrg, j cdvgcch ejvjcg dklgrdhrg10. tdph sgkh ehrhkjrdh= j cdvgcch `gc sgkh ehrhkjrdh17. tdph hstdui prdiui= j cdvgcch gccj odukzdhkg jtrdhvgktrdehcjrg1 vdgkg

jkebg `gkdth ehig ejkjcg jtrdhvgktrdehcjrg pjrzdjcg.

Ldsdhpjthchodj

Cgcgigkth ebdjvg cgktdt `gcch sbukt sdkdstrh-`gstrh `gtgridkjth sdj`jccg `digksdhkd `gc `dlgtth ebg `jccj ehipcdjkeg `gd vgktrdehcd. Chsbukt `gtgridkj shvrjeejrdeh `djsthcdeh `gc euhrg `gstrh g dpgrjlusshphcihkjrg1 cdpgrtgksdhkg phcihkjrg dk gt kghkjtjcg g pg`djtrdej rjrj.

Ejrjttgrdstdebg ecdkdebg

Dk gt pg`djtrdej d sdkthid shkh sejrsd h jssgktd g pgr qugsth ihtdvh cj`djokhsd spgssh ejsujcg. Uhkh phssdndcd cg dklgzdhkd rdehrrgktd. Kgcnjindkh pd orjk`g g kgccj`hcgsegktg rdcgvjndcg jccjsehctjzdhkg=sgehk`h thkh s`hppdjth ssh g shlh sdsthcdeh suc lhehcjdh phcihkjrg.

@djokhsd

GEO= ncheeh `d nrjkej `gstrh1 shvrjeejrdeh `d vhcuig `gstrh.^x thrjeg= spgssh dkutdcg1 tjchrj sgokd `d dpgrjlussh phcihkjrg.Gehejr`dhorjj ehchr hppcgr= dk`dvd`uj cj sg`g gc dlgtth, cg digksdhkdg cg rdpgreussdhkd gih`dkjidebg. Kgd @DJ tdph sgkh vgkhsh kgegssj-rdh gsecu`grg cjsshedjzdhkg ehk uk rdthrkh vgkhsh phcihkjrg jkhijch(^\VJ.) Cgehejr`dhorjiij trjksgshljogh khk dk ogkgrg kgegssjrdh.

Pgrjpdj^jrjigktg d @DJ sd ebdu`hkh sphktjkgjigktg. Cj ebdusurj `gc `dlgtth dk`dejtj dk gt prgsehcjrg (rjrjigktg prdij) sdj pgr gvdtjrg cdidtj-zdhkg jccjttdvdt sdej sdj trjuid psdehchoded `gccgssgrg ehksd`grjthuk ejr`dhpjtdeh. Cj ebdusurj pu gssgrg gsgoudtj trjksejtgtgrg dkhctrg c26% `gd @DJ tdph hstdui sgeuk`ui, igktrg ebdrurodej pgrtuttd ocd jctrd.

Lhcchw-up

Ehktrhccd jkkujcd dkdzdjcigktg g sg khk vd shkh prhncgid rgsd`ud, jkebghokd `ug-trg jkkd. Kgssukj cdidtjzdhkg jccjttdvdt sdeh-sphrtdvj.

7/25/2019 20_Cardiopatie Congenite Optimized

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@DLGPPH @GC UGPPH DKPG^\GKP^DEHCJ^G

@glkdzdhkg

^jpprgsgktj cj ijclhrijzdhkg ejr`djej pd lrgqugktg1 j shcj ehstdtudsegdc 76% `gccg ejr`dhpjtdg ehkogkdtg. Pgkgk`h ehkth gccjkjthidj sgttjcgsd phsshkh ecjssdejrg=:. `dlgttd pgrdiginrjkhsd1>. shtthjrtgrdhsd15. iusehcjrd.

Ldsdhpjthchodj

Ocd gcgigktd ejrjttgrdzzjktd shkh cj `digksdhkg `gc `dlgtth g cg rgsdstgkzgvjsehcjrd phcihkjrd. Dc `dlgtth sd `gkdseg rgstrdttdvh sg dc orj`dgktg trjk-svgktrdehcjrg uoujcg h supgrdhrg jd >/5 gccj prgssdhkg sdsthcdej sdstgidej.Cdpgrjlussh phcihkjrg tdpdeh d uk dlgtth KHK rgstrdttdvh, ehiphrtjjuigkth gccg rgsdstgkzg phcihkjrd vjsehcjrd g uk shvrjeejrdeh djsthcdeh`gc vgktrdehch sdkdstrh.

Ejrjttgrdstdebg ecdkdebg Njindkd ehk `dlgttd pdeehcd rgstrdttdvd= jssgkzj `d sdkthid. Njindkd ehk `dlgttd jipd= sgokd `d dpgrjlussh, ehk sejrsh jeergsed-

igkth stjturh phk`grjcg g tjchrj sehipgksh ejr`djeh. Njindkd ehk `dlgttd pdeehcd rgstrdttdvd= shlh hchsdsthcdeh, ru`g jkebg

5-0/< tjchrj ngk juseuctjndcg jccj puktj g jc igshejr`dh ehk phssdndcgdrrj`djzdhkg jccj cdkgj gidjsegccjrg.

Njindkd ehk dlgttd jipd= shlh d dktgksdt rd`httj, pgreb cg prgssdhkdvgktrdehcjrd shkh qujsd d`gktdebg.

@djokhsd

GEO= khrijcg kgd `dlgttd pdeehcd. Kgd `dlgttd jipd ihstrj sgokd `ddpgrtrhj-shvrjeejrdeh gc vgktrdehch sdkdstrh1 dk prgsgkzj d dpgrtgksdhkgphcihkjrg phssdndcg dpgrtrhj ndvgktrdehcjrg.^x thrjeg= phssdndcd sgokd `d dpgrjlussh phcihkjrg.Gehejr`dhorjj ehchr `hppcgr `heuigktj=:. cj sg`g1>. cjipdgzzj15. dc shvrjeejrdeh `d vhcuig `gc vgktrdehch sdkdstrh10. jkhijcdg `gccjppjrjth tgkshrg shtthvjcvhcjrg17. `dlgttd jsshedjtd1

7/25/2019 20_Cardiopatie Congenite Optimized

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D pjzdgktd sdkthijtded ehk dlgttd jipd gvhkh gssgrg shtthphstd j tgrjpdjig`dej (`durgtded JEG-dkdndthrd).Cdktgrvgkth ebdrurodeh qujk`h kgegssjrdh vj gsgoudth gktrh cjkkh `d

vdtj pgr gvdtjrg cj ehipjrsj `d dpgrtgksdhkg phcihkjrg. jttujcigktg phssdndcg ebdu`grg trjksejtgtgrg dlgttd dktgrvgktrdehcjrd sdjiusehcjrd sdj pgrdiginrjkhsd jkebg dk gt pg`djtrdej.

Lhcchw-up

Ehktrhccd jkkujcd dkdzdjcigktg g sg khk vd shkh prhncgid rgsd`ud, jkebghokd `ug-trg jkkd. Kgssukj cdidtjzdhkg jccjttdvdt sdeh-sphrtdvj.

EJKJCG JP^DH\GKP^DEHCJ^G

@glkdzdhkg

Ehstdtudsehkh dc 5% `d tuttd d `dlgttd ehkogkdtd1 gsdstg ukj strgttj jsshedj-zdhkg ehk cj sdk`rhig `d @hwk.Ud `dstdkouhkh=:. EJ\ pjrzdjcg= @DJ hstdui prdiui ehk ecglt `gc cginh jktgrdhrg `gccj

idtrjcg (cg vjcvhcg jtrdhvgktrdehcjrd shkh `ug, sgpjrjtg)1>. EJ\ ehipcgth= @DJ hstdui prdiui, @D\ `gc trjtth `d jlussh,

vjcvhcj jtrdhvgktrdehcjrg ehiukg15. EJ\ dktgrig`dh= @DJ hstdui prdiui, @D\ pdeehch pjrzdjcigktg h

ehipcgtjigktg heecush j tgssuth trdeuspd`jcdeh jeegsshrdh, dk ogkgrg`ug vjcvhcg jtrdhvgktrdehcjrd.

Ldsdhpjthchodj

Dc EJ\ pjrzdjcg g dc EJ\ dktgrig`dh sd ehiphrtjkh ehig uk @DJ, ehkgvgktujcigktg ukj gvhcuzdhkg pd rjpd`j pgr cj prgsgkzj `gccdksul-edgkzj idtrjcdej sgehk`jrdj jc ecglt vjcvhcjrg.Kgc EJ\ ehipcgth, cj prgsgkzj `d sbukt j cdvgcch jtrdjcg g vgktrdehcjrgg dc rdourodth vjcvhcjrg `d ukj h gktrjing cg ehiphkgktd `gccj vjcvhcj

ukdej gtgridkjkh uk quj`rh d dpgrjlussh phcihkjrg. D ug vgktrdehcdshkh dk ogkgrg gktrjind `dcjtjtd (sg dc EJ\ ndcjkedjth) g` phssdndcgcgvhcuzdhkg dk dpgrtgksdhkg vjsehcjrg phcihkjrg.

Ejrjttgrdstdebg ecdkdebg

D pjzdgktd jllgttd `j EJ\ pjrzdjcg g/h EJ\ dktgrig`dh prgsgktjkh ukquj`rh sdidcg jd njindkd ehk @DJ.

D njindkd ehk EJ\ thtjcg svdcuppjkh, dkvgeg, uk prgeheg quj`rh `dsehipgksh, ehk orjvg rdtjr`h `gccjeergsedigkth stjturh-phk`grjcg,sdidcg j qugcch ebg sd vgrdej dk prgsgkzj `d uk jipdh @D\.

7/25/2019 20_Cardiopatie Congenite Optimized

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Jsehctjthrdjigktg dc EJ\ pjrzdjcg bj uk rgpgrth sdidcg j qugcch gc @DJ. Dc EJ\ dktgrig`dh pu prgsgktjrg uk shlh hchsdsthcdeh j pdeehch @D\.Dk gktrjind d ejsd phssdndcg cj prgsgkzj d uk shlh j rdourodth idtrjcdeh

(shlh sdsthcdeh hceg j gcgvjtj lrgqugkzj ehk ijssdij dktgksdt jccj puktj).@djokhsd

GEO= dpgrtrhj vgktrdehcjrg `gstrj g `gvdjzdhkg j sdkdstrj `gccjssggcgttrdeh `gc Z^U. Ncheeh jtrdhvgktrdehcjrg `d D tdph.^x thrjeg= Hinrj ejr`djej juigktjtj slgrdej ehk sgokd `d dpgrjlusshphcihkjrg.Gehejr`dhorjj ehchr hppcgr= gvd`gkzdj cj cgsdhkg gc sgtth jtrdhvgktrd-ehcjrg, cg ejrjttgrdstdebg `gccj/g vjcvhcj/g jtrdhvgktrdehcjrg/d.

Pgrjpdj

EJ\ pjrzdjcg g dktgrig`dh= trjttjigkth sdidcg jc @DJ. Vhssdndcg ebg sdrgk`j kgegssjrdj ukj tgrjpdj durgtdej sg cdksuledgkzj idtrjcdej dvgktjsdokdejtdvj.EJ\ ehipcgth= tgrjpdj jktdsehipgksh (`durgtded JEG-dkdndthrd). Ebd-

rurodj gktrh cjkkh `d vdtj.

Lhcchw-up

Ehktrhccd jkkujcd ehk pjrtdehcjrg jttgkzdhkg jd `dlgttd sgttjcd rgsd`ud g jcrdourodth idtrjcdeh rgsd`uh. Kgssukj cdidtjzdhkg jccjttdvdt sdeh-sphrtdvjsg khk vd shkh rgsd`ujtd, dk ejsh ehktrjrdh rdijk`jrg cj `gedsdhkg jcejr`dhchoh pg`djtrj.

@HPPH @D NHPJCCH VG^\DH

@glkdzdhkg

Vgrsdstgkzj gccj pgrvdgt gc ejkjcg (`htth d Nhtjcch) ebg urjktg cj vdtjlgtjcg igttg dk ehiukdejzdhkg dc edreudth phcihkjrg ehk cjhrtj.

Ldsdhpjthchodj

Cgcgigkth `gtgridkjktg cgktdt `gcch sbukt sdkdstrh-`gstrh ebg ehk-`dzdhkj uk phssdndcg dpgrjlussh phcihkjrg ehk shvrjeejrdeh d vhcuig`gccg sgzdhkd sdkdstrg.

Ejrjttgrdstdebg ecdkdebg

Dk gt kghkjtjcg d pjzdgktd jllgttd j httd jipd ehk sbukt sdokdejtdvh,phsshkh prgsgktjrg uk quj`rh `d sehipgksh ejr`djeh.

D njindkd dk eud dc `htth sg`g `d ukh sbukt ih`gsth khk bjkkh rdpgr-eussdhkd gih`dkjidebg sdokdejtdvg.

7/25/2019 20_Cardiopatie Congenite Optimized

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Vhssdndcg uk shlh ehktdkuh dk rgodhkg shtthecjvgjrg sdkdstrj.

@djokhsd

GEO= spgssh khrijcg1 phssdndcd sgokd d shvrjeejrdeh vgktrdehcjrg sdkdstrh`d vhcuig.^x thrjeg= khk sdokdejtdvh.Gehejr`dhorjj ehchr `hppcgr= prgsgkzj `gc `htth, `digksdhkd, sgokd `dshvrjeejrdeh.

Pgrjpdj

Kgc kghkjth dk pjrtdehcjrg prgijturh, kgegssjrdj cj ebdusurj rjpd`j`gc `htth `j jttujrg h ljrijehchodejigktg h, sg dkglejeg, ebdrurod-ejigktg.Kgc njindkh jsdkthijtdeh phssdndcg cj ebdusurj `hph d >0 igsd `dvdtj, pgr vdj trjkseutjkgj jkebg dk ehksd`grjzdhkg `gc ijoodhr rdsebdh`d gk`hejr`dtg njttgrdej.

Lhcchw-up

Ehktrhccd ndgkkjcd sg htth pgrvdh1 ehktrhccd sjctujrd hph ebdusurj. Kgs-sukj cdidtjzdhkg jccjttdvdt sdeh-sphrtdvj.

P^WKEWU J^PG^DHUWU

@glkdzdhkg

Ud ejrjttgrdzzj pgr chrdodkg `d uk vjsh ukdeh pgr dc edrehch sdstgideh,phcihkjrg g ehrhkjrdh.Ud `dstdkouhkh 0 tdpd=:. prgsgkzj `d uk trhkeh phcihkjrg ehiukg1>. d rjid phcihkjrd sd hrdodkjkh ehktdoud, phstgrdhrigktg, `jc trhkeh

jrtgrdhsh15. d rjid phcihkjrd hrdodkjkh `jccg pjrgtd cjtgrjcd `gc trhkeh jrtgrdhsh1

0. jssgkzj `gccg jrtgrdg phcihkjrd g `gc `htth jrtgrdhsh. Dc edrehchphcihkjrg sgrvdth `j jrtgrdg sdstgidebg ebg hrdodkjkh `jccjhrtj`dsegk`gktg.

Ldsdhpjthchodj

Ehk`dzdhkg `d dpgrjlussh phcihkjrg.

Ejrjttgrdstdebg ecdkdebg Ehipjrsj `d sehipgksh ejr`djeh kgd prdid trg igsd `d vdtj.

phssdndcg cjssgkzj d rgpgrtd jsehctjthrd spgeded.

7/25/2019 20_Cardiopatie Congenite Optimized

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@djokhsd

GEO= pu gssgrg khrijcg h ehk sgokd `d dpgrtrhj ndvgktrdehcjrg.^x thrjeg= ejr`dhigojcdj ehk juigkth gccj trjij vjsehcjrg phcihkjrg

`d dpgrjlussh.Gehejr`dhorjj ehchr `hppcgr= pgrigttg `d dk`dvd`ujrg dc `dlgtth g `dstu`djrg cj vjcvhcj trukejcg ebg pu gssgrg stgkhtdej h dksuledgktg ehktrg, qujttrh h edkqug euspd`d.

Pgrjpdj

Gsecusdvjigktg ebdrurodej kgd prdid igsd `d vdtj.

Lhcchw-up

Ehktrhccd pgrdh`ded ehk lrgqugkzj ebg dpgk`g jccj prgsgkzj h igkh d`dlgttd rgsd`ud. Kgssukj cdidtjzdhkg pgr cjttdvdt sdej sg khk vd shkhrgcdqujtd.

\GKP^DEHCH @GUP^H J @HVVDJ WUEDPJ

@glkdzdhkg

Ehstdtudseg igkh `gcc:% `d tuttd d `dlgttd ejr`djed ehkogkdtd. Gktrjindd vjsd kjsehkh prgvjcgktgigktg `jc vgktrdehch `gstrh1 sd rdehkhsehkhgssgkzdjcigktg trg vjrdjktd jkjthidebg=:. jhrtj `gstrhphstj ehk `dlgtth shtthjhrtdeh g stgkhsd shtthvjcvhcjrg

phcihkjrg1

>. jhrtj `gstrhphstj ehk `dlgtth shtthphcihkjrg (tdph Pjussdo-Ndko)15. jhrtj `gstrhphstj ehk dlgtth shtthjhrtdeh sgkzj stgkhsd phcihkjrg.

Ldsdhpjthchodj

Dc ussh phcihkjrg `dpgk`g `jccj prgsgkzj h igkh `d ukj hstruzdhkgpgr eud sd vj `jccdphjlussh jccdpgrjlussh phcihkjrg. J ejusj `gccj`dvgrsj phsdzdhkg `gc @D\ sd pu jvgrg ukj sjturjzdhkg khrijcg (@D\

shtthjhrtdeh) h rd`httj (@D\ shtthphcihkjrg), pgr dc `dvgrsh ussh prg-lgrgkzdjcg ebg sd ergj.

Ejrjttgrdstdebg ecdkdebg

Ihcth vjrdjndcd1 sd vj j sgokd d dpgrjlussh, j lhrig ehk edjkhsd tdphtgtrjchodj `d Ljccht.

Upgssh jssgktd. Vhssdndcg prgsgkzj d shlh sg prgsgktg uk @D\ pdeehchh ukj stgkhsd phcihkjrg.

7/25/2019 20_Cardiopatie Congenite Optimized

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@djokhsd

GEO= spgssh khrijcg.^x thrjeg= spgssh khrijcg.

Gehejr`dhorjj ehchr `hppcgr= gssgkzdjcg pgr `gkdrg dc `dlgtth dk tuttgcg sug ejrjttgrdstdebg.

Pgrjpdj

Ebdrurodj gktrh dc prdih jkkh `d vdtj.

Lhcchw-up

Ehktrhccd lrgqugktd prg-ebdrurodj g phd hokd igsd dk rgcjzdhkg jccjprgsgkzj h igkh d dlgttd rgsd`ud. Cjttdvdt sdej dpgk`g jccj prgsgkzjh igkh `d `dlgttd rgsd`ud.

P^JUVHUD]DHKG @GCCG O^HUUG J^PG^DG

@glkdzdhkg

Ejrjttgrdstdej prdkedpjcg cj `dsehr`jkzj vgktrdehch jrtgrdhsj, pgr eudcjhrtj hrdodkj `jc vgktrdehch `gstrh, jktgrdhrigktg g j `gstrj g cjrtgrdjphcihkjrg jc vgktrdehch sdkdstrh, phstgrdhrigktg g j sdkdstrj1 phssdndcgcj prgsgkzj `d uk @D\.

Ldsdhpjthchodj

Cj edrehcjzdhkg jkzdeb dk sgrdg `dvgktj dk pjrjccgch ehk rdedrehch `gc

sjkoug hssdogkjth kgc phcihkg g `d qugcch j njssh ehktgkuth `d H> kgcedrehch sdstgideh1 dc rdsuctjth ukj orjvg `gsjturjzdhkg. Cgcgigkthebdjvg pgr pgrigttgrg cj shprjvvdvgkzj `gc kghkjth dc idxdko, edh cjphssdndcdt `d ehiidstdhkg lrj d `ug edrehcd ebg sd lj phtgkzdjcigktg jcdvgcch `gc `htth jrtgrdhsh g `gc lhrjig hvjcg.

Ejrjttgrdstdebg ecdkdebg

@dlehct rgspdrjthrdg ehk orjvg `gsjturjzdhkg. Edjkhsd pd h igkh sdokdejtdvj `dpgk`gktgigktg `jccj pgrvdgt `gc`htth g `gc lhrjig hvjcg.

Vhssdndcg prgsgkzj d shlh sdj pgr cj pgrvdgt gc htth, sdj sg prgsgktguk @D\ ehk h sgkzj stgkhsd phcihkjrg.

@djokhsdGEO= khk `djokhstdeh.^x thrjeg= pg`ukehch vjsehcjrg rdstrgtth ehk hinrj ejr`djej j uhvh pgrdkorjk`digkth `gccg sgzdhkd `gstrg.

7/25/2019 20_Cardiopatie Congenite Optimized

9/17

Gehejr`dhorjj ehchr `hppcgr= lhk`jigktjcg pgr `gkdrg cj `djokhsdjkjthidej gttjocdjtj.

PgrjpdjDklusdhkg `d prhstjocjk`dkg (Vrhstdk \^ pg`djtrde= 6.67o/ao/idk) pgrijktgkgrg dc @htth `d Nhtjcch pgrvdh.Jtrdhsgpthsthidj sgehk`h ^jsbadk` (sd ergj ukjipdj ehiukdejzdhkgdktgrjtrdjcg utdcdzzjk`h uk pjcchkedkh).Kgccj lhrij sgipcdeg cj ehrrgzdhkg ebdrurodej ebg ehksdstg dk ukh swdtebjrtgrdhsh ehk rgdipdjkth gccg ehrhkjrdg prgvdstj kgccg prdig sgttdijkg`d vdtj.Kgccj POJ ehk @D\ spgssh prgsgktg stgkhsd phcihkjrg, pgr eud sd purdtjr`jrg cj ebdrurodj ebg ehksdstg kgccdktgrvgkth `d ^jstgccd (ebdusurj@D\, tukkgccdzzjzdhkg \U-Jhrtj g ehk`htth prhtgsdeh trj dc vgktrdehch`gstrh g cjrtgrdj phcihkjrg).

Lhcchw-up

Ehktrhccd jinucjthrdjcd jkkujcd. Ejtgtgrdsih ejr`djeh dk gt prgsehcjrgpgr rdvjcutjrg cg jrtgrdg ehrhkjrdg.Cd`hkgdt jccjttdvdt sdeh-sphrtdvj vj vjcutjtj jc ejr`dhchoh pg`djtrj.

P^JUVHUD]DHKG EHKOGKDPJIGKPG

EH^^GPPJ @GCCG O^HUUG J^PG^DG

@glkdzdhkgUd ejrjttgrdzzj pgr ukj `dsehktdkudt jtrdh vgktrdehcjrg g vgktrdehchjrtgrdhsj, pgr eud cjtrdh `gstrh ehkkgssh jc vgktrdehch sdkdstrh `j eudhrdodkj cjrtgrdj phcihkjrg g cjtrdh sdkdstrh ehkkgssh jc vgktrdehch`gstrh `j eud hrdodkj cjhrtj. phssdndcg cj prgsgkzj `d `dlgttd jsshedjtdtdph @D\ g Utgkhsd Vhcihkjrg. Diphrtjktg rdehr`jrg cj dschejzdhkg gckh`h jtrdh-vgktrdehcjrg.

Ldsdhpjthchodj

Dk jssgkzj `d `dlgttd jsshedjtd dc edrehch khrijcg.

Ejrjttgrdstdebg ecdkdebg

Upgssh jsdkthijtdeh1 sg prgsgktd `dlgttd jsshedjtd phssdndcg `dspkgj gedjkhsd kgc prdih jkkh `d vdtj.

Khk gsdsthkh sgokd tdpded sg khk dc shlh sdsthcdeh dk prgsgkzj `d @D\g stgkhsd phcihkjrg.

7/25/2019 20_Cardiopatie Congenite Optimized

10/17

@djokhsd

GEO= hk`j V khrijcg, jssgkzj `d Z sgttjcd kgccg prgehr`djcd sdkdstrg,shvrjeejrdeh gc vgktrdehch gstrh phsth j sdkdstrj ehk prgehr`djcd gstrg

kgojtdvg1 phssdndcg NJ\ `d D, DD g DDD orj`h.^x thrjeg= khk sgokd utdcd jccj `djokhsd.Gehejr`dhorjj ehchr hppcgr= gkdzdhkg jeeurjtj gccjkjthidj gccjpjthchodj g `gd `dlgttd gvgktujcigktg jsshedjtd.

Pgrjpdj

Cj lhrij sgipcdeg dledcigktg djokhstdejtj dk gt pg`djtrdej. Cjttgo-odjigkth ehksgrvjtdvh dc pd lrgqugktg jkebg sg gsdstg cj phssdndcdt ddktgrvgkdrg ehk uk `hppdh swdteb (j cdvgcch jtrdjcg g jrtgrdhsh).

Lhcchw-up

Ehktrhccd sgigstrjcd h jkkujcd.D`hkgdt jccjttdvdt sdeh-sphrtdvj sgehk`h dk`dejzdhkd `gc ejr`dhchohpg`djtrj.

UPGKHUD \JC\HCJ^G VHCIHKJ^G

@glkdzdhkg

Hstruzdhkg chejcdzzjtj j cdvgcch gccj vjcvhcj phcihkjrg ehk lusdhkg gdtrg cgind vjcvhcjrd ebg dk jpgrturj jssuihkh uk jspgtth j euphcj. Pjchrjcj vjcvhcj `dspcjsdej ehk cgind dspgssdtd.

Ldsdhpjthchodj

Kgssukj pjrtdehcjrg pgeucdjrdt sjcvh kgc ejsh `gccj lhrij erdtdej `gckghkjth dk eud cj edrehcjzdhkg phcihkjrg `htth `dpgk`gktg.

Ejrjttgrdstdebg ecdkdebg

Kgc kghkjth ehk stgkhsd erdtdej, phssdndcg ukj ehiprhidssdhkg ecdkdej

diphrtjktg jccj ebdusurj gc htth pgreb cj edrehcjzdhkg phcihkjrg `htth dpgk`gktg. Kgc njindkh ehk stgkhsd ih`grjtj h sgvgrj phssdndcg dspkgj g hchrg

thrjedeh.

Kgc kghkjth ehk lhrij erdtdej= edjkhsd egktrjcg pgr ehktgiphrjkgjehgsdstgkzj `gc lhrjig hvjcg pgrvdh.

Kgd njindkd ehk stgkhsd cdgvg, ih`grjtj g/h sgvgrj= shlh sdsthcdeh,jsprh, gcgttdvh, ehk ijssdij dktgksdt suc lhehcjdh phcihkjrg (sgehk`hspjzdh dktgrehstjcg sdkdstrh).

7/25/2019 20_Cardiopatie Congenite Optimized

11/17

@djokhsd

GEO= spgssh khrijcg kgccg lhrig cdgvd1 kgccg stgkhsd ih`grjtg sd gvd-`gkzdj uk jssg gcgttrdeh ruhtjth j `gstrj g jctgrjzdhkd `gccj ehk`uzdhkg

dktrjvgktrdehcjrg gstrj.^x thrjeg= khrijcg kgccg lhrig cdgvd1 sgokd `d rd`httj vjsehcjrdzzjzdhkgphcihkjrg kgccg lhrig ih`grjth-sgvgrg.Gehejr`dhorjj ehchr `hppcgr= ehksgktg cj `djokhsd g cj prgedsj `gkd-zdhkg jkjthidej.

Pgrjpdj

Kgccj stgkhsd erdtdej kghkjtjcg, dc prdih prgsd`dh tgrjpgutdeh cdklusdhkg`d prhstjocjk`dkg pgr ijktgkgrg pgrvdh dc `htth.Chpzdhkg tgrjpgutdej `d prdij segctj cj vjcvuchpcjstdej pgreutjkgjehk pjcchkedkh.

Lhcchw-up

Ehktrhccd jkkujcd phst-trjttjigkth. Vhssdndcdt d prjtdejrg jttdvdt sdeh-sphrtdvj j ejrjttgrg khk johkdstdeh.

JP^GUDJ VHCIHKJ^G

@glkdzdhkg

Ud dstdkoug=:. jtrgsdj `gccj vjcvhcj phcihkjrg ehk sgtth dktgrvgktrdehcjrg dktjtth

(JVUD)1>. jtrgsdj gccj vjcvhcj phcihkjrg ehk h sgkzj ehktdkudt trj dc vgktrdehch

`gstrh g dc trhkeh gccjrtgrdj phcihkjrg ehk dlgtth dktgrvgktrdehcjrgjipdh shtthjhrtdeh (JV+@D\).

Ldsdhpjthchodj

Kgccj JVUD= `htth`dpgk`gkzj `gc edrehch phcihkjrg.

Kgccj JV+@D\= ihcth sdidcg jccj tgtrjchodj `d Ljccht ehk vjsehcjrdzzj-zdhkg phcihkjrg spgssh iuctdlhejcg (ehccjtgrjcd sdstgideh phcihkjrd).

Ejrjttgrdstdebg ecdkdebg

JVUD= edjkhsd sgvgrj gktrh cj DD-DDD odhrkjtj `d vdtj. JV+@D\= khk `d shcdth uk gigrogkzj kghkjtjcg. Cj ecdkdej `dpgk`g

`jc tdph g` gktdt `gccj vjsehcjrdzzjzdhkg phcihkjrg.

@djokhsd

GEO= khk pjrtdehcjrigktg utdcg.^x thrjeg= pheh dklhrijtdvh.

7/25/2019 20_Cardiopatie Congenite Optimized

12/17

Gehejr`dhorjj ehchr hppcgr= lhk`jigktjcg pgr phrrg djokhsd g gkdrgtuttg cg ejrjttgrdstdebg jkjthidebg.Ejtgtgrdsih ejr`djeh= lhk`jigktjcg dk gktrjing cg lhrig=

JVUD= vjcutjzdhkg `gc edrehch phcihkjrg g ehrhkjrdh. JV+@D\= `gkdzdhkg gttjocdjtj `gccj vjsehcjrdzzjzdhkg phcihkjrg.

Pgrjpdj

JVUD= `gehiprgssdhkg `gc vgktrdehch `gstrh trjidtg pgrlhrjzdhkg ehkshk`j j rj`dhlrgqugkzj g vjcvuchpcjstdej phcihkjrg. Vgr ijktgkgrg dc`htth pgrvdh dipdjkth `d ukh stgkt h ergjzdhkg ebdrurodej `d ukh sbuktsdstgideh phcihkjrg.JV+@D\= ebdusurj @D\ g ehk`htth JV-\@ kgccg lhrig pd ljvhrgvhcd.Kgccg lhrig ehk vjsehcjrdzzjzdhkg iuctdlhejcg, ergjzdhkg `d ukj ehk-kgssdhkg \@-JV dkecu`gk`h tuttd d vjsd ebg vjsehcjrdzzjkh dc phcihkg(tgekdej d ukdlhejcdzzjzdhkg h cj tgekdej gc edcdk`rh jhrtdeh d Jngccj).

Lhcchw-up

Ihcth vjrdjndcg dk rgcjzdhkg jccjkjthidj hrdodkjrdj, jccdktgrvgkth gsg-oudth g jd rgcdqujtd.

PGP^JCHODJ @D LJCCHP

@glkdzdhkg

Ejrjttgrdzzjtj `j=

:. `gvdjzdhkg jktgrh-supgrdhrg `gc sgtth dkluk`dnhcjrg1>. stgkhsd dkluk`dnhcjrg15. @D\ dkluk`dnhcjrg10. jhrtj j ejvjcdgrg.

Ldsdhpjthchodj

Cgih`dkjidej `dpgk`g `jc orj`h `d stgkhsd jccglussh `gstrh.

Ejrjttgrdstdebg ecdkdebg

Ch spgttrh ecdkdeh vj jccj edjkhsd sgvgrj pgr hstruzdhkg diphrtjktgjc quj`rh `d uk jipdh @D\ pgr cg lhrig ehk idkdij stgkhsd (Ljcchtrhsj).

@djokhsd

GEO= gvdjzdhkg jssdjcg gstrj ehk dpgrtrhj vgktrdehcjrg gstrj h ncheeh`d nrjkej `gstrj.^x thrjeg= euhrg j zheehch ehk dphpgrlusdhkg phcihkjrg.Gehejr`dhorjj ehchr `hppcgr= lhk`jigktjcg pgr cj `djokhsd.

7/25/2019 20_Cardiopatie Congenite Optimized

13/17

Ch stu`dh gih`dkjideh dk`dejth kgd ejsd hvg gsdsthkh `unnd succj edr-ehcjzdhkg ehrhkjrdj.

PgrjpdjPgrjpdj ig`dej pgr cg erdsd dpgredjkhtdebg (dklusdhkg d cdqud`d, sg`jtdvh,n-ncheejktg - prhprjkhchch (D) 6.6: io/ao gv g phd :-> io/aopgr hs ehig tgrjpdj ehktdkujtdvj).Pgrjpdj ebdrurodej ehrrgttdvj gktrh cjkkh `d vdtj.

Lhcchw-up

Ehktrhccd pgrdh`ded. Vhssdndcg @D\ rgsd`uh, stgkhsd `gd rjid phcihkjrd,dksuledgkzj phcihkjrg.

UPGKHUD JH^PDEBG

@glkdzdhkg

Ud `dstdkouhkh lhrig=:. vjcvhcjrd1>. shtthvjcvhcjrd15. shprjvjcvhcjrd.

Ldsdhpjthchodj

Jssdidcjndcd jc pukth d vdstj sdhpjthchodeh pgr chstruzdhkg jccglusshsdkdstrh ebg `gtgridkjkh.

Ejrjttgrdstdebg ecdkdebg

Utgkhsd vjcvhcjrg sgvgrj= phcdpkgj, dphsoidj, shlh sdsthcdeh jsprhsuc lhehcjdh jhrtdeh (DD spjzdh dktgrehstjcg j `gstrj), sbhea.

Kgccg lhrig igkh orjvd cukdeh sgokh pu gssgrg dc shlh.

@djokhsd

GEO= dpgrtrhj vgktrdehcjrg sdkdstrj.^x thrjeg= tjchrj sgokd d g`gij dktgrstdzdjcg j shvrjeejrdeh d prgssdhkg`gc vgktrdehch sdkdstrh.Gehejr`dhorjj ehchr `hppcgr= pgrigttg cj `djokhsd rdcgvjk`h= dpgrtrhj vgktrdehcjrg ehkegktrdej h `dcjtjzdhkg vgktrdehcjrg tdph ejr-

`dhidhpjtdj dcjtjtdvj1 ihrlhchodj vjcvhcjrg (trd-ndeuspd`g)1

prgsgkzj `d hstruzdhkg shtthvjcvhcjrg j iginrjkj, tukkgc1 prgsgkzj `d hstruzdhkg shprjvjcvhcjrg j ecgssd`rj h tukkgc1 orj`dgktg vgktrdehch sdkdstrh-jhrtj.

7/25/2019 20_Cardiopatie Congenite Optimized

14/17

Pgrjpdj

\jcvuchpcjstdej jhrtdej dk urogkzj kgccj lhrij kghkjtjcg erdtdej.\jcvuchpcjstdej kgccg lhrig igkh sgvgrg dk gt vjrdjndcg dpgk`gktgigktg

`jc orj`dgktg, jkjthidj g ecdkdej `gc pjzdgktg.Ebdrurodj pgr cg lhrig shprj- g shtth-vjcvhcjrd.Vhssdndcg dktgrvgkth d hss pgr cg lhrig dk gt pd jvjkzjtj g tdpdejigktgdk gt j`hcgsegkzdjcg.

Lhcchw-up

Ehktrhccd pgrdh`ded ehk dk`dejzdhkg jccjttdvdt sdeh-sphrtdvj sgehk`h cjprgsgkzj h igkh `d rgcdqujtd (stgkhsd rgsd`uj, dksuledgkzj vjcvhcjrg).

EHJ^PJ]DHKG DUPIDEJ @GCCJH^PJ

@glkdzdhkg

^gstrdkodigkth (j `djlrjiij, tunucjrg) chejcdzzjth j cdvgcch dstideh`gccjhrtj `dsegk`gktg. Upgssh sd jsshedj jccj ndeuspd`dj jhrtdej.

Ldsdhpjthchodj

@dpgk`g `jc orj`h `d hstruzdhkg. Kgccg lhrig sgvgrg dc vgktrdehch pukhk gssgrg dk orj`h `d j`jttjrsd pgr eud jccj ebdusurj `gc `htth sd pujvgrg `dcjtjzdhkg g sehipgksh. Kgccg lhrig igkh sgvgrg, dc vgktrdehchsd dpgrtrhzzj.

Ejrjttgrdstdebg ecdkdebg@jcch sehipgksh kghkjtjcg diphrtjktg jc sgipcdeg rdsehktrh d dpgrtgk-sdhkg dk gt j`hcgsegkzdjcg.

@djokhsd

Cgsjig ecdkdeh pu gssgrg `djokhstdeh= jssgkzj `d phcsd lgihrjcd gdpgrtgksdhkg higrjcg.

GEO= dpgrtrhj g/h shvrjeejrdeh vgktrdehcjrg sdkdstrh.^x thrjeg= sgokd `d stjsd vgkhsj.Gehejr`dhorjj ehchr hppcgr= djokhsd ehk gvd`gkzj gc rgstrdkodigkth jcdvgcch dstideh ehk juigkth gccj vgchedt d ussh dk sdsthcg g pgrsdstgkzj`d orj`dgktg jkebg `djsthcdeh.

Pgrjpdj

Ebdrurodej dk gt kghkjtjcg. Vhssdndcdt `d jkodhpcjstdej ehk pjcchkedkhdk gt pd jvjkzjtj g kgccg lhrig `d rdehjrtjzdhkg1 phssdndcg dksgrdrgukh stgkt pgr vdj pgr eutjkgj j pjrtdrg `jd >7 ao `d pgsh.

7/25/2019 20_Cardiopatie Congenite Optimized

15/17

Lhcchw-up

Ehktrhccd pgrdh`ded1 sg pgrsdstg dpgrtgksdhkg j rdphsh h `urjktg slhrzhutdcg cush `d ngtj-ncheejktd.

^DPH^KH \GKHUH JKHIJCH

@glkdzdhkg

Unheeh jkhijch pjrzdjcg h thtjcg gccg vgkg phcihkjrd j cdvgcch gccjtrdh`gstrh, `gccj ejvj dklgrdhrg h `gccj ejvj supgrdhrg. Dk njsg jccj sg`g `gc`rgkjoodh sd `dstdkoug=:. ^\VJ shprjejr`djeh1>. ejr`djeh15. dklrjejr`djeh.

Ldsdhpjthchodj

Vjssjoodh `d pjrtg h tutth dc sjkoug rguh `jd phcihkd dk jtrdh `gstrh. Dcedrehch sdstgideh dk ogkgrg rjoodukth jttrjvgrsh ukj ehiukdejzdhkgdktgrjtrdjcg. Kgccg lhrig hstruttdvg phssdndcg g`gij phcihkjrg.

Ejrjttgrdstdebg ecdkdebg

Kgd pjzdgktd ehk hstruzdhkg= edjkhsd, tjebdpkgj, gpjthigojcdj. Vhssdndcgruihrg sdsthcdeh kgccj rgodhkg `gc `rgkjoodh vgkhsh hstrudth.

Kgd pjzdgktd sgkzj hstruzdhkg= tjebdejr`dj, `dstrgss rgspdrjthrdh. Kgccg lhrig pjrzdjcd= ogkgrjcigktg jsdkthijtdebg.

@djokhsd

GEO= phssdndcg dpgrtrhj vgktrdehcjrg `gstrj.^x thrjeg= jspgtth orjkuchsh gd ejipd phcihkjrd ehig j sdk`rhig j`dstrgss rgspdrjthrdh `gc kghkjth. Vhssdndcg sgokd `d g`gij dktgrstdzdjcgkgccj lhrij ehk hstruzdhkg.Gehejr`dhorjj ehchr `hppcgr= `hvrgnng pgrigttgrg cj `djokhsd.

Utu`dh gih`dkjideh= kgd ejsd `unnd g pgr `gkdrg kgc `gttjocdh cj ih-`jcdt `d `rgkjoodh.

Pgrjpdj

Prjttjigkth ebdrurodeh urogkzj kgccg lhrig hstrudtg, gcgttdvh kgccg jctrg.

Lhcchw-up

Ehktrhccd pgrdh`ded g khrijcg jttdvdt sdeh-sphrtdvj sg khk pgrsdsthkhrgcdqujtd.

7/25/2019 20_Cardiopatie Congenite Optimized

16/17

\GKP^DEHCH WKDEH

@glkdzdhkg

Orupph `d ejr`dhpjtdg ejrjttgrdzzjtg `jccj prgsgkzj `d ukj ejigrj vgk-trdehcjrg prdkedpjcg g ukj jeegsshrdj. Cj ejigrj prdkedpjcg pu gssgrg`gstrj, sdkdstrj (cj lhrij pd lrgqugktg) h dk`dllgrgkzdjtj. Vhssdndcg cjehkkgssdhkg vgktrdehch jrtgrdhsj `dsehr`jktg, jkhijcdg `gccjppjrjthvjcvhcjrg jtrdh-vgktrdehcjrg.

Ldsdhpjthchodj

Ud ejrjttgrdzzj pgr cj prgsgkzj d uk idxdko hnncdojth. Dc ussh dk jrtgrdjphcihkjrg g qudk`d cj sjturjzdhkg vjrdj `dpgk`gktgigktg `jccj lhrijjkjthidej.

Ejrjttgrdstdebg ecdkdebg

Ug sd jsshedj j` jtrgsdj h stgkhsd sgvgrj phcihkjrg, cj edjkhsd dc sgokhpd gvd`gktg. Vhssdndcg cj prgsgkzj `d uk shlh `j stgkhsd phcihkjrgh `j `htth jrtgrdhsh pgrvdh.

Jccgstrgih hpphsth `gcch spgttrh ecdkdeh cg lhrig ehk dpgrjlusshphcihkjrg.

@djokhsd

GEO= pheh utdcg.^x thrjeg= khk `djokhstdeh.Gehejr`dhorjj ehchr `hppcgr= pgrigttg cj `djokhsd `gkgk`h cg ejrjt-

tgrdstdebg jkjthidebg `gccj cgsdhkg.

Pgrjpdj

Dklusdhkg `d prhstjocjk`dkg pgr cg lhrig `htth `dpgk`gktd g qudk`d= ergjzdhkg `d ukh sbukt sdstgideh phcihkjrg tdph Ncjchea-Pjussdo1 dkthrkh j uk jkkh `d vdtj jkjsthihsd ejvh-phcihkjrg sgehk`h

Ocgkk1

vgrsh d 0-7 jkkd ehkkgssdhkg ejvh-phcihkjrg thtjcg ehk ehk`htthgxtrjejr`djeh.

Vgr cg lhrig ehk dpgrjlussh phcihkjrg= ngk`joodh gccjrtgrdj phcihkjrg1 ehkkgssdhkg ejvh-phcihkjrg thtjcg.

Lhcchw-upEhktrhccd pgrdh`ded, ehk khtgvhcd cdidtd jccj prjtdej `gccjttdvdt sdeh-sphrtdvj.

7/25/2019 20_Cardiopatie Congenite Optimized

17/17

Ndncdhorjlj gssgkzdjcg

- Pbg Pjsa Lhreg hk tbg Ijkjogigkt hl Orhwk-up Ehkogkdtjc Bgjrt @dsgjsg hl

tbg Gurhpgjk Uhedgty hl Ejr`dhchoy (GUE). Gk`hrsg` ny tbg Jsshedjtdhk lhrGurhpgjk Vjg`djtrde Ejr`dhchoy (JGVE). Gur Bgjrt M. >6:61 5:= >4:77?.- Jig`rh V, @hraj ^, gt jc. Zujcdty hl Cdlg hl Ebdc`rgk wdtb Ehkogkdtjc Bgjrt

@dsgjsgs= J Iuctdegktgr Ehktrhccg` Erhss-Ugetdhkjc Utu`y. Vg`djtr Ejr`dhc.>6:7.

- Ohhssgks G, Ldguws U, gt jc. Gllgetdvgkgss hl strueturg` g`uejtdhk hk akhwcg`-og jk` bgjctb ngbjvdhrs dk pjtdgkts wdtb ehkogkdtjc bgjrt `dsgjsg.M Vg`djtr.>6:71: