Ventricular septal defect - a congenital or acquired heart disease, consisting in incomplete separation of left and right ventricular cavities. As a result, some of the blood from one ventricle (usually from the left, as the more powerful) hits the other and disrupts the normal functioning of the heart and blood circulation of the body.
Ventricular septal defect often occurs even in utero, in rare cases, this pathology is formed in the process of life. This defect may be considered in two ways:
1. Isolated, appearing as a separate problem, congenital or acquired origin,
2. As part of some of the other vices of the combined type.
During the life of this defect may occur as a result of myocardial infarctionLocalized in the septum.
Ventricular septal defect occurs in about 20-25% of all cases of congenital heart disease, one of thousands of newborns. With the development of technologies of caring for premature infants and sick children, the frequency of defect in recent years is increasing.
Causes
Heart defects and ventricular septal defects including, occur at the earliest stages of heart development during the period from 3-4 to 8-10 weeks of intrauterine life.
The main causes of violations are considered internal and external adverse factors. There are several key points:
- genetic predisposition, especially in families with existing heart diseases or diseases
- viral infections, transferred in early pregnancy, are especially dangerous rubella, measles, flu and herpes
- alcohol intake, smoking,
- taking medication with embryotoxic activity (antibiotics, drugs from epilepsySome sedatives)
- diabetes mellitus with sharp fluctuations in blood glucose
- work in hazardous industries (gas stations, paint companies, chemical plants)
- stress factors
Kinds
Depending on the defect in the ventricular septum dimensions are:
- small defect or disease Tolochinova-Roger (hole size of from 1.2 mm to 1 cm),
- a large defect with a size greater than half the size of the aorta or more than 1 cm.
According to the localization of holes are three types of defect in the septum is released:
- membranous. The defect located in the upper segment of the interventricular septum, under the aortic valve area. Typically, small size, and can be closed spontaneously with the growth of the child.
- muscular. The defect is located in the muscular part of the septum, far enough away from the valves and the cardiac conduction system. May close on their own in a small package.
- nadgrebnevy. Is located in the boundary of right and left ventricular outflow vessels, usually on their own can not be closed.
What happens when a vice
In a few times right ventricular cavity blood pressure during the reduction is lower than on the left.
If there is a defect in the ventricular septum, there is blood movement during contraction of the left ventricle to the right. As a result, the pressure rises in it, and it is transmitted to the small vessels (pulmonary) circulation. There also enters the blood, rich in oxygen, and a large circle with the blood loses.
Constant overload of the right ventricle leads to its failure and of pulmonary hypertension. Gradually vessels of the pulmonary circulation creating sclerosis (substituted inextensible and impervious to gases connective tissue) and irreversible changes in the lung.
The symptoms of ventricular septal defect
The first manifestations of defect may develop in the first days or weeks of life. Especially if more defects and pronounced blood discharged into the right ventricle.
appear:
- cyanosis (blue) of the skin, face and extremities, worse when crying,
- eating disorders, poor sucking, with frequent interruptions,
- violation of the weight of increases, the slow pace of development,
- the appearance of dyspnea,
- fatigue, a lot of these children are asleep,
- formation of edema on the legs, the feet and the abdomen,
- tachycardia.
Sometimes, when a small defect in the septum outward signs may not occur, however, they are found on auscultation of the heart in the form of coarse noise.
Diagnostics
Suspected defect can be when viewed from the child and listening to the heart. But, usually about heart defects parents know in advance, even before birth, during skrinningovyh ultrasound during pregnancy. The large size of the defect can be detected by ultrasound in the second or third trimester.
In identifying a heart murmur after birth, assigned survey course:
- Ultrasound of the heart with doplerometrii (study of blood flow)
- chest X-ray with the definition of heart size and possible defects,
- puloksimetriya - measuring the oxygen concentration in capillary blood.
- cardiac catheterization with carrying out a contrast X-ray examination, the measurement of the pressure in the chambers of the heart,
- MRI of the heart with the determination of the structure of the heart and the size of the defect, the presence of complications.
ventricular septal defect treatment
Diagnosis and treatment of defects involved in cardiology and cardiac surgery.
For minor defects expectant management can be selected in the partition - defects often close themselves. If the hole does not interfere with life, health, and does not violate the circulation - are actively watching him, not conducting the operations.
If the defect is large, interferes with the normal work of the heart and blood circulation, you must address the issue of heart surgery.
In preparation for the operation can apply medicated drugs that help regulate heart rhythm, to stabilize the pressure, to maintain the power infarction, regulate blood clotting.
Operation with significant ventricular septal defects do when the child will be able to adequately transfer the anesthetic and will be able to recover quickly.
Several techniques, these include:
- cardiac catheterization with the introduction of the catheter through the femoral vein to the heart cavities and applying under the control of US and other devices patches on the area of the defect. Very good for medium-sized and muscular defects.
- open heart surgery. It is used in the combined disease (tetralogy of Fallot) or with a significant, low-defect location, which you can not close a single patch. In this operation, the child is connected to a heart-lung machine.
At present, due to cardiac surgery can save the lives of those children who had previously been condemned to suffering and death at an early age. After surgery, children begin to develop as usual and continue to live a normal life.
Complications and forecasts
With small defects in the heart in children of 1-2 mm can grow normally and does not give any symptoms, at a significant defects can be observed signs blemish treatment without turning into complications.
The main ones include Eisenmenger syndrome - irreversible consequences of pulmonary hypertension with vascular sclerosis, and loss of a child from cardiac and respiratory failure
Other serious complications include:
- formation heart failure,
- the development of inflammation of the lining of the heart - endocarditis,
- stroke, due to an increase in blood pressure in the pulmonary circulation and the formation of non-uniform blood flow to thrombus,
- violations of the valve apparatus and the formation of valvular heart disease.