Ventricular septal defect in a newborn

You need to understand that this congenital pathology of heart development consists in the communication between the right and left ventricles. The pressure difference in the ventricles is radically different, in the left more powerful, and in the right weaker and thinner. An anomaly leads to the fact that blood flows from the left to the right, thereby violating the interventricular balance.

The severity of the pathology is usually determined by the size of the defect, as well as its location. Single and minor gaps are rarely diagnosed, and disappear in the first days after the birth of the baby. This is due to the beginning of the active work of the heart. In the presence of larger scars and ruptures, a constant injection of blood into the right ventricle can be observed, the total volume of blood decreases, and the right ventricle stretches and increases in volume. As a result of this, the baby begins to have breathing problems, heart failure.

Most often, the anomaly is diagnosed in the first week after birth. If a child with congenital malformations is found, the newborn is immediately prepared for surgical intervention. The diagnosis requires constant monitoring by specialists. However, it is not always possible to diagnose DMC immediately, because the pathology does not immediately appear, and also due to the negligence of the medical staff, it can not be diagnosed immediately. Therefore, it is important for young mother and father to know the symptoms of the most common and dangerous malformation of the cardiovascular system in newborns.

A defect in the interventricular septum or in the fetus is a very dangerous abnormality that occurs in the fetus from 2 to 10 weeks of fetal development. The first trimester of pregnancy is the most dangerous for the fetus, if at this time the pregnant mother is exposed to the negative effects of external or internal factors, the fetus has a risk of developing diseases of the cardiovascular system.

The causes of the disease include:

  • Heredity – the risk of fetal heart failure increases many times, if relatives had people with heart disease.
  • viral infections suffered by the mother during pregnancy, including rubella, herpes, measles and herpes, are among the most dangerous.
  • Mom taking during pregnancy antibiotics of a different spectrum of activity, as well as chemical drugs, since most pharmacy drugs have pronounced embryotoxic properties and their uncontrolled use during pregnancy leads to the development of pathologies of the cardiovascular system in the fetus. Antibiotics, antiepileptic drugs, as well as hormonal drugs are considered the most dangerous for the fetus.
  • The use of drugs, alcohol and smoking during pregnancy – it is proved that the use of alcohol by a pregnant woman 3 times increases the risk of giving birth to a child with heart defects.
  • somatic diseases in a pregnant woman – dropsy, thyrotoxicosis, diabetes mellitus.

Violation of the formation of the septum can occur for several reasons.

Group of factorsSpecific examples
MaternalAlcoholism

Poorly adjusted sugar diabetes

Phenylketonuria – a hereditary pathology of amino acid metabolism in the body

Infections – rubella, chickenpox, syphilis, etc.

GeneticThe presence of heart defects in relatives, especially parents, sisters and brothers

In case of twin birth

ExternalAction of ionizing radiation

Teratogens – drugs that cause impaired fetal development

The mechanism of development of hemodynamic disorders (blood movement)

In a fetus located in the mother’s uterus, blood circulation is carried out according to the so-called placental circle (placental circulation) and has its own characteristics. However, shortly after birth, the newborn establishes normal blood flow in the large and small circles of blood circulation, which is accompanied by the appearance of a significant difference between the blood pressure in the left (pressure is greater) and right (pressure is less) ventricles.

At the same time, the existing LCV leads to the fact that blood from the left ventricle is pumped not only into the aorta (where it should flow normally), but also through the CSJ into the right ventricle, which should not be normal. Thus, with every heart beat (systole), a pathological discharge of blood from the left ventricle of the heart to the right occurs.

The volume of this pathological discharge depends on the size and location of the cerebrospinal fluid: in the case of small sizes of the defect, the latter practically does not affect the work of the heart. On the opposite side of the defect in the wall of the right ventricle, and in some cases on the tricuspid valve, cicatricial thickening may develop, which is the result of a reaction to an injury from a pathological discharge of blood spurting through the defect.

In addition, due to pathological discharge, additional blood flowing into the vessels of the lungs (pulmonary circulation) leads to the formation of pulmonary hypertension (increased blood pressure in the vessels of the pulmonary circulation). Over time, the body switches on compensatory mechanisms: there is an increase in the muscle mass of the ventricles of the heart, a gradual adaptation of the blood vessels of the lungs, which first absorb the incoming excess blood volume, and then pathologically change – a thickening of the walls of arteries and arterioles forms, which makes them less elastic and more dense .

An increase in blood pressure in the right ventricle and pulmonary arteries occurs until, finally, there is equalization of pressure in the right and left ventricle in all phases of the cardiac cycle, after which the pathological discharge from the left ventricle of the heart to the right stops. If, over time, the blood pressure in the right ventricle is higher than in the left ventricle, the so-called “reverse vent” occurs, in which venous blood from the right ventricle of the heart through the same DI passes into the left ventricle.

Causes

There are no specific reasons that can provoke a ventricular septal defect in children. It was established that a defective septum occurs as a result of abnormal formation of the fetal heart (in the 1st trimester of pregnancy).

A muscle defect in the interventricular septum in a newborn can appear if future parents are at risk. They fall into it for the following reasons:

  • Genetic predisposition. If one of the future parents or their close relatives has defects in the interventricular septum, then the fetus has a 50% chance of acquiring this disease.

Also, fetal health can be affected by:

  • Age-related changes in the pregnant woman (applies to women after 40 years).
  • Radiation effect on the body.
  • Genetic mutations of the fetus.
  • Vitamin deficiency during pregnancy or lack of nutrients.

To reduce the risk of intrauterine disorders, you need to seriously approach the lifestyle during pregnancy: give up bad habits and protect your health, take vitamins ascribed to by your doctor. It is best to get tested by both partners before conception. This will allow you to identify pathologies, infections, and other factors that can affect the fetal development in time.

This pathology is formed even before the birth of a child due to impaired development of the heart.

Its appearance is promoted by such reasons:

  1. Infectious diseases of the mother in the first three months of pregnancy: measles, rubella, chickenpox.
  2. The use of alcohol and drugs.
  3. Some medicines: warfarin, preparations containing lithium.
  4. Hereditary predisposition: heart disease is inherited in 3-5% of cases.

In the interventricular septum there are different types of defects:

  1. Multiple small holes are the easiest form, which has little effect on the state of health.
  2. Multiple large holes. The septum resembles Swiss cheese – the most severe form.
  3. Holes in the lower part of the septum, consisting of muscles. They more often than others drag on their own during the first year of a child’s life. This is facilitated by the development of the muscle wall of the heart.
  4. Holes located under the aorta.
  5. Defects in the middle of the septum.

Violations of the formation of the interventricular septum, as established, occur during the first three months of pregnancy. The interventricular septum of the fetus is formed of three components, which during this period should be matched and adequately connected to each other. Violation of this process leads to the fact that a defect remains in the interventricular septum.

At the stage of early intrauterine development of the fetus, a hole appears in the muscular septum separating the left and right chambers of the heart. In the first trimester of pregnancy, its main parts develop, correlate and correctly connect with each other. If this process is disrupted under the influence of endogenous and exogenous factors, a defect will remain in the septum.

The main causes of breast cancer:

  1. Heredity – the risk of having a sick child is increased in those families where there are people with congenital heart abnormalities.
  2. Infectious diseases of a pregnant woman – SARS, mumps, chickenpox, rubella.
  3. Reception of a pregnant woman with antibiotics or other medicines with an embryotoxic effect – antiepileptic drugs, hormones.
  4. Adverse environmental conditions.
  5. Alcohol and drug intoxication.
  6. Ionizing radiation.
  7. Early toxicosis of a pregnant woman.
  8. Lack of vitamins and minerals in the diet of a pregnant woman, hungry diets.
  9. Age-related changes in the body of a pregnant woman after 40 years.
  10. Endocrine diseases in a pregnant woman – hyperglycemia, thyrotoxicosis.
  11. Frequent stress and overwork.

The most common cause of a ventricular septal defect or DMS is considered:

  • infectious diseases (respiratory infections, rubella, mumps, chickenpox);
  • early pregnancy toxicosis;
  • side effects of drugs;
  • mother’s hungry diets;
  • lack of vitamins in the diet of a pregnant woman;
  • possible age-related changes in pregnancy after 40 years;
  • chronic diseases of the expectant mother (diabetes mellitus, cardiovascular failure);
  • radiation exposure;
  • genetic mutations (from ¼ to ½ cases of interventricular defect combined with other congenital changes, Down’s disease, abnormalities in the development of limbs, kidneys).

Types of operations for ventricular septal defect

If the condition of the child allows, then it is advisable to perform an operation between 1 and 2,5 years. During this period, the baby is already strong enough and will best endure such an intervention. In addition, he will soon forget the treatment period and the child will not have psychological trauma.

What are the indications for surgery?

  1. The presence of holes in the interventricular septum.
  2. Blood flow from the left ventricle to the right.
  3. Enlarged right heart.
  1. The third degree of the development of the disease, irreparable changes in the vessels of the lungs.
  2. Blood poisoning is sepsis.

Pulmonary Artery Narrowing Surgery

The surgeon bandages an artery with a special braid or thick silk thread, which carries blood from the heart to the lungs so that less blood flows into them. This operation is a preparatory stage before the defect is completely closed.

Indications for operation

  1. Increased pressure in the vessels of the lungs.
  2. Blood flow from the left ventricle to the right.
  3. The child is too weak to undergo surgery to repair the defect in the interventricular septum.
  1. Reduces blood flow to the lungs and reduces pressure in them.
  2. It becomes easier for the child to breathe.
  3. It makes it possible to postpone the operation to eliminate the defect for 6 months and allow the child to get stronger.
  1. The child and parents will have to undergo 2 operations.
  2. The load on the right ventricle increases, as a result, it stretches and increases.

This type of treatment requires opening the chest. An incision is made along the sternum, the heart is disconnected from the vessels. For a while it is replaced by a cardiopulmonary bypass system. The surgeon makes an incision in the right ventricle or in the atrium. Depending on the size of the defect, the doctor chooses one of the treatment options.

  1. Suturing a defect. If its size does not exceed 1 cm and it is located away from important vessels.
  2. The doctor puts a sealed patch on the septum. It is cut to the size of the hole and sterilized. There are two types of patches:
    • from a piece of the outer membrane of the heart (pericardium);
    • from artificial material.

After that, the tightness of the patch is checked, blood circulation is restored and a suture is applied to the wound.

Indications for open surgery

  1. It is not possible to improve a child’s condition with medication.
  2. Changes in the vessels of the lungs.
  3. Overload of the right ventricle.
  1. It allows you to simultaneously remove blood clots that may have formed in the heart.
  2. Allows you to eliminate other pathologies of the heart and its valves.
  3. It makes it possible to fix defects at any location.
  4. Held by children of any age.
  5. Allows you to once and for all get rid of heart problems.
  1. It is quite traumatic for a child, lasts up to 6 hours.
  2. Requires a long recovery period.

The essence of the operation is that the defect in the interventricular septum is closed using a special device that is inserted into the heart through large vessels. The device resembles interconnected buttons. It is installed in the hole and blocks the flow of blood through it. The procedure is under the control of x-rays.

Indications for closure of the defect by the occluder

  1. The defect is located at least 3 mm from the edge of the interventricular septum.
  2. Signs of stagnation of blood in the vessels of the lungs.
  3. Blood flow from the left ventricle to the right.
  4. Age over 1 year and weight more than 10 kg.
  1. Less traumatic for the child – no need to cut the chest.
  2. Recovery takes 3-5 days.
  3. Immediately after the operation, improvement occurs and blood circulation in the lungs normalizes.
  1. It is used only to close small defects that are located in the central part of the partition.
  2. You can not close if the vessels are narrow, there is a blood clot in the heart, valve problems or persistent heart rhythm disturbances.
  3. There is no way to fix other heart disorders.

The only effective treatment for medium to large defects of the interventricular septum is open heart surgery. Surgeons of large cardiology centers carry out this operation quite often and have extensive experience in this matter. Therefore, you can be sure of a successful outcome.

Indications for operation

  • defect in the interventricular septum;
  • reflux of blood from the left ventricle to the right;
  • signs of enlargement of the right ventricle;
  • heart failure – the heart does not cope with the pump function and poorly supplies the organs with blood;
  • signs of circulatory disorders in the lungs: shortness of breath, moist rales, pulmonary edema;
  • ineffectiveness of drug treatment.
  • blood flow from the right ventricle to the left;
  • 4 times increase in pressure in the vessels of the lungs and sclerosis of small arteries;
  • severe exhaustion of the child;
  • severe concomitant diseases of the liver and kidneys.

The urgency of the operation depends on the size of the defect.

  1. Minor defects, less than 1 cm – the operation can be delayed up to 1 year, and if there are no circulatory disorders, then up to 5 years.
  2. Medium defects, less than 1/2 of the diameter of the aorta. The child needs to be operated on in the first 6 months of life.
  3. Large defects, diameter equal to the diameter of the aorta. An urgent operation is needed until irreversible changes in the lungs and heart develop.
  1. Preparing for the operation. On the appointed day, you and your child will come to the hospital, where you will have to stay a few days before the operation. Doctors will do the necessary tests:
    • blood type and rhesus factor;
    • blood coagulation test;
    • general blood analysis;
    • Analysis of urine;
    • analysis of feces for worm eggs.

      An ultrasound of the heart and a cardiogram will also be repeated.

  2. Before the operation, a conversation with the surgeon and anesthetist will take place. They will examine the child and answer all your questions.
  3. General anesthesia. The child will be given intravenous painkillers and he will not feel any pain during the operation. The doctor accurately doses the drug, you can be sure that anesthesia will not harm the baby.
  4. The doctor will make an incision along the sternum to gain access to the heart and connect the child to the heart-lung machine.
  5. Hypothermia – a decrease in body temperature. Using special equipment, the blood temperature of the child is reduced to 15 ° C. Under such conditions, the brain can more easily tolerate oxygen starvation, which can occur during surgery.
  6. A heart disconnected from blood vessels does not temporarily contract. The coronary pump will clear the heart of blood so that it is more convenient for the surgeon to work.
  7. The doctor will make an incision on the right ventricle and eliminate the defect. He will stitch it to tighten the edges. If the hole is large, then the surgeon uses a specially prepared patch from the external connective tissue of the heart or synthetic material.
  8. After this, the tightness of the interventricular septum is checked, the hole in the ventricle is sutured and the heart is connected to the circulatory system. Then the blood is gradually heated to normal temperature with a heat exchanger, and the heart begins to contract on its own.
  9. The doctor sutures a wound on his chest. He leaves drainage in the seam – a thin rubber tube to drain fluid from the wound.
  10. A bandage is placed on the baby’s chest and the child is transferred to the intensive care unit, where he will have to spend a day under the supervision of medical personnel. You may be allowed to visit him. But in some hospitals it is forbidden to protect the baby from infections.
  11. Then the child will be transferred to the intensive care unit, where you can be near him, calm and support. Raising the temperature to 40 ° C is a frequent phenomenon – do not panic. Worse, when at this temperature the child turns pale, and the pulse becomes weak and slow. Then urgently need to inform the doctor.

Remember, the child’s body is better adapted to the struggle for survival and is able to recover much faster than an adult. Therefore, your baby will quickly get to his feet, especially if you will properly care for him.

NameWhere is the defect located?Incidence as a percentage of total interventricular septal disorders
PerimembranousLeft ventricular exit region above the aortic valve75 – 80%
MuscularThe muscular part of the septum5 – 20%
InfundibularUnder the pulmonary and aortic valve4 – 5%

The size of the ventricular septal defect can be very different, have a favorable prognosis or significantly reduce the quality of life of patients.

  1. Muscular. About 90 percent of all defects of the interventricular septum (MJP) are located in its muscle part.
  2. Membranous. The perimembranous interventricular septal defect is located near the aortic valve (under the valve).
  3. Grebnevy. The defect is located in the area of ​​exit of large vessels from the left and right ventricles (RV).
  1. Small defects. LCF with sizes from 1 to 10 mm are referred to small defects, which are collectively called Tolochinov-Roger disease.
  2. Big defects. The hole in the interventricular septum from 10 mm and above is classified as large.

According to the location of the hole, 3 types of pathology are distinguished:

  1. Perimembranous defect,
  2. Muscle defect
  3. Podterial defect.
  • Large DZHP – more aortic lumen,
  • Middle DMS – half aortic lumen,
  • Small VSD – less than a third of the aortic lumen.

Between the ventricles is a septum, consisting of 2/3 of muscle tissue and only in the upper part – of the fibrous membrane (membrane). Accordingly, according to the location of the hole, a muscle defect in the interventricular septum and membranous are distinguished. More common localization at the docking of these parts (perimembranous opening).

Types of defects in the development of the septum

A muscle defect in the septum is formed with a frequency of up to 20%, and perimembranous – 4 times more. Muscular “windows” are characterized by a size of up to 10 mm in diameter, and holes up to 3 cm appear in the membrane.

The location of the hole is important in the functioning of the conductive fibers of the atrioventricular bundle (His bundle), which ensure the transmission of nerve impulses from the atria to the ventricles. There are blockades of varying degrees.

Baby care after heart surgery

You and the baby will be discharged home when the doctors make sure that the child is recovering.

At this time, it is advisable to carry the child in her arms more – this is called a massage position. It develops, calms and improves blood circulation. Do not be afraid to teach a child to hand – health is more expensive than pedagogical principles.

Protect your child from infections: Avoid being in crowded places. Do not hesitate to take him away, if a person with signs of illness appears nearby, protect the baby from hypothermia. If there is a need to visit the clinic, then lubricate the child’s nose with Oxoline ointment or use sprays for the prevention of Euphorbium Compositum, Nazaval.

Scar Care The wound will heal for about 4 weeks. At this time, lubricate the seam with tincture of calendula and protect it from sunlight. To avoid scar formation, there are special creams – Kontraktubeks, Solaris. Ask your doctor which one is right for your child.

After the seams are completely healed, you can bathe the baby in the bath. It is better if the first times the water is boiled with the addition of potassium permanganate. The water temperature is 37 ° C, and the bathing time is reduced to a minimum. For an older child, an ideal option would be a shower.

The sternum is bone, it will heal for about 2 months. During this period, you can not pull the child by the arms, raise his armpits, spread on his stomach, massage him and, in general, physical activity should be avoided to prevent deformation of the chest.

After the sternum is fused, there is no particular reason to limit the child’s physical development. But still, for the first six months, try to avoid serious injuries, so do not allow the child to ride a scooter, bicycle or roller.Take the drugs prescribed by the doctor: Veroshpiron, Digoxin, Aspirin. They will help to avoid the accumulation of fluid in the lungs, improve heart function and prevent the appearance of blood clots. In the future, they will be canceled, and your baby will live like an ordinary child.

The first six months you will need to measure the temperature in the morning and evening and write down the results in a special diary.

Tell your doctor about these symptoms:

  • temperature increase above 38 ° C;
  • the seam is swollen and fluid will start to flow out of it;
  • chest pain;
  • pallor or bluish tint of the skin;
  • swelling of the face, around the eyes, or other swelling;
  • shortness of breath, fatigue, refusal of games;
  • nausea, vomiting ;
  • dizziness, loss of consciousness.
  1. A urine test will have to be taken the first month every ten days. And the next six months, 2 times a month.
  2. An electrocardiogram, phonoradiogram, echocardiography will need to be done once every three months for the first six months. In the future, twice a year.
  3. After some time, it is advisable to go with a child to a special sanatorium for 1-3 months.
  4. Vaccinations will have to be postponed for six months.
  5. In total, the child will remain registered with cardiologists for 5 years.

A complete and high-calorie diet should help the child recover quickly after surgery and gain weight.

The best choice for babies up to a year is breast milk. It is necessary to introduce complementary foods in a timely manner: fruits, vegetables, meat and fish.

Older children eat according to their age. The menu should include:

  1. Fresh fruits and juices.
  2. Fresh and cooked vegetables.
  3. Dishes of meat, boiled, baked or stewed.
  4. Dairy products: milk, cottage cheese, yogurt, sour cream. Cottage cheese casserole with dried fruits will be especially useful.
  5. Boiled or omelet eggs.
  6. Various soups and cereal dishes.
  • margarine;
  • fatty pork;
  • meat of duck and goose;
  • chocolate, strong tea.

To summarize: although the operation is considered rather traumatic and causes fear among parents and the child, only it can give a chance for a healthy life. The percentage of adverse outcomes is very small. Doctors can restore health to absolutely everyone, from premature babies weighing about a kilogram, to adults in whom this pathology previously passed secretly.

Characterization of the defect in adults

Previously, there were no such effective methods for studying defects and their treatment. As a result, many children died before they reached adulthood, but there are those who have suffered the disease and adapted to it. Most often, a septal defect between the cardiac ventricles in adults is detected as a result of impaired functionality of the cardiovascular system: heart failure, arrhythmia, pain in the chest, accompanied by a wet cough.

In some cases, a defective septum is found in women during pregnancy. Then urgent diagnosis and clarification of the diameter of the defect is required. If a small defect is detected, an abortion or a cesarean section is not required, because a woman can give birth on her own, and this will not affect her well-being.

With severe defects found during pregnancy, a woman has problems in the form of a failure in the rhythm of the heart, its insufficiency, shortness of breath, swelling of the limbs. These deviations can provoke the birth of a child with cardiac pathologies, therefore, for some women, childbirth is contraindicated.

In the absence of the necessary diagnosis, the anomaly is detected already in an adult state. The most characteristic signs are manifested in the form of developed heart failure: shortness of breath at rest, wet cough, arrhythmia, pain in the heart.

If a heart defect is detected in a woman during pregnancy, then an urgent diagnosis should be made to determine the size of the defect. With a small interventricular passage, problems during pregnancy are not expected. Childbirth passes independently.

But with a pronounced defect, the load during pregnancy contributes to the decompensation of the woman’s condition: there is heart failure, rhythm disturbance, swelling, shortness of breath.

Maternal oxygen deficiency affects fetal development. Significantly increases the risk of having a baby with congenital diseases. Treatment during pregnancy can also adversely affect the unborn baby. It is necessary to use strong cardiac drugs that have a toxic effect on the fetus.

Under such conditions, the inheritance of malformations increases. Therefore, pregnancy is categorically contraindicated for some women with child cancer. Doctors recommend planning a pregnancy and treatment in advance.

Symptoms and external signs

Manifestations of VSD depend on the size of the defect and the stage of development of the disease.

The size of the defect is compared with the lumen of the aorta.

  1. Minor defects – less than 1/4 of the diameter of the aorta or less than 1 cm. Symptoms can appear at 6 months and in adulthood.
  2. Medium defects are less than 1/2 of the diameter of the aorta. The disease manifests itself in 1-3 months of life.
  3. Large defects – the diameter is equal to the diameter of the aorta. The disease manifests itself from the first days.

Stages of changes in the vessels of the lungs (stage of pulmonary hypertension).

  1. The first stage is stagnation of blood in the vessels. The accumulation of fluid in the lung tissue, frequent bronchitis and pneumonia.
  2. The second stage is vasospasm. The phase of temporary improvement, the vessels are narrowing, but the pressure in them increases 30 to 70 mm RT. Art. It is considered the best period for surgery.
  3. The third stage is vascular sclerosis. It develops if the operation was not performed on time. Pressure in the right ventricle and vessels of the lungs from 70 to 120 mm RT. Art.

With a large defect in the interventricular septum in newborns, their health worsens from the first days.

  • bluish tint of skin at birth;
  • shortness of breath
  • the baby quickly gets tired and cannot suckle normally;
  • anxiety and tearfulness due to hunger;
  • sleep disorders;
  • poor weight gain;
  • early pneumonia that is not treatable well.
  • elevation of the chest in the region of the heart – heart hump;
  • during contraction of the ventricles (systole), trembling is felt, which creates a flow of blood passing through an opening in the interventricular septum;
  • when listening with a stethoscope, noise is heard that is caused by insufficiency of the valves of the pulmonary artery;
  • wheezing and hard breathing are heard in the lungs associated with the release of fluid from the vessels into the lung tissue;
  • when tapping, an increase in heart size is detected;
  • an increase in the liver and spleen is associated with stagnation of blood in these organs;
  • in the third stage, a bluish tint of the skin (cyanosis) is characteristic. First on the fingers and around the mouth, and then throughout the body. This symptom appears due to the fact that the blood is not sufficiently enriched with oxygen in the lungs and body cells experience oxygen starvation;
  • in the third stage, the chest is swollen, looks like a barrel.

Symptoms of DMZhP

A defect in the interventricular septum in children is accompanied by a violation of the heart rhythm, as a result of which blood clots can form that enter the lungs or brain through the vascular system. Timely detection of this deviation avoids complications.

When detecting small defective holes up to 10 mm in size, the size of the aorta is also taken into account. If a muscle defect in the interventricular septum in a newborn is less than 1/3 of the left ventricle, then minor symptoms appear.

In full-term babies with normal weight, from the first day after birth, a strong noise is heard in the heart (from the chest and back). Sometimes you can feel the chest tremble if you put your hand on the baby’s chest. This indicates the leakage of blood through the hole of a narrow diameter.

In children of school and preschool age, having small defects of the interventricular septum, intracardiac murmurs disappear almost completely. This is due to compression of the interventricular lumen by the muscle tissue of the heart.

The septal defect between the ventricles (heart) of moderate severity is a hole of 10-20 mm. A severe defect includes a defect larger than 20 mm in size. The first sign of the disease is hypertrophy, characterized by a lack of body mass. In the future, the child will slowly gain weight, coming to dystrophy.

If a malignant defect in the interventricular septum is detected, the following symptoms appear, indicating the need for emergency treatment to a specialist:

  • The baby often breaks away from the breast due to the fact that it has difficulty sucking. As a result of this, the baby does not overeat and loses weight.
  • Sweating of the palms and shortness of breath appears.
  • The skin becomes pale, cyanosis appears around the mouth. During crying, she becomes more pronounced.

With a stable course of the disease, the child will regularly suffer from bronchopulmonary diseases provoked by an overload of the pulmonary circulation. Over time, infections will lead to a worsening of the patient’s condition.

If a defective interventricular septum was diagnosed in 3-4 years (at a moderate or severe stage), the baby will complain about:

  • Stop work of the heart.
  • Heart pain, loss of consciousness.
  • Shortness of breath at rest (lying down).
  • Bleeding from the nasal cavity.
  • Cyanosis near the mouth, which will become permanent, pronounced.
  • Serious weight loss and stunted growth.
  • Chronic cough

Using a phonendoscope, the doctor hears a noise characteristic of a defective septum and moist rales in the pulmonary system. On palpation, it will detect an enlarged liver.

Confirmed information that this condition is characterized by swelling of the extremities, but in children they do not occur.

The timing of the onset of the first signs of DMS depends on the size of the defect itself, as well as the size and direction of the pathological discharge of blood.

Small defects in the lower parts of the interventricular septum in most cases do not significantly affect the development of children. Such children feel satisfactory. Already in the first few days after birth, a moderate-intensity heart murmur of a rough, scratching timbre appears, which the doctor listens to in systole (during a heart beat).

This noise is better heard in the fourth to fifth intercostal space and is not carried out to other places; its intensity in the standing position may decrease. Since this noise is often the only manifestation of a small CSF that does not significantly affect the well-being and development of the child, this situation in the medical literature has received the figurative name “a lot of noise from nothing.”

In some cases, in the third or fourth intercostal space along the left edge of the sternum, you can feel the trembling at the time of cardiac contraction – systolic tremor, or systolic “cat purr”.

With large defects of the membranous (membranous) portion of the interventricular septum, the symptoms of this congenital heart disease, as a rule, do not appear immediately after the birth of the baby, but after 12 months. Parents begin to notice difficulties while feeding the baby: he has shortness of breath, he is forced to pause and take breaths, which may leave him hungry, and anxiety appears.

Born with normal weight, such children begin to lag behind in their physical development, which is explained by malnutrition and a decrease in the volume of blood circulating in a large circle of blood circulation (due to pathological discharge into the right ventricle of the heart). Severe sweating, pallor, marbling of the skin, slight cyanosis of the final departments of the arms and legs (peripheral cyanosis) appear.

Characterized by rapid breathing with the involvement of auxiliary respiratory muscles, paroxysmal cough arising from a change in body position. Repeated pneumonia (pneumonia) develops that are difficult to treat. To the left of the sternum, a deformation of the chest occurs – a cardiac hump forms.

The apical impulse is shifted to the left and down. Systolic trembling is felt in the third or fourth intercostal space at the left edge of the sternum. During auscultation (listening) of the heart, a gross systolic murmur in the third or fourth intercostal space is determined. In children of an older age group, the main clinical signs of the disease persist, they have complaints of soreness in the heart and heart palpitations, children continue to lag behind in their physical development. With age, the well-being and condition of many children improves.

A defect in the interventricular septum in a newborn (a child of the first 28 days of life) manifests itself only in the case of an extensive window or combination with other defects, if this is not the case, clinical symptoms of a significant defect occur only after 6-8 weeks. Severity depends on the amount of blood discharged from the left chambers of the heart to the right.

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Big defect

The same symptoms as with a moderate defect, but in a more pronounced form, in addition:

  • blue face and neck (central cyanosis) on the background of physical activity;
  • constant bluish staining of the skin is a sign of concomitant defect.

The entire clinical picture is determined by the size of the defect. If the hole size is up to 5 mm, then complaints from the patient or parents may be absent. Defects exceeding 10-15 mm usually affect the condition of the baby. Parents may notice the following symptoms:

  • The color of the skin is blue (cyanotic), mainly on the face and limbs. This symptom is aggravated by feeding, crying, screaming, straining. At first, such symptoms occur only during physical exertion, then they are present at rest.
  • The baby does not suckle well on the mother’s breast, and may refuse to breastfeed.
  • There is a slow increase in the growth and weight of newborns.
  • Respiratory rate exceeds normal.
  • The child is sleepy.
  • There may be swelling on the feet and stomach.
  • Frequent respiratory diseases (pneumonia, colds).

CSF does not cause problems to the fetus and does not prevent it from developing. The first symptoms of the pathology appear after the birth of the baby: acrocyanosis, lack of appetite, shortness of breath, weakness, swelling of the abdomen and extremities, tachycardia, slow psychophysical development.

Severe forms of pneumonia, which respond poorly to therapy, often occur in children with signs of DMS. The doctor, examining and examining a sick child, discovers enlarged heart sizes, systolic murmur, hepatosplenomegaly.

  • If there is a small breast cancer, the development of children does not change significantly. There are no complaints, shortness of breath and slight fatigue occur only after exercise. The main symptoms of the pathology are systolic murmur, which is found in newborns, spreads in both directions and is well heard on the back. He for a long time remains the only symptom of pathology. In more rare cases, when you put your palm on your chest, you can feel a slight vibration or trembling. There are no symptoms of heart failure.
  • A pronounced defect manifests itself in children acutely from the first days of life. Children are born with malnutrition. They eat poorly, become restless, pale, they develop hyperhidrosis, cyanosis, shortness of breath at first with food, and then at rest. Over time, breathing becomes rapid and difficult, a paroxysmal cough appears, and a heart hump forms. Wet rales appear in the lungs, and the liver enlarges. Older children complain of palpitations and cardialgia, shortness of breath, frequent nosebleeds and fainting. They are significantly behind in development from their peers.

Stages of the development of the disease:

  1. The first stage of the pathology is manifested by an increase in the size of the heart and stagnation of blood in the pulmonary vessels. In the absence of adequate and timely therapy, pulmonary edema or pneumonia may develop.
  2. The second stage of the disease is characterized by spasm of the pulmonary and coronary vessels in response to their overextension.
  3. In the absence of timely treatment for CHD, irreversible sclerosis develops in the pulmonary vessels. At this stage of the disease, the main pathological signs appear, and cardiac surgeons refuse to perform the operation.

Instrumental diagnostics of DMZhP

To diagnose a ventricular septal defect in newborns, radiography, electrocardiography, and two-dimensional Doppler echocardiography are used. All of them are painless and the child tolerates them well.

A painless and informative x-ray examination of the chest. A stream of rays passes through the human body and forms an image on a special sensitive film. The picture allows you to assess the condition of the heart, blood vessels and lungs.

In case of breast cancer in newborns:

  • an increase in the borders of the heart, especially its right side;
  • enlargement of the pulmonary artery, which carries blood from the heart to the lungs;
  • overfilling and spasm of the vessels of the lungs;
  • fluid in the lungs or pulmonary edema, manifested by darkening in the picture.

This study is based on the registration of electrical potentials that occur during the work of the heart. They are written as a curved line on a paper tape. The doctor evaluates the condition of the heart by the height and shape of the teeth. The cardiogram may be normal, but overload of the right ventricle more often appears.

Heart ultrasound Doppler study

Ultrasound examination of the heart. Based on the reflected ultrasonic wave, a real-time image of the heart is created. This type of ultrasound allows you to identify the features of the movement of blood through a defect.

  • a hole in the septum between the ventricles;
  • its size and location;
  • red color reflects the flow of blood, which moves towards the sensor, and blue – blood that flows in the opposite direction. The lighter the shade, the higher the blood speed and pressure in the ventricles.
  1. In the first stage:
    • enlarged heart, it is round, without narrowing in the middle;
    • the vessels of the lungs look fuzzy and blurry;
    • there may be signs of pulmonary edema – darkening over the entire surface.
  2. In transition:
    • the heart is normal;
    • blood vessels look normal.
  3. The third stage is sclerotic:
    • the heart is enlarged, especially on the right side;
    • enlarged pulmonary artery;
    • only large vessels of the lungs are visible, and small ones are invisible due to spasm;
    • the ribs are horizontal;
    • diaphragm down.
  1. The first stage may not manifest itself in any changes or may appear:
    • overload of the right ventricle;
    • enlargement of the right ventricle.
  2. The second and third stage:
    • overload and enlargement of the left atrium and ventricle.
    • violations of the passage of biocurrents through the heart tissue.
  • reveals the location of the defect in the septum;
  • defect size;
  • the direction of blood flow from one ventricle to another;
  • the pressure in the ventricles of the first stage is not more than 30 mm RT. Art., in the second stage – from 30 to 70 mm RT. Art., and in the third – more than 70 mm RT. Art.

1. Electrocardiography (ECG): In the case of small sizes of breast cancer, significant changes in the electrocardiogram may not be detected. As a rule, the normal position of the electrical axis of the heart is characteristic, but in some cases it may deviate to the left or right. If the defect is large, this is more significantly reflected in electrocardiography.

With a pronounced pathological discharge of blood through a defect from the left ventricle of the heart to the right without pulmonary hypertension, signs of overload and increase in muscle mass of the left ventricle are detected on the electrocardiogram. In the event of significant pulmonary hypertension, symptoms of overload of the right ventricle of the heart and right atrium appear. Heart rhythm disturbances are rare, as a rule, in adult patients in the form of extrasystole, atrial fibrillation.

2. Phonocardiography (recording vibrations and sound signals issued during the activity of the heart and blood vessels) allows you to instrumentally record pathological murmurs and altered heart sounds due to the presence of VSD.

3. Echocardiography (ultrasound examination of the heart) allows not only to detect a direct sign of a birth defect – a break in the echo signal in the interventricular septum, but also to accurately determine the location, number and size of defects, as well as to determine the presence of indirect signs of this defect (an increase in the size of the ventricles of the heart and left atrium , increase in wall thickness of the right ventricle and others).

4. X-ray of the chest organs (heart and lungs). With small sizes of breast cancer, pathological changes are not determined. With significant sizes of the defect with a pronounced discharge of blood from the left ventricle of the heart to the right, an increase in the size of the left ventricle and the left atrium, and then the right ventricle, and an increase in the vascular pattern of the lungs are determined. As pulmonary hypertension develops, the expansion of the roots of the lungs and the bulging of the arc of the pulmonary artery are determined.

5. Cardiac catheterization is performed to measure pressure in the pulmonary artery and in the right ventricle, as well as to determine the level of blood oxygen saturation. A higher degree of blood oxygen saturation (oxygenation) in the right ventricle is characteristic than in the right atrium.

6. Angiocardiography – the introduction of contrast medium into the cavity of the heart through special catheters. When contrast is injected into the right ventricle or pulmonary artery, their contrast is observed again, which is explained by the return to the right ventricle of contrast with a pathological discharge of blood from the left ventricle through the pancreas, after passing through the pulmonary circulation. With the introduction of a water-soluble contrast in the left ventricle, the flow of contrast from the left ventricle of the heart to the right through the BC is determined.

It is impossible to identify a ventricular septal defect in children, based only on clinical manifestations, given that the complaints are not specific.

Heart defect – JMP is diagnosed until the child is three years old. Until this time, the opening between the two ventricles may still close independently. After three years of age, the defect remains. Large-sized defects are diagnosed much easier and faster, since already the appearance of the child gives clear questions with the heart.

The second point that the doctor draws attention to is the presence of gross noise during auscultation of the heart. To clarify the nature of the noise, as well as assess the state of the circulatory system, other examinations are prescribed – echocardiography (ultrasound of the heart), electrocardiography, chest x-ray, pulse oximetry (assessment of the gas composition of the blood), catheterization of the heart cavities, magnetic resonance imaging.

Diagnosis of the disease includes a general examination and examination of the patient. During auscultation, specialists detect cardiac murmurs, which makes it possible to suspect the presence of a patient with SMD. To make a final diagnosis and prescribe adequate treatment, special diagnostic procedures are performed.

  • Echocardiography is performed to detect a defect, determine its size and location, the direction of blood flow. This method provides comprehensive data on heart disease and condition. This is a safe, highly informative study of heart cavities and hemodynamic parameters.
  • Only in the presence of a large defect on the ECG do pathological changes appear. The electrical axis of the heart usually deviates to the right, signs of left ventricular hypertrophy appear. In adults, arrhythmia, conduction disturbances are recorded. This is an indispensable research method that allows you to identify dangerous heart rhythm disturbances.
  • Phonocardiography allows you to detect pathological murmurs and altered heart sounds, which are not always determined by auscultation. This is an objective qualitative and quantitative analysis that does not depend on the characteristics of the doctor’s hearing. A phonocardiograph consists of a microphone that converts sound waves into electrical impulses, and a recording device that records them.
  • Dopplerography is the primary technique for making a diagnosis and identifying the consequences of valvular disorders. She estimates the parameters of pathological blood flow due to CHD.
  • On the roentgenogram, the heart with DMS is significantly enlarged, there is no narrowing in the middle, spasm and overflow of the vessels of the lungs, flattening and low standing of the diaphragm, horizontal location of the ribs, fluid in the lungs in the form of blackout over the entire surface are revealed. This is a classic study that allows you to detect an increase in the shadow of the heart and a change in its contours.
  • Angiocardiography is performed by introducing a contrast medium into the heart cavity. It allows you to judge the localization of a birth defect, its volume and to exclude concomitant diseases.
  • Pulse oximetry – a method for determining the amount of oxyhemoglobin in the blood.
  • Magnetic resonance imaging is an expensive diagnostic procedure, which is a real alternative to echocardiography and dopplerography and allows you to visualize an existing defect.
  • Cardiac catheterization – a visual examination of the cardiac cavities, which allows you to establish the exact nature of the lesion and features of the morphological structure of the heart.

All newborn babies are examined by a pediatric neonatologist who has special training in congenital diseases and developmental abnormalities. Signs detected by listening to the heart are reasonable indications for the use of additional methods. The baby and mother are transferred to a children’s clinic or specialized medical institution for further examination and the choice of treatment.

  1. The ECG indicates congestion of the ventricles and the right atrium, reveals a disturbed rhythm, a change in conductivity in the form of a blockage of the bundle of His.
  2. Phonocardiography allows you to record heart murmurs from different points.
  3. Ultrasound diagnostics visually demonstrates an increase in heart cavities, pathological discharge of blood through an opening in the septum, thickening of the heart muscle wall, and a change in blood flow velocity. Be sure to check the operation of the valve apparatus for the diagnosis of combined multiple developmental anomalies.
  4. If necessary, a probe is inserted into the right atrium through a catheter in the subclavian vein and pressure in the right chambers and oxygen saturation of the blood are measured. Significant increase in pressure and oxygen saturation are characteristic of severe DZHP. This indicates a “robbery” of arterial blood and tissue hypoxia.
  5. An x-ray shows the expansion of the shadow of the heart due to both ventricles, bulging of the pulmonary artery, congestion in the lungs.

Treatment

So that the outflow of blood from the lungs can be normalized, experts prescribe medication for a defect in the interventricular septum in newborns.

Diuretic pharmacy drugs are prescribed: Furosemide.

Diuretic to reduce blood volume in blood vessels, thereby reducing pressure and pulmonary edema. For children, the drug is prescribed to be taken once a day, before lunch, at the rate of 1–2 mg / kg.

Cardiometabolic drug: Phosphidene, Cocarboxylase, Cardinate

Nutrition of the heart muscle is improved with the help of drugs, oxygen starvation passes. The drug is prescribed to be taken once a day, after meals. Dissolve preparations in sweetened water. The course usually lasts from three weeks to three months.

Cardiac Glycosides: Strofintin, Digoxan

The baby’s heart has more powerful contractions, which leads to more efficient pumping of blood through the vessels. A solution of 0,05% strophanthin of calculation of 0,01 mg / kg of weight, and digoxin of 0,03 mg / kg is prescribed to newborns.

Pulmonary and bronchial spasm removal: Eufillin

For pulmonary edema and bronchial spasm, or when breathing difficulties in a baby, prescribe a 2% solution of aminophylline. The drug is administered intravenously in the calculation of 1 ml per year of life.

The specifics of treating a defective septum is to heal a hole. Before prescribing optimal therapy, doctors carefully examine the heart, find out the exact size of the hole, their number (2-3 can form immediately in the interventricular septum).

If the detected defects are small, there are no complaints from the patient, his condition is stable, that is, there is a chance that after a few years the child will fully recover, without the use of radical therapeutic methods. However, this is possible provided that the child does not suffer from infectious diseases, experience stress or overload.

Unfortunately, there are no medications that contribute to the closure of the opening in the septum, therefore medications are prescribed for the general maintenance of the patient’s heart and blood vessels.

  • “Anaprilin”, “Digoxin”, “Inderal” are used to restore heart rate, supply energy to the heart muscle and reduce oxygen deficiency.
  • “Warfarin” or “Aspirin” is prescribed to reduce blood clots.
  • Vitamin complexes, “Inosine”, “Potassium orotate”, “Folic acid”, are used to feed the myocardium.
  • Captopril is prescribed for unstable intravascular pressure.

These medications are very serious, especially for treating children. Dosages are also important. For example, Captopril is dispensed in pharmacies at a dosage only for adults. This amount of medication can harm the baby. When prescribing the drug, the doctor writes a prescription, which indicates the necessary dose, starting from the age, weight of the patient, detected deviations. Then it can be bought ready-made, packaged for one-time use. For newborns, Captopril is packaged in powder form.

The same applies to other medications, so it’s strictly contraindicated to independently select drugs for treatment, calculate dosages and give them to children.

Modern techniques

As the main method of treatment of a defective septum, surgical intervention is used. Experienced doctors recommend heart surgery as soon as possible to prevent the development of complications. Together with the child, internal organs also grow. Because of this, the anomaly can increase in size, leading to death.

Surgery is the removal of a defect by suturing it (this therapy is appropriate for a small diameter). The procedure is performed under cardiopulmonary bypass. The child is connected to a special apparatus, the chest is cut and the heart stops working (during the operation).

With a larger defect put a patch. This method of eliminating a hole in the heart can be more traumatic, because doctors are not always able to freely place an artificial implant in the right place. Then an autopsy of the right ventricle is performed.

More recently, an endovascular method for eliminating a ventricular septal defect has appeared. There is no need to cut the chest. The operation is performed by piercing the femoral artery or vein, and then a special device, the occluder, is inserted using thin catheters. Further, the circulatory system independently delivers the device to the heart, and the defect closes.

At the end of any of the operations described above, the hole passing the depleted blood is eliminated, and the blood flow returns to normal. However, if the surgery was not performed on time, then due to the adaptation of the cardiovascular system to the current circumstances, doctors are not able to fully normalize the intravascular blood flow.

Therefore, a defect of the septum located between the ventricles is dangerous only in advanced cases. Modern medicine has the necessary equipment, qualifications, allowing to get rid of diseases and prevent complications that can provoke fatal consequences. At the end of treatment, it is recommended to show the child a cardiologist once a year to assess the current state of his heart. With a favorable prognosis of the attending physician, after 1-4 years after the operation, the baby will be absolutely healthy.

Drug treatment for a defect in the interventricular septum in newborns and older children is aimed at normalizing the outflow of blood from the lungs, reducing edema in them (fluid accumulation in the pulmonary alveoli), and reducing the amount of blood circulating in the body.

They help reduce blood volume in the vessels and get rid of pulmonary edema. The drug is prescribed for children at the rate of 2-5 mg / kg. You need to take it once a day, preferably before lunch.

Cardiometabolic agents: Phosphaden, Cocarboxylase, Cardonate

They improve the nutrition of the heart muscle, fight oxygen starvation of cells and improve metabolism in the body. If the doctor prescribed Cardonate to a child, then the capsule must be opened, and its contents dissolved in sweetened water (50-100ml). Take 1 time per day after meals. The course is from 3 weeks to 3 months.

Cardiac Glycosides: Strofantin, Digoxin

They help the heart contract faster and more efficiently pump blood through the vessels. Prescribe a 0,05% solution of strophanthin based on 0,01 mg / kg of weight or digoxin 0,03 mg / kg. At this dose, the drug is administered for the first 3 days. Then its amount is reduced by 4-5 times – the maintenance dose.

To relieve bronchospasm: Eufillin

It is prescribed for pulmonary edema and bronchospasm, when it is difficult for a child to breathe. A solution of aminophylline 2% is administered intravenously or in the form of microclysters of 1 ml per year of life.

Taking medication will help reduce the manifestations of the disease and gain time to give the chance to the defect to close on its own.

With small sizes of VSD, the absence of signs of pulmonary hypertension and heart failure, normal physical development in the hope of spontaneous closure of the defect, it is possible to refrain from surgery.

In children of early preschool age, indications for surgical intervention are early progression of pulmonary hypertension, persistent heart failure, recurring pneumonia, marked lag in physical development and lack of body weight.

Indications for surgical treatment in adults and children over the age of 3 years are: fatigue, frequent acute respiratory viral infections, leading to the development of pneumonia, heart failure and a typical clinical picture of the disease with pathological discharge of more than 40%.

Surgery comes down to plastic surgery of the breast. The operation is performed using a cardiopulmonary bypass. With a defect diameter of up to 5 mm, it is closed by suturing with U-shaped sutures. If the diameter of the defect is more than 5 mm, it is closed with a patch of synthetic or specially processed biological material, which is covered with its own tissues for a short time.

In cases where an open radical operation is not immediately possible due to the high risk of surgical intervention using cardiopulmonary bypass in children of the first months of life with large sizes of VSD, insufficient weight, with inappropriate drug correction of severe heart failure, surgical treatment is carried out in two stages .

First, a special cuff is applied to the pulmonary artery above its valves, which increases the resistance to ejection from the right ventricle, thereby leading to equalization of blood pressure in the right and left ventricles of the heart, which helps to reduce the amount of pathological discharge through DIC. A few months later, the second stage is carried out: removal of the previously applied cuff from the pulmonary artery and closure of the breast.

Small VSD does not require treatment. Children develop in accordance with the norms and live a full life.

It has been shown that antibacterial prophylaxis of pathogens that can cause endocarditis in the bloodstream in the treatment of teeth or infectious diseases of the oral cavity and respiratory system is indicated.

Such a vice does not affect the quality of life, even if it does not close on its own. Adult patients should be aware of their pathology and warn medical personnel about the disease for any treatment of other diseases.

Children with moderate and large defects are observed by cardiologists throughout life. They are given treatment that compensates for the manifestations of the disease or, in the case of surgery, can relieve the pathology. There are moderate mobility restrictions and the risk of inflammation of the inner lining of the heart, but life expectancy, as in people without defects.

Indications: moderate and large defect in the septum between the ventricles.

  • diuretics to reduce the load on the heart muscle (Furosemide, Spironolactone);
  • ACE inhibitors that help the myocardium under conditions of increased stress, dilate blood vessels in the lungs and kidneys, and reduce blood pressure (Captopril);
  • cardiac glycosides that improve myocardial contractility and stimulation of nerve fibers (Digoxin).

Baby care after heart surgery

Indications for operation

Indications for operation

After heart surgery, not everything is over or decided. A very important recovery period is coming. The doctor gives recommendations on nutrition, scar care, prescribes the necessary drugs. It is very important to protect children from infections. Do not visit crowded places. It is worthwhile to carefully monitor the condition of the baby and, at the very first symptoms, alarming parents, seek medical help. Take care of the heart of your little ones!

Consequences of BCM

It should be remembered that the fetus is a very scary and serious pathology and that the prognosis of the disease directly depends on the care and attention of young parents. A kid with a disease of breast cancer requires special care, strict adherence to a special regimen, a specialized diet, therapeutic exercises and so on.

When the first suspicions appear, a defect in the interventricular septum in a newborn should urgently consult a pediatrician, because a highly qualified specialist will be able to correctly and timely assess the condition of the child. The specialist must prescribe the necessary treatment depending on the severity of the disease – medication or surgery.

Sad facts should be noted. Mortality in the first year of life among children suffering from a large number of children with severe defects, reaches more than 50%. About 27 years is the average duration of patients with this pathology.

When the condition of the baby allows for surgery, doctors advise not to postpone the procedure. Although experts believe that the age between 1 and 2,5 years is the most suitable. During this period, the child is already stronger and easier to endure the procedure, and it will also be easier for the baby to forget the operation. In this case, the child will not experience psychological trauma.

Indications for surgical intervention.

Blood is dispensed from the left to the right ventricle.

Enlargement or swelling of the right ventricle or atrium.

Contraindications to surgery.

Irreversible changes in the pulmonary vessels of the lungs.

Sepsis – Internal blood poisoning.

The operation is carried out in two stages. Using a special braid or thick silk thread, a children’s surgeon bandages the carrying blood from the heart to the lungs of the artery, so that blood does not temporarily enter the lungs. This procedure is a preparatory stage before the operation of complete closure of the defect.

The operation ultimately reduces the injection of blood into the pulmonary regions, and also reduces pressure in the left ventricle. It becomes much easier for the baby to breathe. The procedure allows the child to feel good, the next stage to eliminate the defect is postponed for 6 months.

The baby, just like the parents, will have to undergo two operations. During the operation, the pressure in the right ventricle increases, as a result of which the ventricle is stretched and increases in size. Before the operation, a conversation with the anesthetist will be held to select an anesthetic. And also the surgeon will examine the baby and answer the questions of the parents.

The operation is performed under general anesthesia. The anesthetic is injected into the arm intravenously, and the baby will not feel pain during further procedures. The specialist must accurately measure the dose of the anesthetic so that anesthesia does not harm the child. The surgeon makes an even incision along the sternum of the baby, yet he gets access to the heart and, according to the instructions, connects the baby to the heart-lung machine.

Further, hypothermia follows – an artificial decrease in the baby’s body temperature. Using special medical equipment, the baby’s blood temperature is reduced to 13-15 ° C. At low temperatures, the brain is much easier to tolerate hypoxia or oxygen starvation.

The surgeon will carefully make an incision in the lower part of the right ventricle or align the walls of the defect. The doctor will make an even seam to tighten the edges. In the case where the hole is large, the doctor uses a synthetic patch to secure the external connective tissue.

Aortic regurgitation is observed among patients with congenital malignancy in about 5% of cases. It develops if the defect is located in such a way that also causes sagging of one of the valves of the aortic valve, which leads to a combination of this defect with aortic valve insufficiency, the attachment of which significantly complicates the course of the disease due to a significant increase in the load on the left ventricle of the heart.

Infundibular stenosis is also observed among patients with DMS in about 5% of cases. It develops if the defect is located in the posterior part of the interventricular septum under the so-called septum valve of the tricuspid (tricuspid) valve below the supraventricular ridge, which causes a large amount of blood to pass through the defect and traumatize the supraventricular ridge, which consequently increases in size and is scarred.

As a result, there is a narrowing of the infundibular part of the right ventricle and the formation of subvalvular pulmonary stenosis. This leads to a decrease in the pathological discharge through the LCF from the left ventricle of the heart to the right and unloading of the pulmonary circulation, however, there is a sharp increase in the load on the right ventricle.

Infectious (bacterial) endocarditis is a lesion of the endocardium (inner lining of the heart) and heart valves caused by an infection (most often bacterial). In patients with cholelithiasis, the risk of developing infectious endocarditis is approximately 0,2% per year. Usually occurs in children of an older age group and adults;

more often with small sizes of VSD, which is caused by an endocardial injury at a high jet velocity of pathological blood discharge. Endocarditis can be triggered by dental procedures, purulent skin lesions. Inflammation first occurs in the wall of the right ventricle, located on the opposite side of the defect or along the edges of the defect itself, and then the aortic and tricuspid valves spread.

Pulmonary hypertension – high blood pressure in the vessels of the pulmonary circulation. In the case of this congenital heart disease, it develops as a result of the additional blood volume entering the lung vessels, caused by its pathological discharge through the left ventricle of the heart into the right ventricle.

Eisenmenger syndrome is a subaortic location of an interventricular septal defect combined with sclerotic changes in the pulmonary vessels, expansion of the pulmonary artery trunk and an increase in muscle mass and size (hypertrophy) of the predominantly right ventricle of the heart.

Recurring pneumonia – due to stagnation of blood in the pulmonary circulation. Heart rhythm disturbances.

Thromboembolism is an acute blockage of a blood vessel by a thrombus that breaks away from the place of its formation on the wall of the heart and enters the circulating blood.

A significant hole size in the interventricular septum or the lack of adequate therapy are the main reasons for the development of severe complications.

  1. Hypotrophy is a pathology caused by a violation of trophic tissue and leading to loss of body weight. In this case, the child is disturbed by the correct development and functioning of organs and systems. Defects of internal organs, including the heart, are one of the main causes of malnutrition. In severe cases, in the presence of a large defect, hypotrophy passes into dystrophy, which is associated with tissue hypoxia and malnutrition. Her treatment is aimed at restoring the water-salt balance and the intake of nutrients in the body in accordance with the age and body weight of the child. Patients are prescribed enzymes, drugs that stimulate digestion and increase appetite, hormones, drugs for parenteral nutrition.
  2. Eisenmenger syndrome is a consequence of persistent and irreversible pulmonary hypertension, which, in combination with DMC, leads to the development of severe cardiological pathology. In addition to the symptoms of asthenia, the disease is manifested by pressing pain in the heart, loss of consciousness, cough. The treatment for the syndrome is surgical.
  3. Bacterial endocarditis is an inflammation of the inner lining of the heart of staphylococcal etiology. The disease is manifested by symptoms of intoxication, skin rashes, fever, respiratory failure, myalgia and arthralgia, asthenia. Treatment of pathology – antibacterial, detoxification, thrombolytic, cardioprotective, immunostimulating.
  4. Pulmonary hypertension is an increase in blood pressure in the vessels of the pulmonary circulation. The symptomatology of the disease is nonspecific: shortness of breath, fatigue, cough, heart pain, fainting.
  5. Aortic insufficiency is a congenital or acquired pathology caused by incomplete closure of the valve cusps. Patients are shown surgical treatment – plastic or aortic valve replacement.
  6. Aortic pseudo-aneurysm.
  7. Recurrent pneumonia.
  8. Arrhythmia.
  9. Heart failure.
  10. Embolism of coronary and pulmonary vessels, leading to heart attack and lung abscess.
  11. Stroke.
  12. Sudden death.
  13. Blockade of the heart.

Forecast

The duration and quality of life with an interventricular septal defect depend on the size of the defect, the state of the vessels of the pulmonary circulation, the severity of developing heart failure.

Defects of the interventricular septum of a small size do not significantly affect the life expectancy of patients, but up to 1-2% increase the risk of developing infectious endocarditis. If the defect is small in size, it is located in the muscle area of ​​the interventricular septum, it can independently close up to the age of 4 years in 30-50% of such patients.

In the case of medium-sized defects, heart failure develops already in early childhood. Over time, an improvement in the condition is possible due to a slight decrease in the size of the defect, and 14% of such patients have an independent closure of the defect. At an older age, pulmonary hypertension develops.

In the case of a large size of breast cancer, the prognosis is serious. Such children already at an early age develop severe heart failure, pneumonia often occurs and recurs. About 10-15% of these patients develop Eisenmenger syndrome. Most patients with large interventricular septal defects without surgery die already in childhood or adolescence from progressive heart failure more often in combination with pneumonia or infectious endocarditis, pulmonary thrombosis or rupture of its aneurysm, paradoxical embolism in the cerebral vessels.

The average life expectancy of patients without surgical intervention in the natural course of DMS (without treatment) is approximately 23-27 years, and in patients with small sizes of the defect – up to 60 years.

Isolated breast cancer can be easily corrected, provided timely diagnosis, observation and necessary treatment are carried out.

  • With the muscle variant of the defect, if the defect is small or moderate in size, 80% of pathological messages spontaneously close during the first two years, another 10% can close at a later age. Large septal defects do not close, but are reduced in size, allowing surgery to be performed with less risk of complications.
  • Perimembranous defects independently close in 35–40% of patients, while part of them in the area of ​​the former window forms aneurysm of the septum.
  • The infundibular type of violation of the integrity of the septum between the ventricles cannot close itself. All defects of moderate and large diameter require surgical correction during the second half of the first year of a child’s life.
  • Children with small sizes of the defect do not require any therapy, but only observation in dynamics.

All patients with such heart disease are shown antibacterial prophylaxis during dental procedures, due to the risk of developing inflammation of the inner lining of the heart.

A restriction on the level of physical activity is shown for any type of defect of moderate and large diameter until it spontaneously heals or closes surgically. After the operation, the children are observed by a cardiologist and, in the absence of relapse, are admitted to any type of load for one year.

The total mortality in case of violation of the wall structure between the ventricles, including postoperative, is about 10%.

The prognosis of congenital heart disease – JMP in a newborn can be very different. But by the size and presence of symptoms, the cardiac surgeon or cardiologist can draw preliminary conclusions. Expectant tactics are chosen for small defects. Defects up to 2 mm in diameter do not affect the baby’s condition and do not pose a danger to his health.

A child with an untreated ventricular septal defect has a risk of developing complications such as:

  • the development of pulmonary hypertension (increased pressure in the pulmonary artery system) with irreversible consequences in the form of vascular sclerosis with the development of respiratory failure,
  • heart failure,
  • infectious endocarditis,
  • cerebrovascular accident in the form of strokes,
  • the formation of valvular heart defects in the form of aortic valve insufficiency.

Small defects close independently in 25-60% of children under the age of five. For medium sizes, this figure is much less (10%). Closure is provided by the fabric of the adjacent valve. During heart growth, the effect of a small defect on blood circulation is reduced.

However, for large defects, the prognosis is not so comforting. Without timely surgery, up to a year, 1/10 patients die, in adulthood, the average life expectancy does not exceed forty years.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

Detonic