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 factors||Specific examples|
Poorly adjusted sugar diabetes
Phenylketonuria – a hereditary pathology of amino acid metabolism in the body
Infections – rubella, chickenpox, syphilis, etc.
|Genetic||The presence of heart defects in relatives, especially parents, sisters and brothers|
In case of twin birth
|External||Action 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.
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.
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:
Also, fetal health can be affected by:
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:
In the interventricular septum there are different types of defects:
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:
The most common cause of a ventricular septal defect or DMS is considered:
Types of operations for ventricular septal defect
What are the indications for surgery?
Pulmonary Artery Narrowing Surgery
Indications for operation
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.
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
Indications for closure of the defect by the occluder
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
The urgency of the operation depends on the size of the defect.
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.
The size of the ventricular septal defect can be very different, have a favorable prognosis or significantly reduce the quality of life of patients.
According to the location of the hole, 3 types of pathology are distinguished:
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.
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.
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:
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:
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.
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.
Stages of changes in the vessels of the lungs (stage of pulmonary hypertension).
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.
If a malignant defect in the interventricular septum is detected, the following symptoms appear, indicating the need for emergency treatment to a specialist:
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:
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.
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”.
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.
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.
Detonic – a unique medicine that helps fight hypertension at all stages of its development.
The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.
Detonic not addictive and withdrawal syndrome, since all components of the product are natural.Detailed information about Detonic is located on the manufacturer’s page .
The same symptoms as with a moderate defect, but in a more pronounced form, in addition:
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:
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.
Stages of the development of the disease:
Instrumental diagnostics of DMZhP
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:
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.
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.
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.
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.
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
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).
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.
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.
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.
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.
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.
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.
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.
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
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 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 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.
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.
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.
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 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.
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:
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.