All about ventricular septal defect in newborns and adults

Ventricular septal defect (DMS) is a hole in the septum dividing the left and right ventricular cavities, the presence of which leads to pathological blood bypass. In cardiology, an interventricular septal defect is the most common congenital heart disease (9–25% of all CHD). The frequency of critical conditions with an interventricular septal defect is about 21%. With the same frequency, defect is found in newborn boys and girls.

A defect in the interventricular septum may be the only intracardiac anomaly (isolated DMS) or enter the structure of complex defects (tetralogy of Fallot, common arterial trunk, transposition of the great vessels, atresia of the tricuspid valve, etc.). In some cases, the interventricular septum may be completely absent – this condition is characterized as the only ventricle of the heart.

Defect of the interventricular septum

Diagnosis of breast cancer in children and adults

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, since the pathology does not immediately appear, and also due to the negligence of medical staff, it may 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.

In order to make a diagnosis of breast cancer, take into account the medical history, the patient’s condition, the presence of heart failure, skin color, weight and height compliance with age standards, chest deformity of the “heart hump” type, heart rate, heart rate rhythm, size liver and spleen.

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Auscultation of noise

When the lungs are full of blood, then, in response to an overextension of the vessel wall, a reflex spasm occurs in them. This leads to an improvement in the clinical picture, the noise weakens, splitting and accent of the second tone that is heard over the pulmonary artery appear.

In the next stage, the emphasis is enhanced and takes on a metallic hue. Diastolic murmur is growing instead of a weakening systolic murmur. In the lungs, breathing is weakened, wheezing is heard.

During the period of intrauterine development, the pressure in the IWC and the big circle do not differ. The fetus develops normally before birth, heart murmur is not detected. Diagnosis of breast cancer is possible in rare cases by indirect signs, which include increased thickness of the collar space and the right ventricle. They are detected by ultrasound in 16% of cases.

Minor defects (up to 3 mm) may not be detected on the radiograph. With large openings, the pulmonary pattern is enhanced, the right heart is enlarged, increased pulsation of the roots, signs of congestive changes are detected. When examined in an oblique projection, the shape of the heart resembles a pear.

X-ray (direct projection) of the chest with DMS: hypertrophy of both ventricles, bulging of the arc of the pulmonary trunk (indicated by an arrow).

Electrocardiography

During ECG examination, the presence of breast cancer has characteristic features: the ventricles of the heart are enlarged, and at first there are signs of overload of the left, and then the right departments. For adult patients, atrial fibrillation or extrasystoles are characteristic. Conductivity is impaired by the type of right-sided bundle blockade, paroxysmal tachycardia (Wolf-Parkinson-White syndrome).

This study helps to determine the size of BC, the direction of discharge, the function of the heart valves, the degree of hypertrophy of the ventricles and atria, and to assess the increase in pressure in the ICC. Of non-invasive techniques, such examinations are more informative.

Features of the course and causes

With the formation of a small defect in the septum between the ventricles of the organ, the course of the disease directly depends on the size of such damage. The message between the chambers of the heart may not always close, and if there is a constant discharge of blood from the left areas of the organ to the right, then the pathology develops, leading to a change in the entire functioning of this system.

  1. It becomes harder for the heart to pump blood, as a result of which organ failure develops.
  2. The cavities of the ventricle and atria on the left side expand significantly, leading to a thickening of the wall of the ventricle itself.
  3. Blood pressure in the circulatory system of the lungs increases, hypertension gradually develops in this area of ​​the body.

An infant who has a similar disease is at risk of serious complications, since it is during the first months of life that such hemodynamics is observed. If a heart defect is small, then it can spontaneously overgrow, is not accompanied by severe violations of the organ.

In adults, the course of the disease does not differ from children, a vice can be observed throughout life and not cause serious harm – if its size is small, and therapy is carried out in full. If the ailment is extensive, then the child undergoes an operation in the first years of life, so this person is already relatively healthy by growing up.

ZHMP negatively affects the work of the heart. When the organ is contracted, blood flows from left to right into the formed passage, which occurs due to increased pressure in the left part. When the window is quite large, a high volume of blood enters the right ventricle, this provokes the development of wall hypertrophy of this organ site.

When the heart relaxes, the pressure in the left ventricle decreases much more than in the right, as the left part is better emptied. Blood begins to flow in the opposite direction, from the right side to the left. As a result of this process, the left ventricle is filled with blood from the left atrium, and additionally from the region of the right ventricle. Such an overabundance creates the conditions for expansion of the cavity, and later hypertrophy of the wall of the left heart or ventricle.

Regular pathological discharge from the left ventricle, as well as dilution of venous blood, practically devoid of oxygen, threatens a person with hypoxia of all organs and body tissues. The clinical manifestations of the disease completely depend on several factors: the magnitude of the defect that has formed, the rate of increase in changes in hemodynamics, the total duration of the disease, and compensatory possibilities.

The etiology of the disease has been fairly studied and suggests that it begins to form only at the level of fetal development in the womb, in adults such destructive processes do not occur. Whatever the cause of the occurrence of VSD, it is associated with violations in bearing a child.

  1. Early and severe toxicosis during pregnancy.
  2. Diets that the expectant mother observes during the period of bearing the child. A severe dietary restriction, when even the minimum set of nutrients a woman needs on a daily basis is absent, leads to the development of many abnormalities in the fetus, including a violation of the structure of the MJP (interventricular septum).
  3. Infectious diseases such as rubella, viral pathologies, mumps, or chickenpox.
  4. A serious lack of vitamins in the body of the expectant mother.
  5. The manifestation of side effects when taking various medications.
  6. Failures of a genetic nature. Often, a similar pathology accompanies other abnormalities, Down syndrome in the baby, kidney problems or problems with the formation of limbs.
  7. Diseases of a chronic course present in a pregnant woman. It can be cardiovascular disease or diabetes.
  8. If the age of a woman expecting a baby is already over 40 years old, then changes in the body of the expectant mother can provoke pathological processes of fetal development.
  9. Radiation exposure.
  10. Smoking, drinking, or using a pregnant woman

All women should be observed by a gynecologist during the period of bearing the baby. The constant intake of vitamins, proper nutrition and a healthy lifestyle will partially protect the child from such a pathology.

Doctors share the disease according to several classifications. Depending on the localization of the destructive process occurring in any part of the heart, DMS may be:

  • membranous defect of the interventricular septum;
  • violation in the muscle area of ​​the organ;
  • trabecular pathologies or epigastric (secondary).

The vast majority of cases of such a disease are defined as a primibranous defect that occurs in the interventricular septum, and it, in turn, is divided into subtricuspid and subaortic. Such pathologies make up about 80% of all recorded diseases and are localized in the upper part of the interventricular septum, located under the aortic valve and septal valve.

The septum is located between the ventricles of the organ, it consists of more than half of the special muscle tissue, and its upper zone is the membrane. The place of docking of such parts of the septum is called the primembranous opening, where pathology is most often detected. Accordingly, the localization of disorders is called the types of disease.

A muscle defect in the interventricular septum in newborn children, as well as a supra crested version of the disease, are rare, about 20% of all cases of this disease. The trabecular type of disease develops in the area located slightly above the supraventricular ridge, and the muscle is localized in the eponymous septum, the muscular. This part of the heart is removed from the conduction and valve system.

The interventricular septum forms the inner walls of both ventricles and is approximately 1/3 of the area of ​​each of them. The interventricular septum is represented by membranous and muscle components. In turn, the muscular section consists of 3 parts – the inflow, trabecular and outflow (infundibular).

The interventricular septum, along with other ventricular walls, takes part in the contraction and relaxation of the heart. In the fetus, it is fully formed by the 4th-5th week of embryonic development. If this for some reason does not occur, a defect remains in the interventricular septum. Hemodynamic disturbances in the case of an interventricular septal defect are caused by the message of the left ventricle with high pressure and the right ventricle with low pressure (normally during the systole, the pressure in the left ventricle is 4-5 times higher than in the right one).

After birth and the establishment of blood flow in the large and small circles of blood circulation due to a defect in the interventricular septum, a left-right blood discharge occurs, the volume of which depends on the size of the hole. With a small volume of shunted blood pressure in the right ventricle and pulmonary arteries remains normal or increases slightly. However, with a large flow of blood through the defect into the pulmonary circulation and its return to the left parts of the heart, volumetric and systolic overload of the ventricles develops.

A significant increase in pressure in the pulmonary circulation with large defects of the interventricular septum contributes to the occurrence of pulmonary hypertension. An increase in pulmonary vascular resistance causes the development of blood flow from the right ventricle to the left ventricle (reverse or cross bypass), which leads to arterial hypoxemia (Eisenmenger syndrome).

Long-term practice of cardiocircles shows that the best results in closing a ventricular septal defect can be achieved by discharging blood from left to right. Therefore, when planning the operation, hemodynamic parameters (pressure, resistance and volume of discharge) are carefully taken into account.

What is congenital heart disease?

What is meant by the words “congenital heart disease”? Is this diagnosis really so scary and the child is doomed to severe suffering? Congenital heart defects (CHD) are called abnormalities of the heart, in which the main departments of the organ itself or its main (main) vessels are improperly located or have various defects.

There are a lot of different heart defects. They differ in their anatomical features, and in the severity of the course, and in the clinical picture that develops in humans. There are vices with which a person lives to a very old age, goes in for sports, leads an active lifestyle and does not even suspect or forgets about their presence.

According to various researchers, the frequency of congenital heart abnormalities ranges from 2 to 17 per 1000 babies born. The most common is a defect in the septum dividing the ventricles. In addition to this anomaly, a defect in the septum separating the atria and the open ductus arteriosus are often found. We note immediately that these defects with timely diagnosis are successfully treated. But even this treatment is far from always required, because the baby can recover by itself without medication and surgery.

Ventricular septal defect classification

The size of the interventricular septal defect is estimated based on its absolute size and comparison with the diameter of the aortic orifice: a small defect is 1-3 mm (Tolochinov – Roger disease), the average is approximately 1/2 the diameter of the aortic orifice, and the large is equal to or greater than its diameter .

Given the anatomical location of the defect, there are:

  • perimembranous defects of the interventricular septum – 75% (inflow, trabecular, infundibular) are located in the upper part of the septum under the aortic valve, can be closed spontaneously;
  • muscle defects of the interventricular septum – 10% (inflow, trabecular) – are located in the muscular part of the septum, at a considerable distance from the valve and conductive systems;
  • epigastric defects of the interventricular septum – 5% – are located above the supraventricular crest (the muscle bundle that separates the cavity of the right ventricle from its outflow tract), do not spontaneously close.

Frequently asked Questions

The average hospital stay is 3-4 days. As a rule, on the day of admission in the morning, you undergo an examination that includes a clinical and biochemical blood test (you need to come on an empty stomach), take an X-ray, an ECG, an ultrasound scan of the heart and a consultation with a cardiologist and cardiac surgeon. If all indicators are normal, the next day surgery is performed to eliminate the defect. On the third day, we conduct control studies and write you out.

For hospitalization in our hospital you will need a passport or birth certificate of a child.

If the patient is a child, you need a certificate of sanitary and epidemiological environment (that the child has not recently been in contact with infected patients), which you will receive in the clinic at the place of residence.

It is advisable to carry with you previous advisory opinions, an ECG and an x-ray of the chest organs.

A referral from a cardiologist at your place of residence is NOT REQUIRED. You can come for a consultation and subsequent treatment in the form of self-treatment. If you are over 30 years old or have felt a malfunction in the heart, it is advisable to conduct Holter monitoring at the place of residence. Such a study can be carried out with us, but it will increase your time in hospital by 1-2 days.

If you suffer from chronic gastritis, peptic ulcer of the stomach or duodenum, you need to do fibrogastroduodenoscopy. In case of confirmation of the disease, you need to undergo treatment at the place of residence. Such a study can be carried out with us, but it will increase your time in hospital by 1-2 days in the absence of ulcers and erosion.

As a rule, the duration of the operation is within 1-1,5 hours. But with complex anatomical options, the operation time may increase.

All adult patients undergo local surgery under local anesthesia. The patient can monitor the progress of the operation and communicate with staff. An exception is made by patients with an atrial septal defect who during the operation require transesophageal ultrasound monitoring and for the patient’s comfort the operation is performed in a state of drug sleep. All endovascular surgeries in children and suspicious patients are performed under general anesthesia.

The most unpleasant moment is a local anesthetic injection into the inguinal region. Then the pain sensitivity completely disappears.

After 3-6 months, the implanted devices completely germinate with their cells – they are covered with endothelium and they can no longer be distinguished from the inner surface of the heart. All devices are made of high-tech medical alloy, which does not cause rejection reactions or allergic reactions.

No, installed devices are not felt.

Yes, there are no restrictions on CT. On MRI, implant manufacturers guarantee safety at 1,5 and 3 Tesla. Before the examination, be sure to inform the radiologist that you have an intracardiac implant installed.

It is necessary to limit strong physical activity for 6 months. Prevention of respiratory infections, tonsillitis, caries is necessary. In the event that the disease begins to develop, antibacterial drugs should be included in the treatment regimen, after consulting a doctor. During the first month after surgery, it is also necessary to limit sexual activity.

Call an ambulance immediately, indicating by phone what type of operation you have rescheduled. Then call the doctor who performed the operation.

Symptoms

The clinical manifestations of large and small isolated defects of the interventricular septum are different. Small defects of the interventricular septum (Tolochinov-Roger disease) have a diameter of less than 1 cm and are found in 25-40% of the number of all VSDs. They are manifested by mild fatigue and shortness of breath during exercise. The physical development of children, as a rule, is not impaired. Sometimes they have a mild domed protrusion of the chest in the region of the heart – the “heart hump”. A characteristic clinical sign of minor defects of the interventricular septum is the auscultation of the presence of gross systolic murmur over the region of the heart, which is recorded already in the first week of life.

Large defects of the interventricular septum, which are larger than 1/2 of the diameter of the aortic orifice or more than 1 cm, are symptomatic in the first 3 months of life of newborns, leading to the development of a critical condition in 25-30% of cases. With large defects of the interventricular septum, hypotrophy, shortness of breath during physical exertion or at rest, increased fatigue are noted. Difficulties in feeding are characteristic: intermittent sucking, frequent tearing from the chest, shortness of breath and pallor, sweating, oral cyanosis. A history of most children with a ventricular septal defect is frequent respiratory infections, protracted and recurrent bronchitis and pneumonia.

At the age of 3-4 years, as heart failure increases, such children have complaints of palpitations and pain in the heart, a tendency to nosebleeds and fainting. Transient cyanosis is replaced by constant oral and acrocyanosis; disturbed by constant shortness of breath at rest, orthopnea, cough (Eisenmenger syndrome). The presence of chronic hypoxia is indicated by the deformation of the phalanges of the fingers and nails (“drumsticks”, “watch glasses”).

An examination reveals a “heart hump”, developed to a lesser or greater extent; tachycardia, expansion of the boundaries of cardiac dullness, gross intense pansystolic murmur; hepatomegaly and splenomegaly. In the lower parts of the lungs, congestive rales are heard.

Depending on the size, defects are divided into:

  • Small ones. Compared with the aorta, their size is small, only 1-3 mm. Mostly located in the muscle area below the septum. Accompanied by loud noise, but do not carry a special threat. Such pathologies are called Tolochinov-Roger disease. They grow over time and do not cause any trouble. The exception is when a small defect is multiple, that is, the interventricular septum becomes like a colander or cheese. This condition is quite serious. The pathology of small sizes is not dangerous, special monitoring of it is not required. A small defect does not affect the length of life, but there is a risk of endocarditis due to infection.
  • Medium. From 4 mm to 1 cm. With medium sizes, heart failure develops. Subsequently, the hole may be tightened or reduced, then improvement will come.
  • Big ones. If the operation is not performed on time, children with large sizes of breast cancer (from 1 cm) do not survive to adolescence, and if they survive, they have symptoms of right and left ventricular failure.

There are such types of breast cancer:

  1. Muscular. Located away from the aorta and heart valves. If the defect is small, even multiple, then in most cases it grows on its own. It occurs in 10% of cases.
  2. Perimembranous. It is div />Defect of the AV channel. Defect of the interventricular membrane of the right ventricle delivery tract. It is located at the place of attachment of valves and rings in the rear of the partition. It is diagnosed in 10% of victims of congenital malformations. Often found in Downism. It can be combined with other heart diseases.

The main symptom of a septal defect is heart murmur. It occurs in a newborn not immediately after birth, but after a few days, while small defects can occur without symptoms. Large gaps can cause developmental delays, frequent SARS.

There are a number of symptoms that indicate children with breast cancer:

  • cachexia;
  • weakness;
  • Harrison Furrows;
  • cyanosis;
  • swelling of veins in the neck;
  • trembling or noises in the lower chest on the left side.

The fetal benign prostatic hypertrophy does not manifest itself in any way; it can be detected only by echocardiography, which is performed from the 18th week of pregnancy. In born children, the symptoms of the disease appear in the first year of life. Symptoms

  • cyanosis of the lips and fingertips;
  • poor appetite;
  • lag in development;
  • dyspnea;
  • insufficient weight gain;
  • edema;
  • cardiopalmus;
  • instant fatigue after minor physical activity (after eating, frequent posture changes).

All these signs can indicate not only a ventricular septal defect, but also other diseases in children. A small defect in the septum may not affect the quality of life of the patient, however, when listening to the child’s heart, the pediatrician (cardiologist) may hear noises. Less commonly, an interventricular septal anomaly first manifests itself in adulthood, when the patient develops shortness of breath, indicating the development of heart failure.

When the following symptoms appear, a person should immediately call an ambulance:

  • severe swelling of the legs;
  • shortness of breath even when lying down;
  • fast (irregular) heartbeat;
  • slump;
  • pallor or blueness of the skin.

The manifestations of this disease depend entirely on the size of the damage. A small atrial defect may not be accompanied by symptoms at all, and a large window in the septum will cause a lot of unpleasant and severe signs. The pediatrician, Dr. Komarovsky warns that one small hole is not dangerous for the baby’s life, does not manifest itself and does not require treatment, but if there are a lot of lesions, the situation needs immediate medical attention.

An adult with similar disorders in the heart will experience the same symptoms as a 2-3 year old child.

Symptoms in infants:

  • lack of weight gain or poor weight gain;
  • breathing problems, shortness of breath;
  • constant anxiety, the baby cries all the time;
  • pneumonia, which occurs at an early age and is difficult to treat;
  • sleep disturbance;
  • at birth, his skin has a bluish tint;
  • babies get tired quickly, even with sucking.

There are several diagnostics that make it possible to identify a pathology in infancy and immediately take all steps to eliminate it. If we talk about adult patients, then severe symptoms rarely accompany DMC at this age.

Symptoms in adults:

  1. moist cough;
  2. pain in the area of ​​the heart;
  3. organ rhythm disturbance (arrhythmia);
  4. shortness of breath, which is observed even at rest.

If the size of the defect is considered large, then surgical treatment is carried out, the window disappears, and the person no longer experiences any deviations in well-being. When the hole is small, the manifestations of this ailment are practically absent.

  1. The formation of a heart hump, which looks like an elevation on the chest, localized in the zone of the heart.
  2. A doctor, when listening to an organ, distinguishes wheezing in it, breathing becomes hard, which is associated with the release of blood from arteries into the lung tissue.
  3. During the period of systole (or contraction) of the heart, one can feel the trembling created by the blood stream passing through the window in the septum between the atria.
  4. Examination by tapping reveals an increase in the main organ in volume.
  5. Listening with a stethoscope allows you to hear the noise caused by insufficient activity of the valves of the arteries of the lungs.
  6. The spleen and liver increase in size, which is caused by stagnant blood phenomena in these areas.
  7. At the 3 stages of the disease, the rib cage noticeably swells, making this site look like a barrel.
  8. Also, at the 3rd stage of the disease, the skin becomes blue, begins to change color from the fingers and the mouth, gradually spreading to the whole body. This symptom appears because the blood contains insufficient oxygen, and internal organs, especially the lungs, undergo hypoxia.

Diagnostics

Today, all babies after birth are examined by a neonatologist, whose specialization is to detect abnormalities in the development of the child. The main reason for the suspicion of a defect in the ventricular septum is a violation identified by listening to the area of ​​the heart.

  • Auscultation. When listening to a patient with this method, doctors detect the presence of systolic murmur, indicating the development of pathology.
  • Electrocardiogram (ECG). This method of examination shows congestion of the right atrium and ventricles of the organ. In addition, conduction disorders, often expressed as blockade of the bundle of His, are often observed.
  • Roentgenography. The method allows you to assess the condition of the heart, lungs and arteries.
  • Echocardiography. A method for detecting a disease by the specific features of a hemodynamic disorder.
  • Ultrasound study with doppler. Such a diagnostic measure is very informative. If a patient is diagnosed with congenital malformations, the specialist will notice the changes. Using this technique, one can study the presence of a hole in the septum between the ventricles, its size, shape and location, the speed of blood movement and its direction in the ventricles.

Sometimes a doctor needs to prescribe the patient to undergo several additional diagnostic procedures. Any kind of ailment – primembranous, membranous or muscle will be detected during the examination. It is important to start therapy in time so that the prognosis of the disease is favorable.

Treatment and prognosis

When the course of the disease is asymptomatic, and the size of the defect is small, then doctors advise to refrain from surgery. The attending physician regularly monitors the small patient. Sometimes such violations go away on their own, by the onset of 1-4 years of age and later. The resulting hole in the septum between the ventricles can overgrow without the use of therapeutic and other methods of treatment. If there is a development of heart failure, then the doctor will prescribe a number of medications.

Signs of breast cancer in newborns depend on how large the defect is and where the septum is located. If the defect is small, and it is located at the top of the septum, symptoms may not occur at all. Major defects are usually diagnosed during the intrauterine development of the baby or after his birth, even in the hospital. Small defects that are located at the bottom of the partition are considered the most dangerous. In the first few days after the birth of the baby, they may not appear, but over time, the baby will have symptoms of heart and respiratory failure.

In general, you should consult a doctor if the following symptoms are found in a baby infant:

  • pallor of the skin and cyanosis, which are especially manifested when crying, overstressing the baby. Blueing usually occurs on the skin of the lips, hands and feet;
  • fatigue during feeding, low weight, poor appetite;
  • shortness of breath while crying;
  • frequent colds, which are practically not treatable.

If all these symptoms are found in the baby, the parents urgently need to seek medical help.

Diagnosis of a ventricular septal defect in newborns

A ventricular septal defect in newborns is diagnosed on the basis of a general examination. Auscultation of the child is also carried out, parents are questioned for the presence of clinical manifestations of the pathology. The baby can be prescribed an x-ray, an ultrasound of the heart, an electrocardiogram. If necessary, cardiac catheterization can be performed in order to measure the pressure in the chambers of the heart. In addition, the doctor may give the baby an MRI of the heart.

What is the danger of pathology in childhood and adulthood

Auscultation of noise

With untimely surgery, heart failure progresses. At the age of three years, children feel pain in the heart, a strong heartbeat, they have nosebleeds, fainting. Cyanosis becomes permanent, shortness of breath is noticeable at rest, the child has difficulty sleeping while lying down, he occupies a semi-sitting position, and is coughing.

Signs of a constant lack of oxygen are deformations of the fingers and nails – “drumsticks” with “watch glasses”.

In adult patients, there are two options for BC, congenital and acquired. The first type means that the defect is very small, because without surgery, children can not cross the teenage line. Such patients are usually well compensated, they can even play sports professionally. Also, the cause of a satisfactory condition is the simultaneous narrowing of the pulmonary artery, since the blood does not overflow the lungs.

Complications that may require surgery may include:

  • aneurysm in the area of ​​aortic valves;
  • aortic valve insufficiency;
  • bacterial endocarditis.

With acquired VSD, there is an increase in signs of insufficiency of cardiac function, extrasystole, arrhythmia, and congestive pneumonia. Due to the constant passage of blood through the hole in this place, there is an increased formation of blood clots, which lead to blockage of the vessels of the brain – strokes develop.

If the treatment of breast cancer is not carried out in time, various consequences arise:

  • pulmonary hypertension;
  • Eisenmenger syndrome – irreversible pulmonary hypertension due to blood discharge from left to right;
  • heart failure, including acute;
  • endocarditis – inflammation of the inner lining of the heart;
  • thrombosis;
  • stroke;
  • the development of additional valvular heart defects;
  • death.

Methods for instrumental diagnosis of an interventricular septal defect include ECG, FCG, chest x-ray, echo-catheterization, cardiac catheterization, angiocardiography, ventriculography.

An electrocardiogram for a ventricular septal defect reflects ventricular overload, the presence and severity of pulmonary hypertension. In adult patients, arrhythmias (extrasystole, atrial fibrillation), conduction disorders (right bundle branch block, WPW syndrome) can be recorded. Phonocardiography captures high-frequency systolic murmur with a maximum in the III-IV intercostal space to the left of the sternum.

Echocardiography can detect a ventricular septal defect or suspect it of characteristic hemodynamic impairment. X-ray of the chest with large defects of the interventricular septum reveals an increase in pulmonary pattern, increased pulsation of the roots of the lungs, an increase in heart size. Probing of the right cavities of the heart reveals an increase in pressure in the pulmonary artery and the right ventricle, the possibility of a catheter into the aorta, and increased oxygenation of venous blood in the right ventricle. Aortography is performed to exclude concomitant CHD.

Differential diagnosis of an interventricular septal defect is performed with an open atrioventricular canal, a common arterial trunk, an aorto-pulmonary septal defect, isolated pulmonary artery stenosis, aortic stenosis, congenital mitral insufficiency, thromboembolism.

When should I see a doctor?

For any symptoms reminiscent of the symptoms of DMZh, Dr. Komarovsky advises you to immediately contact a pediatrician, who will, if necessary, give a referral to a specialist.

CSF, despite the fact that it may not bother a small patient and does not appear symptomatically, still requires mandatory observation by a specialist. Heart disease is a pathology in which a worsening of the clinical picture can occur at any minute. In order not to miss the moment of the occurrence of alarming symptoms, parents should constantly monitor the baby’s behavior and record atypical signs. It is worth going to a consultation with a cardiologist if:

  • the child sleeps a lot of time;
  • very moody, for no good reason;
  • problems with weight gain are noted;
  • lags behind in development.

Therapies

Diagnosis methods for breast cancer:

  1. History taking. A survey of parents about hereditary diseases, the presence of heart pathologies in relatives, the course of pregnancy, drugs taken in the first trimester, and past illnesses, etc.
  2. Medical examination. It consists of measuring the pulse, auscultation of the heart (listening to noise), examining the color of the skin and changing the shape of the chest, palpation in the heart. In case of breast cancer, this method in most cases already makes it possible to make a diagnosis.
  3. Echocardiography. The defect is displayed as a rupture of the echo signal in the interventricular septum with a reset detected in the continuous wave and color Doppler mode.
  4. MRI It is carried out in case of insufficient echocardiography or blurry result.
  5. Cardiac catheterization. Allows you to check the hemodynamics of the pulmonary circulation, the number, size and location of defects, the presence of concomitant anomalies.
  6. Roentgenography. It is used to diagnose large cerebrospinal flu >

The following treatments are available:

  1. Conservative. Drug therapy with diuretics and cardiac glycosides, the use of ACE synthesis inhibitors that reduce blood discharge through DMS. Treatment of concomitant diseases (anemia, infectious processes).
  2. Surgical. Recommended for patients with benign prostatic hyperplasia if there are clinical signs of LV overload. The operation is carried out by suturing the defect or installing a patch from the biomaterial.
  3. Endovascular interventions. Catheter closure of defect.
  4. Rehabilitation. Restorative treatment with limited physical activity during the year. Especially necessary after surgery.

What can you do

Parents who find signs of a child with breast cancer in a baby should seek immediate medical attention. This pathology is dangerous for the life of the baby, so its therapy should be carried out in a timely manner. After diagnosis and treatment, the task of the parents is to follow all the recommendations received from the doctor.

What does the doctor do

Therapy for an interventricular septal defect in newborns always depends on the size of the defect and where it is located. Often, small defects at the top of the septum tighten themselves in the first few years of the baby’s life. If this does not happen, the baby is under constant medical supervision. If he develops symptoms of heart failure or pulmonary hypertension, the doctor prescribes medication.

In the presence of large defects, when the outflow of blood is constantly carried out in the right chamber of the heart, surgery is performed. Operations, at the same time, can be carried out both immediately after the birth of the child, and after he turns 1-2 years old. In this case, it all depends on the severity of the condition of the newborn.

Surgical intervention is carried out in two main ways: palliative and radical. That is, in the first case, the operation is performed to prevent possible complications of the pathology, and in the second case, the hole in the septum is completely eliminated with the help of plastic.

The asymptomatic course of the defect of the interventricular septum with its small size allows you to refrain from surgery and carry out dynamic monitoring of the child. In some cases, it is possible to spontaneously close the ventricular septal defect by 1-4 years of life or at a later age. In other cases, surgical closure of a ventricular septal defect is indicated, usually after a child reaches 3 years of age.

With the development of heart failure and pulmonary hypertension, conservative treatment is carried out with the help of cardiac glycosides, diuretics, angiotensin-converting enzyme inhibitors, cardiotrophic, antioxidants.

Cardiac surgical treatment of an interventricular septal defect can be radical and palliative. Radical operations include suturing small defects of the interventricular septum with U-shaped sutures; plastic of large defects with a synthetic (Teflon, Dacron, etc.) patch or biological (canned xenopericardium, autopericardium) tissue; X-ray endovascular occlusion of a ventricular septal defect.

In infants with severe hypotrophy, large left-right blood bypass surgery and multiple defects, palliative surgery aimed at creating artificial pulmonary stenosis using a cuff is preferred. This stage allows you to prepare the child for a radical operation to eliminate the ventricular septal defect at an older age.

With heart defects in children, the only method of radical treatment is surgery. With the help of drug therapy, you can reduce the symptoms of the disease. This can be used as a preoperative preparation.

Open operations

An operation to open the chest is performed for severe combined defects, when a large amount of intervention is expected. All patients who are shown treatment can be divided into four groups:

  1. Patients whose condition allows the operation to be performed as planned, that is, for a year or more.
  2. Children who need intervention in the next six months.
  3. Patients requiring treatment within 1-2 weeks.
  4. Extremely severe cases when immediate surgery is required (within 24-48 hours), otherwise the child will die.

Open heart surgery should be performed by an experienced heart surgeon

Unfortunately, there is a group of CHD in which it is possible to perform only palliative intervention, that is, temporarily improving the condition of the baby. These include defects in which some departments are absent (a single ventricle, a complete absence of a septum, underdevelopment of valves).

It is fashionable to put a special occluder that closes the defect in the septum through a puncture in the vessel

Minimally invasive interventions can be performed as a preparatory stage for an open operation. In addition, this method is suitable for correcting defects in the atrial or interventricular septa. Using the endovascular treatment method, a special occluder can be installed that completely closes the defect and prevents further communication between the cavities.

With an open arterial duct, you can apply the technique of applying a clip to a vessel or sclerosing it with chemicals. In the latter case, indomethacin is prescribed immediately after birth. The effectiveness of this treatment method reaches 80-90%.

Expectant tactics are acceptable for small defects in the structure. For example, the open ductus arteriosus may close on its own during the first few months of life. In this case, a prerequisite is the absence of clinical manifestations and monthly ultrasound monitoring.

Some CHD, for example, a bicuspid aortic valve, do not manifest themselves in any way, therefore, they do not require specific treatment. A child who was born with a heart defect of this type can lead a perfectly normal life and even play sports.

Violation of intrauterine development is often manifested by congenital heart defects. They may be incompatible with life, but in most cases, the operational correction of anatomical anomalies is possible. Modern diagnostic capabilities, as a rule, make it possible to identify gross structural disturbances even during the gestation period. Therefore, if necessary, the baby can be operated on in the first hours after birth.

You can also read what is dangerous sinus arrhythmia during pregnancy.

Beta-blockers (Anaprilin, Inderal): help normalize heart rhythm. Anticoagulants (Heparin, Warfarin, Aspirin): reduce the risk of blood clots, provide stroke prevention

When taking anticoagulants, it is important to control the number of platelets in the blood .. All drugs are prescribed by a cardiologist

It is necessary to take medicines according to the scheme prescribed by the doctor. Self-treatment of heart defects is associated with a danger to life and health!

All drugs are prescribed by a cardiologist. It is necessary to take medicines according to the scheme prescribed by the doctor. Self-treatment of heart defects is associated with a danger to life and health!

As for the surgical treatment of heart disease, cardiologists and cardiac surgeons strongly recommend performing operations in childhood. The essence of cardiac surgery in case of benign prostatic hyperplasia is to block the defect with the help of a peculiar “patch”, which does not allow mixing of left ventricular and right ventricular blood. There are 2 types of operations for breast cancer:

  1. Cardiac catheterization is a non-traumatic method for the treatment of breast cancer, carried out under the control of an x-ray machine using a contrast medium. Through the femoral vein, the thinnest probe is injected to the patient, which is sent to the heart, and more precisely, to the interventricular septum. Using a probe, a mesh blocking the defect is implanted into the septum. After some time, the implant is overgrown with tissue. The advantage of this operation is a minor trauma and a short period of postoperative recovery. However, catheterization is contraindicated in patients who are allergic to iodine, which is the basis of the contrast medium.
  2. Open heart surgery is performed under general anesthesia. The patient’s chest is opened and connected to a cardiopulmonary bypass. Then the heart is cut, and a patch made of synthetic material is introduced into the interventricular septal defect. After such an operation, the patient needs a long recovery period.

After surgery, the patient should be regularly observed by a cardiologist.

In most cases, operations give a positive result, so patients undergoing surgical treatment have a chance of a full life, the duration of which can be more than 60 years. If a person with a large defect in the interventricular septum is not operated on, the probable duration of his life will not exceed 27 years.

Atrial septal defect

Normally, there should be no openings in the septum dividing the atria, and the blood between these chambers of the heart should not mix. If a person has a pathological message between the atria, then this is regarded as a heart defect “atrial septal defect”, abbreviated ASD.

In about a quarter of all cases of ASD, the pathological opening is located in the lower third of the septum. This is called a primary defect. Sometimes this opening can be very large and reach the heart valves. Such a defect can be seen in utero by ultrasound.

A secondary defect, which forms at the site of the oval window and is, as it were, a continuation, is much more common. Most rarely, there is a complete absence of a septum between the atria. It also happens that the baby has several pathological holes in the septum between these heart chambers. In some cases, ASD is just a part of concomitant heart disease.

Features of the atrial septal defect in infants:

  • The larger the diameter of the defect, the more pronounced the clinical signs.
  • In girls, this defect is recorded more often.
  • Blood through the pathological hole is discharged from left to right, that is, a larger volume of blood goes into the pulmonary vessels, and the vessels of the large circle of blood circulation receive less. A significant load falls on the right heart chambers.
  • Due to the peculiarities of blood circulation adjustment in infants of the first months of life, even a large malformation can be asymptomatic. Therefore, in the neonatal period, the existence of such a defect can not even be guessed: heart murmur is rare, and clinical symptoms have not yet developed.
  • Self-expansion of the duct may occur.

The course of pregnancy with a ventricular septal defect

Women with a slight defect in the interventricular septum, as a rule, are able to bear and give birth to a baby normally. However, with large sizes of the defect, arrhythmia, heart failure or pulmonary hypertension, the risk of complications during pregnancy increases significantly. The presence of Eisenmenger syndrome is an indication for abortion. Women with an interventricular septal defect have an increased likelihood of having a baby with a similar or other congenital heart disease.

Before planning pregnancy, a patient with a heart defect (operated or not) should consult with an obstetrician-gynecologist, cardiologist, geneticist. Pregnancy management in the category of women with a ventricular septal defect requires increased attention.

Forecasts and preventive measures

The natural course of the ventricular septal defect as a whole does not allow us to hope for a favorable prognosis. Life expectancy for this defect depends on the size of the defect and averages about 25 years. With large and medium defects, 50-80% of children die before the age of 6 months. or 1 year from heart failure, congestive pneumonia, bacterial endocarditis, cardiac arrhythmias, thromboembolic complications.

In rare cases, CSD does not significantly affect the duration and quality of life. Spontaneous closure of an interventricular septal defect is observed in 25-40% of cases, mainly with its small size. However, even in this case, patients should be under the supervision of a cardiologist due to possible complications of the cardiac conduction system and a high risk of infectious endocarditis.

Forecasts in most cases are favorable. After spontaneous tightening of the lumens in the septum, surgical interventions and other procedures that ended with the elimination of the defect, it is recommended:

  • ensuring the proper care of a child with CSD;
  • Compliance with the doctor’s recommendations on nutrition and taking the necessary drugs;
  • restriction of visits to crowded places in order to avoid infectious diseases;
  • examination at regional centers for the treatment of congenital heart defects with self-tightening once every three years, with surgical and other interventions – 1 time per year.

Attestattau Maalalari

Figure 1. A diagram of a healthy heart. Figure 1 shows a blood circulation diagram. Through the vena cava, venous (blue) blood comes to the right atrium (PP). Then it enters the right ventricle (pancreas) and through the pulmonary artery (LA) into the lungs. In the lungs, the blood is saturated with oxygen and returns to the left atrium (LP).

Next – into the left ventricle (LV) and the aorta (AO), which is distributed throughout the body. After saturating the tissue with oxygen and taking carbon dioxide, the blood collects in the vena cava, the right atrium, etc. Naturally, the left ventricle performs significantly more work than the right one, therefore its pressure is higher (4-5 times higher than in the right one).

What happens if there is a defect in the septum between the ventricles? Blood during systole (contraction) of the heart enters from the left ventricle not only into the aorta, as it should be, but also into the right ventricle, in which the pressure is lower, and in the right ventricle is not only venous, but also arterial (saturated with oxygen) blood.

Figure 2. Hemodynamics of BC, Let us trace the blood flow in case of an interventricular septal defect (Fig. 2): blood flows from the vena cava into the right atrium, then the right ventricle, pulmonary artery, lungs, left atrium, left ventricle, and then part of it is shunted into the right ventricle, and it again enters the pulmonary artery, lungs, etc.

Thus, in a small circle of blood circulation (right ventricle – lungs – left atrium) an additional volume of blood is constantly moving. In this case, an additional load occurs at the beginning on the left (he still must provide the body with oxygen, i.e. the necessary amount of blood that carries this oxygen), and then on the right ventricle, which leads to their hypertrophy, i.e. . increase.

increasing pressure. There is a condition called pulmonary hypertension. The pressure in the pulmonary artery (and, accordingly, in the right ventricle) increases to beyond the limit, eventually becomes higher than in the left ventricle, and the blood changes the direction of shunting: it begins to be discharged from the right ventricle to the left. This is a serious condition called Eisenmenger syndrome. In this case, only a heart and lung transplant can help the patient.

The course of the disease depends on many factors: one of the main ones is the size of the defect and the volume of shunted blood. It often happens that children are already inoperable by the year. Ultrasound examination of the heart is sufficient for diagnosis, sometimes in doubtful cases they resort to cardiac catheterization (sounding).

There is only one defect treatment method: surgical. The operation is performed under cardiopulmonary bypass, with cardiac arrest. It is usually enough to stop the heart for 20-30 minutes to close the cerebrospinal fluid, which is completely safe for the patient. Small defects are sutured, large defects are closed with patches made of various synthetics. The treatment results are good. Sometimes children receive digoxin and other heart medications to treat heart failure before surgery.

There are interventricular defects that do not require surgical treatment, the so-called Tolochinov-Roger disease. These are muscle defects with a diameter of 1-2 mm, with a minimum discharge of blood. This diagnosis must be confirmed by a qualified cardiologist at a cardiac surgical hospital. Recently, it has become possible to close some of the breast cancer with endocardial special occluders without opening the chest.

The danger and complications of pathology

A ventricular septal defect is an extremely dangerous disease for a newborn. If the defect is not large, it will not interfere with the normal development of the baby. But if it is medium or large, the baby may develop a number of complications. Among them:

  • lag in physical development;
  • cardiopulmonary failure;
  • endocarditis;
  • Eisenmenger syndrome, that is, constant pulmonary hypertension, due to which irreversible changes develop in the lungs
  • strokes.

The prognosis in this case depends only on the parents. A kid who has such a pathology needs special care. That is, parents should provide care for the baby, attention. It is also important to carefully monitor his diet. In the first year of life, the number of fatal outcomes of children with VSD reaches 50%, therefore it is extremely important to consult a doctor in time if signs of heart disease are detected.

Consequences of BCM

Small scars do not affect the condition of the baby and do not interfere with the normal development, as well as the full life of the crumbs. Large defects with deformed edges, there is a risk of developing many diseases, including chronic ones:

  • lagging in the growth and psychophysical development of the baby compared to peers;
  • chronic pathology of the cardiovascular system, as well as pulmonary failure;
  • violation of the valve system of the heart;
  • chronic endocarditis;
  • development of Eisenmenger syndrome, chronic pulmonary hypertension;
  • irreversible changes in the structure of the lungs;
  • the risk of heart attack and stroke increases.

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.

Prevention

Preventive methods to prevent the development of a ventricular septal defect in a newborn, as such, do not exist. In this case, it all depends on the future mother. In general, it is recommended that a pregnant woman follow some rules that will prevent intrauterine development of the pathology. Among them:

  • timely visit to the obstetrician-gynecologist in accordance with the gestational age;
  • lack of bad habits;
  • careful pregnancy planning, elimination of all chronic diseases even before the conception of a child;
  • adherence to the day;
  • good nutrition;
  • lack of uncontrolled medication.

If there are relatives with a similar disease, the development of the fetus must be observed with particular care. This will allow timely detection of heart disease and correct it.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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