CSD refers more to childhood congenital pathologies. It accounts for 10-24% of all congenital malformations. In a serious condition, no more than 20% of defects are diagnosed, while gender does not play a role.
With pathology of the septum, blood under pressure from the left departments is transferred to the right, the so-called left-right shunt occurs. It is formed in the prenatal period of the fetus, in the interval between 4 and 18 weeks.
Pathology can develop as an independent disease, and in combination with a number of other ailments of the arterial trunk, atresia of the tricuspid valve, transposition of the great vessels, tetralogy of Fallot. A single ventricle is rarely diagnosed, in this case there is no septum at all.
In the first trimester of intrauterine development, the baby’s heart is laid.
The appearance of the hole at this stage refers to the physiological norm, since all components are still formed and are compared with each other. If at this moment a failure occurs due to the influence of factors of exogenous and endogenous nature, then this hole is not delayed, but is converted into a birth defect.
The most common causes of the development of pathology:
- Hereditary predisposition.
- The presence of bad habits that the woman did not get rid of, even when pregnant.
- Side effects of taking certain drugs during the gestation period.
- The onset of conception after 40 years.
- Improper nutrition during pregnancy, when there was a deficiency of vitamins and minerals.
- Bad ecology.
- Severe toxicosis.
- Transfer of various viral diseases during the gestation period.
- Chronic pathologies of the pregnant woman, as well as lack of proper rest and overwork.
Since the pathology is considered congenital, a defect in adults can only be a consequence of an unstretched septum opening from childhood.
In newborns, until the month after the birth, the symptoms appear only with a significant window size or if there are other deviations in the structure and functionality of the organ.
In the future, with a small defect in the baby, the pathology does not manifest itself in any way. The baby is active, eats well and gains weight depending on age.
If the average size of the hole is observed, then when the infection enters the respiratory tract, the symptoms of the disease worsen, as the blood pressure in the pulmonary structures rises and their springiness decreases.
You can notice the ailment by the following symptoms:
- Increased sweating under normal temperature conditions.
- Lethargy in the process of sucking, the child quickly becomes tired, he often takes breaks.
- The baby does not get the monthly rate by weight, at the same time, growth is in the right range.
- The appearance of tachypnea. A child makes 40 or more respiratory movements in one minute, and the shoulder area also takes part in this process.
A significant defect in size is accompanied by vivid symptoms and is an indication for an urgent doctor’s call. Symptoms may accompany both constantly and appear spontaneously. This includes all the characteristic symptoms of an average defect, but in an acute form.
In addition, the child may be disturbed by:
- The appearance of cyanosis. The neck and front part turns blue, especially during loading.
- The cyanotic color of all skin can indicate the presence of a combined defect.
- Swelling of the extremities and abdomen.
- Loss of appetite.
- Difficulty with breathing, the baby’s moodiness. With any load, the pressure in the pulmonary blood flow system increases and it becomes difficult for the child to breathe, a restrictive symptom of shortness of breath appears, and pain in the chest area.
At an older age, children experience severe dizziness right up to loss of consciousness.
If a child squats, it becomes a little easier. As the pathology develops, breathing becomes more frequent and a cough of a paroxysmal nature appears, then a heart hump can form.
In sick children, the liver is significantly enlarged and moist rales are heard, cardialgia is observed. Epistaxis can become constant companions of adolescents, and against the background of the overall picture, the latter lag behind peers in mental and physiological development.
In men and women, the symptoms are similar to those of children. During physical exertion, the patient does not have enough air, he has severe shortness of breath. At rest, breathing may become smoother, but still a little shortness of breath is present.
Pain in the chest is accompanied by a wet cough, nosebleeds often occur. The heart rate is inconsistent, the patient is diagnosed with arrhythmia.
In children, puffiness mainly affects the upper limbs; in adults, this process can also spread to the legs.
The defect of the interventricular septum (DMS) can be a hole 2-5 mm in size, in which the patient does not feel discomfort, while there is no obvious symptomatology of the disease. If its diameter exceeds 10-15 mm, urgent surgery is required. In the complete absence of the septum, a lethal outcome occurs.
CSF is characterized by the fact that with muscle contraction, the pressure in the left side of the heart is much higher compared to the right. As a result, the blood mixes, which leads to an increase in the load on the vessels of the lungs. Excess oxygen-rich blood enters the pulmonary circulation, while enriched blood is inadequate in large circulation. This can contribute to the fact that pulmonary hypertension, insufficiency of the right ventricle, and sclerotic dynamics of the pulmonary vessels will be observed.
As a rule, a ventricular septal defect develops in the fetus. It can arise in the process of life, but a similar case is noted much less often. In children, it is observed with a small size in the case of echocardiography. Usually, this defect closes on its own by one year of age or a little later.
According to the International Classification of Diseases 10 revision (ICD-10), any breast cancer is encoded with a code – Q 21.0. However, in practical pediatrics, doctors distinguish four anatomical types of this anomaly, according to the Clinical Guidelines for the Management of Children with Congenital Heart Diseases, approved by the Association of Cardiovascular Surgeons in 2013:
- Subarterial defect of the interventricular septum. Located directly under the valve of the pulmonary artery. The aortic leaf can “bend”, “wedge” into an existing hole, which causes aortic regurgitation (reverse discharge of blood).
- Perimembranous defect of the interventricular septum – the hole is located in the membrane part adjacent to the tricusp />
- An inflow ventricular septal defect is localized in the inflow of the right ventricle.
- A muscle defect in the interventricular septum – can be located in the center of the muscle, in the upper part, and also on the border between the wall of the right ventricle and the septum itself. Sometimes, several small holes are determined at once (the multiple type of muscle DMS is Tolochinov-Roger disease).
So that you are not afraid of medical terms, and it became clear exactly where the hole in the interventricular septum of your child, I will try to explain more. Anatomists divide this structure into three parts – upper (membranous), middle (muscle), lower (trabecular). Consequently, the trabecular defect is located in the lower, the muscle – in the middle, the membranous defect of the interventricular septum – in its upper part.
Depending on the cause of occurrence:
- Independent or congenital malformation.
- As a component of a number of pathologies of CHD.
- Complication after a heart attack.
- Big defect. It exceeds the size of the lumen of the aorta.
- Average. It occupies half the diameter of the aorta.
- Small, where less than a third of the diameter of the aortic lumen.
The location distinguishes:
- Perimembranous defect. It is located at the exit of the left ventricle, in the area above the aortic valve. It is most common in patients, occurs in 80% of the total.
- Muscular DMZhP. Diagnosed less often, in 10-20% of cases. It is located along the muscular part of the septum.
- Subaortic, infundibular defect. It occurs only in 5% of cases. Affects the area under the aortic and pulmonary valve.
Depending on the location, several forms of this defect are distinguished:
- trabecular – when located in the lower part of the septum;
- Topochinov-Roger disease – muscle defects;
- perimembranous – when located in the upper part.
In addition, the defect may be located under the aorta.
The first form is characterized by the inability to independently close the hole. If the defect is present in the middle of the heart muscle, then with a small hole size it can close itself. The perimembranous defect of the interventricular septum almost always goes away on its own.
Doctors divide the interventricular septal defect into several types, based on some characteristics of the disease. Depending on the volume of the anomaly, there are:
- Small defect when the hole size does not exceed 1 cm.
- A big defect when the hole is larger than 1cm.
At the location, the anomaly is divided into the following types:
- Membranous. In this case, the defect is located in the upper segment of the septum, under the aortic valve. As a rule, the hole is small in size, therefore, with the growth of the patient, it can independently close.
- Muscular. With this kind of pathology, the anomaly is located in the septum muscles. It is located quite far from the valves and the conductive cardiac system. May have different sizes. A small hole can grow over time without medical intervention.
- Nadgrebnevy. The defect is localized in the zone of the border of the efferent vessels of the heart ventricles. This type of pathology is not prone to self-closure.
The disease proceeds in three stages – mild, moderate and severe. They differ from each other in the volume of the lesion and the clinical manifestations.
The ventricular septal defect is classified not only by size, but also by location
A defect in the interventricular septum in a newborn or an adult is a heart defect in which there is an incomplete separation of the right and left ventricles. As a result, blood from one part of the heart enters the other, which disrupts its work and blood flow in general.
Also, pressure increases in one ventricle, which is transmitted to the blood vessels of the pulmonary circulation. More oxygen-enriched blood enters the same circle, while the larger circle receives less nutrition, which causes the tissues to suffer.
On the heart with impaired blood flow, the load increases, which leads to malfunctions in its work, the development of insufficiency, pulmonary hypertension. All this contributes to serious consequences if timely treatment measures are not taken.
Healthy heart and ventricular septal defect
Such a disease in most cases is congenital in nature, is formed in the fetus even during fetal development. Rarely, it can occur after birth during life. Heart attack, which occurred in the septum zone, is capable of playing a large role in this.
There are two possible options for the development of the disease:
- Isolated, that is, an anomaly is an independent pathology.
- Compound, that is, is included in a combined heart disease in conjunction with other disorders.
The incidence rate averages 25% of all existing heart defects. An abnormality is diagnosed in about one in a thousand patients. Unfortunately, over the years, statistics are only getting worse.
The defect of MJP arises due to the influence of adverse factors on the human body or the future mother and fetus. These include the following:
- Viral pathology.
- Infectious processes.
- Drinking alcohol.
- Taking medications for a pregnant woman, which are prohibited during the bearing of the baby.
- Work related to hazardous production.
- Frequent stress.
- Heavy loads.
Also, a genetic predisposition cannot be excluded from a number of possible causes. Often, parents who suffer from such a pathology have children with the same diagnosis.
The exact cause of the anomaly is difficult to establish. In the etiology of congenital heart diseases, the role of heredity, a polluted environment, bad habits of parents, and the future mother’s intake of certain medications transferred from viral infections during pregnancy is proved.
Repeatedly, parents tormented themselves and me, trying to find out the exact etiology of the birth defect in the child. When such a diagnosis is found in a native baby, I want to certainly find the culprit. My grandmother on my father’s side sometimes accuses the daughter-in-law of “bad genetics”, and my mother’s relatives are the son-in-law of smoking and drinking alcohol.
I categorically do not advise you to do this. Of course, it is important to find out the reason in order to predict the birth of healthy or sick children from the parents and the child himself. A child with a VSD will one day become a father or mother. But the disease of a small person is not a reason to clarify the relationship. Forget family quarrels. Focus on taking care of the baby.
A defect in the interventricular septum in a newborn can appear for three main reasons:
- the use by the mother during pregnancy of drugs, tobacco, alcohol, potent drugs, her viral infections;
- the impact on the fetus of adverse environmental factors leading to genetic mutations;
- genetic – transmitted from parents to children.
Newborns with such a defect can be born if the mother has a threat of spontaneous miscarriage at the beginning of pregnancy.
It is used with a small size of a defect in the interventricular septum in a newborn or in preparation for surgery. The patient is prescribed cardiac glycosides, cardiotrophics, diuretics. They prevent the formation of complications without curing the defect.
Treatment is prescribed in the form of a solution of “Strofantin” at a dose of 0,01 mg/kg body weight or “Digoxide” – 0,03 mg/kg in the first three days, after which the dosage is reduced by 4 times, designed to help the patient in pumping blood.
For newborns, the following cardiometabolic agents are used: Cocarboxylase, Cardonate, Phosphaden. They nourish the heart muscle, preventing oxygen starvation, improve metabolic processes. The course of treatment is from 3 weeks to 3 months. For very young children, the contents of the capsule are dissolved in sweetened water and given once a day.
Diuretics are necessary to remove excess fluid from the spleen, heart and lungs. When giving medications, it is necessary to prevent dehydration and give a dose of 2-5 mg/kg of the body once a day until lunch.
When bronchospasm is prescribed, “Eufillin” is prescribed, which is also prescribed for pulmonary edema. The solution can be used in the form of microclysters or intravenously at a dose of 1 mg for 1 year of life.
The child should not push, cry, or experience other physical exertion on the body.
Influence of BCF on blood flow
If this is not done, then at any time the doctor may recommend interruption of gestation when there is a threat to the life of the future mother. In addition, there is a great risk of detecting this pathology in the baby.
If the diagnosis was not established before conception, then if a disease is detected, it is imperative to follow all the doctor’s recommendations and, if necessary, hospitalization, not to refuse it.
The size of the hole can reach from 0,5 to 3-4 cm. The shape is either in the form of a circle, or like a gap. With a small defect, blood flow is not disturbed, if the hole is large, then the magnitude of the pathological complication is directly proportional to the diameter of the window.
When there is a gap in the left ventricular systole, blood under pressure enters the right ventricle, which causes pathological changes and wall hypertrophy in this area.
In addition, the pulmonary vessel, where venous blood enters, expands. In this zone, pressure increases, which is transmitted to the arterial bed of the organ. To prevent the lung from being overloaded with blood, the body responds with spasm of the arteries, which is fraught with pulmonary insufficiency.
The left ventricle functions better, with its diastole there is less blood than that of a right-sided relative.
The left-sided organ can receive blood again from the same atrium or right-sided ventricle by seeping through the septal defect.
Such circulatory disorders can lead to thrombosis with subsequent movement of clots and blockage of blood vessels. Also dangerous is the state of oxygen starvation of the brain and, as a consequence, hypoxia of the cells.
If the window is too large or even with moderate severity no measures are taken to stabilize the condition, then the patient faces the development of serious pathologies, and in the worst case, even death.
The most common consequences are:
- Heart failure leading to tissue hypoxia.
- Hypotrophy of muscle structures. Trophy is impaired, which causes weight loss, slowing the development of all systems and organs of the child.
- Eisenmenger syndrome. It arises as a complication of pulmonary hypertension, backed up by VSD. Such a complication can only be treated promptly.
- Bacterial endocarditis occurs with staphylococcal infection.
- Pulmonary hypertension. In this case, the pressure of the pulmonary artery and all vessels in the pulmonary circulation is increased.
- Aortic insufficiency. Valves do not close to the end.
- Sudden death.
- Pneumonia with frequent relapses.
- Heart block, embolism of pulmonary or coronary vessels.
Treatment of perimembranous or other interventricular septal defect depends on the severity of the pathology. If the disease is detected in a newborn, then therapy can be delayed until a year. During this time, the hole can grow on its own.
If it did not close, but significantly decreased in volume, then conservative treatment is prescribed for up to 3 years with constant monitoring by the doctor. During this time, the defect can disappear without medical intervention.
With a large size of the hole, an operation is prescribed, and medications are used only as a supplement to improve heart function.
In case of breast cancer, the following groups of drugs are used:
- Cardiac glycosides, which produce a cardiotonic effect, normalize the heart rhythm, increase the efficiency of the organ.
- Diuretics that have a diuretic effect, normalize high blood pressure, reduce the load on the heart and blood vessels.
- Cardioprotectors, which help stabilize the metabolism in the tissues of the heart, improve its nutrition, and also protect the organ from external influences.
- Anticoagulants that thin the blood and prevent blood clots.
- Adrenergic blockers, which reduce high blood pressure, normalize heart rate, relieve chest pain.
- ACE inhibitors that help in stabilizing pressure, improving heart function.
The exact list of necessary medicines is determined by the attending physician. He sets a specific dosage, which must be strictly observed.
Drug therapy is aimed at maintaining normal heart function.
Surgical intervention is used in the presence of such indications as:
- Big hole.
- The presence of concomitant pathologies of the heart.
- Inefficiency of conservative therapy.
The safest and least traumatic method for the treatment of muscle and other ventricular septal defect is endovascular correction. In the process, the hole is completely closed using a special device inserted into the organ through a catheter. Over time, the defect is completely overgrown. After such treatment, the patient quickly recovers and returns to a full life.
They also use a more radical method – plastic defect. In this case, the patient is attached to a cardiopulmonary bypass. The chest is opened, the heart is cut and access to the focus is obtained. If the hole is large, make plastic, covering it with a patch. This method is traumatic, requires a long recovery, but gives good results.
Installation of a “patch” on the atrial septal defect
After any surgical treatment, the patient must fully recover. The duration of rehabilitation depends on the type of operation. In the prescribed period, it is important to follow all the recommendations of the attending physician.
Operations for a defect in the interventricular septum are the main method of treatment of pathology. They can be scheduled and urgent. The latter are used if the defects are large and there is a danger of death.
When prescribing a planned operation, the patient preliminarily prepares for it with the help of conservative treatment. Surgical intervention can be performed in two ways:
- Palliative, in which the defect of the interventricular septum as a congenital defect is not eliminated, but the narrowing of the pulmonary artery is carried out, which makes life easier for the patient, preventing possible complications. It is used for those patients who cannot tolerate the second method.
- Radical – a patch of artificial material or a cardiac membrane is placed on the hole, connecting the patient to an artificial blood pump.
The operation is not performed if the defect has developed to the third stage, in the presence of sepsis or infection in the blood.
There are several types of surgical procedures:
- Narrowing of the pulmonary artery – it is carried out with the weakness of the child, as a result of which he can not tolerate other types of operations, with increased pressure in the vessels and throwing blood into the right ventricle from the left by ligating the artery that carries blood to the lungs from the heart. Its implementation helps to avoid pulmonary edema, asthma attacks. It is preliminary, then the child must grow stronger and undergo another operation. The negative point is the stretching and enlargement of the right ventricle.
- Open heart surgery is the most effective, they are performed in the presence of medium and large openings. The incision is made along the chest, the defect is sutured or a patch is made on it, while the heart is disconnected from the main vessels, and blood circulation is artificially performed. With this operation, additional ailments of the heart and valves are eliminated and blood clots are removed if any. Its implementation allows you to rid the child of these defects forever, but such an intervention is traumatic, requiring a long rehabilitation period.
- Closing the interventricular septum with an occluder is a less traumatic surgical procedure. During its implementation, the hole is closed with a special device placed in the heart through the lumen of large vessels. It is carried out with blood stasis in the vessels of the lungs and blood flow through the left ventricle to the right. This type of operation is performed when the defect is located at a distance of 3 mm or more from the border of the interventricular septum. When conducting such a surgical intervention, improvement of health and recovery occur quickly, blood circulation in the lungs normalizes. But such an operation cannot be performed with large openings located in the center of the septum, as well as narrow vessels, problems with the valves and the presence of blood clots, as well as persistent arrhythmias. Such surgical intervention is not performed in children under 1 year old and having a weight of less than 10 kg.
With small and medium-sized windows, doctors are in no hurry to perform an operation, but sometimes certain circumstances appear when surgical treatment is inevitable:
- The presence of other vices.
- Pulmonary hypertension.
- Slowing the growth of the head circumference.
- Down syndrome.
- Frequent colds, in particular, aggravated by pneumonia.
- Severe heart failure.
- Inefficiency of conservative methods.
- Large DZHP.
An anomaly can be fixed in several ways:
- Endovascular correction. It allows you to block the hole with a special mesh. Refers to minimally invasive treatment.
- Palliative method. The pulmonary artery is pulled by the cuff, which reduces the flow of blood through the window. Stabilizes for a while. It is indicated in severe cases in the first days of life or with multiple holes.
- Radical intervention. During the operation, a cardiopulmonary bypass is used. Small defects are stitched together, large ones are patched. There is a need for opening the right atrium and penetration to the cerebrospinal fluid through the tricuspid valve. In the absence of such an opportunity, the right ventricle becomes by access.
Recommendations for future mothers
Since there are no preventive measures to prevent a congenital ventricular septal defect in children, doctors give recommendations only for future women in labor:
- take only those medicines that are prescribed by a doctor;
- to refuse from bad habits;
- regularly visit a gynecologist;
- Healthy food;
- observe the daily routine;
- timely register with the antenatal clinic.
If a woman is about to have a breast, she needs to visit a cardiologist to determine the size of the defect, to determine the presence of pulmonary hypertension and arrhythmia. In the presence of Eisenmenger syndrome, pregnancy is interrupted, since a maternal death is possible.
Women with heart disease should understand that they can give birth to a child with the same disease. If they decide on pregnancy, then before conception, you need to take drugs to maintain cardiac activity. With small defects, childbirth is carried out independently, and in the presence of complications – only with the help of a caesarean section.
If fetal malignancy is detected in the fetus, then you should know that from the formation until the birth of the baby, this defect does not interfere with its formation, since the small circle in the fetal state does not function.
Methods of treatment for benign prostatic hypertrophy
An untreated defect in the interventricular septum of the heart can lead to the development of the following pathologies:
- fainting and injuries associated with it;
- angina pectoris;
- high pulmonary hypertension;
- heart failure;
- pulmonary diseases;
- bacterial endocarditis;
- Eisenmenger syndrome, which is irreversible and appears as a result of vascular sclerosis and pulmonary hypertension.
If the defect of MJP is not eliminated in a timely manner, it can provoke serious consequences, many of which pose a threat to the life of a sick person.
The following complications are possible:
- Hypotrophy, in which there is a failure of tissue trophism and a significant decrease in body weight. The disease leads to a violation in the activity of many organs. For treatment, medications are used that stimulate appetite, provide the body with the necessary useful components.
- Eisenmenger syndrome, characterized by persistent pulmonary hypertension. Together with the defect, this ailment causes severe disturbances in the work of the heart, pronounced clinical manifestations. The pathology is treated only by surgical intervention.
- Bacterial endocarditis, in which an inflammatory process develops in the inner heart membrane. The patient is tormented by symptoms of intoxication, for example, fever, muscle pain, weakness. Antibacterial drugs are prescribed to combat the disease.
- Pulmonary hypertension, manifested in the form of high blood pressure in the vessels of the lungs. With it there are breathing problems, fainting, chest pain. Pathology is treated conservatively.
- Aortic insufficiency, which is characterized by a violation of the closure of the valve leaves. To solve this problem, surgery is performed.
- Arrhythmia, in which the heart rhythm and pulse rate are disturbed. With a mild form, it is asymptomatic, but over time causes attacks with unpleasant symptoms. Antiarrhythmic drugs are prescribed for treatment.
Such diseases as heart failure, vascular thromboembolism, and cerebral stroke can also develop. Sudden cardiac arrest is also possible.
At the time of the operation to eliminate a congenital defect of the interventricular septum, it is relatively favorable. Good prognosis for self-closing a defect.
A person’s life with a malignant hypertrophy is usually short, the disease progresses and leads to other ailments.
If small defects do not close on their own, it is better to carry out the operation even in adulthood, since otherwise the average life expectancy is less than sixty years.
Life expectancy and prognosis entirely depend on the diameter of the hole and the quality of the functioning of the vascular bed in the pulmonary circulation.
With a minor defect, the quality of life indicator does not change, only 2% have a chance of the appearance of viral endocarditis. About 40-50% of small holes themselves are tightened up to 4-5 years.
With an average window size, heart failure occurs early. Only 14% can gradually close on their own, others can decrease in size. As they mature, the remaining patients often develop pulmonary hypertension.
With a large opening, heart failure is an integral companion to the patient.
Pneumonia often appears. Eisenmenger syndrome affects 10-15% of such children. There is a high risk of death in childhood or adolescence.
If surgery is not performed, then with average openings the patient can live for about 30 years, and with a minor defect, almost 60 years.
Muscular defects are most prone to self-closure, while infundibular ones need surgical correction.
When visiting dentistry, all patients with defects should receive antibacterial prophylaxis. Physical activity is limited for all patients. If the operation is performed and the problem is eliminated, then after a year the children can perform any load.
Mortality from septal defect is not more than 10%, including postoperative mortality.
A septal defect appears in the prenatal development, which can be detected by ultrasound diagnostics at a routine examination. A small window does not bring significant inconvenience to the patient and even sometimes grows to birth, medium and large spaces are dangerous.
Most often, a perimembranous defect arises, the probability of self-tightening of which is many times more than other types. The total mortality of patients with this defect does not exceed 10%.
The prognosis for a defect is favorable if you start treatment in a timely manner and follow all the recommendations of doctors. A good result brings surgery. Thanks to him, most patients recover completely.
If the anomaly is accompanied by other pathologies and complications, then the prognosis is less favorable. But with proper treatment of all existing diseases, you can achieve a good result.
For small defects, wait-and-see tactics are chosen.
The prognosis of congenital heart disease – JMP in a newborn can be very different. But by the size and presence of symptoms, the cardiac surgeon or cardiologist can draw preliminary conclusions. Expectant tactics are chosen for small defects. Defects up to 2 mm in diameter do not affect the baby’s condition and do not pose a danger to his health.
A child with an untreated ventricular septal defect has a risk of developing complications such as:
- the development of pulmonary hypertension (increased pressure in the pulmonary artery system) with irreversible consequences in the form of vascular sclerosis with the development of respiratory failure,
- heart failure,
- infectious endocarditis,
- cerebrovascular accident in the form of strokes,
- the formation of valvular heart defects in the form of aortic valve insufficiency.
The prognosis of the disease largely depends not only on the type of defect, but also on timely surgical intervention. I will never forget one family. The faith of the parents did not allow them to protect themselves from pregnancy. A wonderful girl was born the eighth child in a row. All older children are absolutely healthy. No risk factors. Great heredity. Great weight and performance on Apgar. The baby took breasts, was active and was a universal favorite.
In the maternity ward, a neonatologist suspected congenital heart disease. Ultrasound examination revealed a muscle defect in the interventricular septum in the newborn. Specialists of the cardiocenter recommended performing an operative correction up to 6 months of age, since the hole size was too large.
Parents tuned in for surgical treatment, but according to their faith, the blessing of the pastor was required. And he, seeing a seemingly healthy girl, advised me to postpone the operation a bit. Like, she’s still very small, her vice doesn’t bother her, you’ll always be able to “cut” her.
At the seventh month of life, the baby had the first signs of pulmonary hypertension, with which we tried unsuccessfully to fight with the prescription of medicines. On the ninth – the parents begged the cardiac surgeons to save the child, but it was too late to operate – the heart failure clinic developed. At one year old, the girl died.
And yesterday a young man came to the reception. Eighteen years. He was indignant that the doctors of the draft board sent him for an additional examination to the hospital. Engaged in athletics. Dreams to enter a military school. I open an outpatient card, and there is an operative treatment for benign prostatic hyperplasia. On the chest – a thin strip of postoperative scar, almost imperceptible. The operation guy does not remember. Sincerely does not understand why he is sick. Just the parents at one time were not afraid to “cut it”.
Features of the blood circulation of the fetus
Usually, defects can be detected on a planned ultrasound already at week 20 or in the third trimester. Small holes are sometimes not visible until the baby is born. It happens that they are delayed even in the womb. Consultation with a neonatologist or ECHO of the fetus may be prescribed.
To make it a little easier to understand the essence of a particular heart disease, you should first talk about the features of the circulatory system in a baby during its intrauterine development.
- In utero, the baby’s lungs do not participate in oxygen saturation of the blood. The child receives all the necessary oxygen from her mother through the umbilical vein. The role of gas exchange in the fetus is performed by the placenta.
- There is no completely oxygenated blood (saturated with oxygen) in the heart of the child, since the arterial blood received from the mother is mixed with venous blood (saturated with carbon dioxide) from the liver and lower half of the baby’s body. This mixed blood flow is directed to the right atrium.
- Blood saturated with carbon dioxide from the upper half of the body also goes to the right atrium, where it is found with mixed blood from the lower half of the body.
- Part of the oxygen-rich blood is discharged into the left atrium through an oval window. This is a hole that is open in the fetus and does not need a person after he is born.
- The baby has another education that he needs only during intrauterine development. This is the ductus arteriosus, which is the communication between the aorta and the pulmonary artery. What is it for? Since the baby’s lungs are not involved in gas exchange in utero, their large blood supply at this time is not necessary. Therefore, 90% of the blood that enters the pulmonary artery from the right ventricle is discharged through this arterial duct into the descending aorta and supplies the lower half of the body. Only 10% of the blood from the pulmonary artery enters the lungs.
- The child’s brain receives blood that is richer in oxygen than other organs, since the arteries supplying the brain extend above the point where the arterial duct flows into the aorta, through which less oxygenated blood flows.
- In both circles of blood circulation in a child in utero, the difference between the oxygen content in them is insignificant. Both circles of blood circulation in the fetus work in parallel. Therefore, the fetus is very resistant to many defects and can develop normally, despite severe cardiac abnormalities.
- As the baby grows, the blood supply to the placenta decreases and the blood flow in the internal organs increases.
A ventricular septal defect is most often congenital, although it can also occur in adults, especially those who have had myocardial infarction. If there are small holes in this septum between the right and left ventricles, they can be eliminated independently. Particularly large defects are fatal.
Prescribing disability is a mandatory procedure after heart surgery. Even if the correction has not yet been carried out, but in addition to the defect, the baby is diagnosed with Tetrad Fallot’s defect or other complex pathologies, the group can be given earlier.
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