One of the most common congenital heart defects diagnosed in children under three years old is the defect of the interventricular septum. Such ailment is the second most frequent disease that occurs among heart muscle defects. It represents a hole in the wall between the left and right ventricles. Because of this, the blood from the left side of the heart gets to the right and overflows the small circle of blood circulation. It occurs both as an independent defect and as a complex with other defects.
Features of the disease
With a defect of the interventricular septum( DMF), the condition of patients can vary greatly - this directly depends on the size of the pathology. It goes so far that patients with a hole size of two to five millimeters do not feel a defect in any way, and the disease runs without any visible signs. If the diameter of the defect is large( ten to fifteen millimeters), urgent surgical intervention is necessary. There are cases when the septum is completely absent, but such a pathology leads to a fatal outcome and is not operated.
In the case of an interventricular septal defect in the period of muscle contraction, the pressure in the right side of the heart is much lower than in the left one. There is a mixture of blood and increased pressure on the vessels of the lungs. In the small circle of blood circulation there is an excess of blood enriched with oxygen, and a large one - it receives less. This can lead to sclerotic changes in the vessels of the lungs, insufficient right ventricular and pulmonary hypertension.
VSD is formed in the fetus during the intrauterine development. In rare cases, such a defect develops already in the process of life. With a small defect size, it can be detected only in a random way, according to the results of echocardiography. He usually closes himself to one-year age, and sometimes later. But the child in this case must constantly be observed at the pediatrician, to prevent the development of the disease and its transition to the active phase. If up to three years of age the baby's malformation is not lost, then the treatment is possible only by surgical means.
The basic concepts and categories of such a defect as an interventricular septal defect will be described by the following video:
Forms and types of
Cardiologists distinguish several forms of an interventricular septal defect, depending on its location:
- , the lower part of the septum - trabecular pathologies( peregrinous);
- middle part - muscular defects of the interventricular septum( Tolochinov-Roger disease);
- upper part, the most common defects are pyremembranous pathologies.
The first form of the defect is not self-closing. In case of pathology in the middle part of the heart muscle, the defect closes itself with a small hole diameter. Piromembranous pathology almost always overcomes itself.
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The opinion of doctors. .. & gt; & gt;
The differences in the size of the VSD are classified as follows:
- is small. Practically invisible, proceed asymptomatically;
- average. Symptoms of the disease begin to manifest itself in the first months of the child's life;
- large. They flow extremely hard, often lead to death.
Next, we will tell you what causes subaortic, sliced, restrictive, peremembranous and other types of interventricular septal defect in the fetus and the newborn.
Reasons for the appearance of
Defects of the interventricular septum arise under the influence of two factors:
- genetic. In a large number of cases, VSW is inherited from parents to children. If a similar pathology was observed in the family of close relatives, its appearance in offspring is not ruled out. This is due to changes in chromosomes or genes. In fact, heart defects are caused by gene mutations;
- environmental. When exposed to the fetus, which is in the womb, adverse environmental factors may develop gene mutations. With the use of potent drugs, alcohol, tobacco and drugs, and the disease with strong viral infections, the risk of a pathology is significantly increased.
Scheme of interventricular septal defect
Symptoms of an interventricular septal defect
- With small defects of the interventricular septum, symptoms do not appear.
- Symptoms that are not typical for heart defects may occur with moderate VSD.Weakness, fatigue, lag in physical development, propensity to pneumonia and pulmonary infections.
- Large defects appear in the form of pale skin, edema of the feet, pain in the chest, severe dyspnoea with physical exertion. Such symptoms are more typical for heart defects.
The most accurate diagnosis of VSD allows ultrasound( echocardiography) of the heart muscle.
Diagnosis
The doctor can diagnose the defect of the interventricular septum on the basis of this kind of diagnostics:
- a careful analysis of the patient's complaints or his parents( fatigue in exercise, pallor of the skin, pain in the heart, shortness of breath, weakness);
- detailed consideration of anamnesis of life and heredity( state at birth, transferred operations and diseases, presence of heart muscle defects in relatives);
- examination of the doctor, percussion and examination of heart murmurs;
- examination of blood and urine test data;
- analysis of electrocardiogram and echocardiography data;
- viewing the results of the radiographic study;
- studies of the heart using catheterization, ventriculography, and angiography. Special procedures with the help of which the catheter or contrast substances are introduced into the body, allowing to see pathology by various methods;
- analysis of magnetic resonance therapy data.
Treatment of
Therapeutic and medicamentous methods of
Conservative treatment for an interventricular septal defect is mainly used as preparation for surgery or if the hole has a small diameter and it is hoped that it will close on its own. Patient prescribed diuretic drugs, cardiotrophic drugs and inotropic support. But non-surgical treatment, as a rule, only does not allow to develop complications, and the vice itself does not eliminate.
Remember that you should avoid physical activity in the child. Try to make it less crying and pushing. After all, these actions are also a kind of strain of the body. Be sure to take care that the baby does not pick up heavy objects.
Operation
The main way to treat VSD is an operation intervention. Operations are emergency and planned. In an emergency, surgical intervention in the patient's body is performed to prevent a fatal outcome without prior preparation.
In the case when a planned operation is scheduled( usually carried out in childhood), the patient is preliminarily prepared for it. Cardiologists monitor his condition and conduct a course of conservative treatment. The operation to close the defect of the interventricular septum is carried out in two different ways:
- is radical. A method in which a patch from a shell of the heart or an artificial material is superimposed on a hole in the septum. In this case, the patient must be connected to the device for artificial blood pumping;
- palliative. With such an operation, the defect of the heart muscle is not eliminated, but only the pulmonary artery contracts. The method makes life easier for the patient and prevents the development of complications. Used for patients with intolerance of radical intervention.
More details on what the technology of minimally invasive removal of an interventricular septal defect is, you will be told the following video:
Prevention of the disease
There are no preventive measures to prevent the development of VSD.There are only recommendations for expectant mothers that will help to avoid fetal malformation or detect it at an early stage:
- timely registration in a women's consultation( for up to twelve weeks);
- observance of the regime of the day and adequate nutrition;
- regular visit to obstetrician-gynecologist;
- to exclude smoking, the use of alcohol and drugs;
- take medication under strict medical supervision.
Complications of
In the absence of proper treatment for an interventricular septal defect, complications may develop:
- Eisenmenger syndrome( irreversible effects of pulmonary hypertension and vascular sclerosis);
- inflammation of the inner membrane of the heart( bacterial endocarditis);
- pneumonia and other pulmonary diseases;
- heart failure;
- stroke;
- high pulmonary hypertension;
- angina;
- fainting and trauma associated with them.
Atrial and interventricular septal defects are very common, so it is important to know what predictions doctors make.
Forecast
In our time, cardiologists do not allow the development of vice, conducting an operation in early childhood. But there are cases when the parents of the child do not agree to carry out the operation for some reason( most often religious).The probability of a child's death with this approach increases in geometric progression.
A person with BCF does not live long and experiences a significant development gap. The disease progresses and entails the occurrence of other serious ailments. All this in a complex leads to a premature lethal outcome.
Even more useful information on the defect of the interventricular septum contains the following short film: