Defect of interventricular septum
The defect of the interventricular septum (DSCP) is a defect in the wall separating the left and right ventricles of the heart. The extent of the defect may vary from the size of the pin to the complete absence of the ventricular septum, thereby creating one common ventricle. The ventricular septum consists of the lower muscular and upper membrane parts, which are abundantly innervated by conducting cardiomyocytes.
The membrane part, which is close to the atrioventricular node, is most commonly affected by adults and older children living in the United States. Such information is indicated in Taylor, Michael D., "Muscular Ventricular Septal Defect."
Membrane defects of the interventricular septum are more common than defects in the interventricular septum of the muscle.Today they are the most common congenital cardiac anomaly.In some cases, small defects can close independently, which happens in 3-5% of newborns.In other situations, an immediate intervention of the cardiopulmonary brigade is required.
Video Defect of interventricular septum. Congenital heart defects
Today, there are several classifications of the defect of the interventricular septum, but the most acceptable and unified classification is the Classification of the nomenclature and the database of congenital cardiological surgery.The classification is based on the location of the SEM and looks like this:
- Multiple defects - it is determined in 5-7% of patients, more asians, often there is a connection with the aortic valve.
- Defect in the membrane part of the septum - the defect is known as subaorateral. The most common, is defined in 70% of patients.
- Defective muscular (trabecular) part - located in the muscular part of the septum, defined in 20% of cases. Can be further divided into species, depending on the location of the defect - in the anterior, apical, posterior and middle parts.
- Podortal defect - usually associated with atrioventricular septal defect, which is detected in about 5% of cases.
- Complete absence of interventricular septum.
A bit of statistics
- Among the newborn infants, the incidence of congenital malformation is approximately 6 cases per 1000.
- The incidence of DMZH among boys and girls is the same.
- At birth, up to 90% of DMZH is determined in the muscular part of the interventricular septum.
- In the first month of life, up to 80% of defects in the muscle part of the MHP themselves close.
- Defects with a diameter of ¼ of the aorta and less are considered small and treatment is not required.
During the development of the fetus, the defect of the interventricular septum occurs when the muscular wall separating the heart on the left and right sides (partition) is not completely formed between the lower chambers of the heart (ventricles).
In the normal state, the right side of the heart pumps blood into the lungs so that it is enriched with oxygen. The left side pumps blood-rich oxygen over all other parts of the body.
Congenital heart defects (VPS) promotes the mixing of oxygen-containing blood from deoxygenated blood, thereby causing the heart to work more intensely to ensure adequate concentration of oxygen in the tissues of the body.
The defects of the heart are of different sizes, and they can be present in several places in the wall between the ventricles. There may be one or several defects at a time.
Congenital heart defects, including the defect of the interventricular septum, arise due to adverse effects of the early development of the heart in the fetus, but often the cause is not completely clear.
The main causes of DMZH are genetics and environmental factors. The defect may occur in isolation or together with other congenital anomalies of the heart or developmental disorders (for example, in Down syndrome).
In some cases, the defect is formed a few days after myocardial infarction (heart attack). This is due to the mechanical breakage of the wall of the partition. In the future, the formation of scar tissue occurs when macrophages begin to remodel the tissue of the dead region of the myocardium.
DMZP often becomes a complication of certain procedures performed on the heart.
- Hereditary predisposition.
- Birth of children with Down syndrome.
- The presence of bad habits (alcoholism, smoking).
- Unfavorable working conditions.
- Bad nutrition
DVPF video or interventricular septal defect: causes, symptoms, diagnosis and treatment of DSC
Signs and symptoms of serious congenital interventricular septal defects often appear within the first few days, weeks, or months of a child's life.
Symptoms of a defect in the ventricular septum in a child may be as follows:
- Bad nutrition
- Delay in development
- Frequent breathing or shortness of breath
- Fast fatigue
Immediately after birth, only experienced doctors may notice signs of a minor defect of the interventricular septum. Generally, if the defect is small, symptoms may appear much later if they do occur. Signs and symptoms vary depending on the size of the orifice and other heart defects associated with it.
For the first time, a doctor may suspect a heart defect during a regular examination, when noisy, more or less pronounced, is heard in the auscultation of the child's heart. Sometimes the UP can be detected by an ultrasound method before the baby is born.
When you diagnose the following symptoms, you should immediately contact your doctor:
- Fast tired when eating or playing
- Does not gain weight
- It is suffocating when it is eating or crying
- Breathe fast or hard
Children aged 3-4 years can make the following complaints:
- It is difficult to breathe, especially when moving
- Rapid or irregular heartbeat
- Fatigue or weakness
The small defect of the interventricular septum most often does not cause serious problems. Medium or large defects can cause a number of diseases - from mild gravity to life-threatening. Timely treatment helps prevent many complications.
Diseases that develop on the background of DMP:
- Heart failure. A heart with a medium or large defect should work several times more actively, which allows you to pump enough blood throughout the body. Due to this, heart failure can develop quite rapidly, so it is important to have a long-term operation of patients with middle and large airways.
- Pulmonary hypertension. An increase in blood flow in the lungs due to the UPI causes high blood pressure in the pulmonary arteries (pulmonary hypertension), which can provoke their irreparable disturbance. Such a complication often develops against a background of altered blood flow through the defect of the MI (Eisenmenger's syndrome).
- Endocarditis This cardiac infection is a fairly frequent complication of SLE.
- Other heart problems. These include varying degrees of severity of heart rhythm disturbance and valvular problems.
During the examination of a child, the doctor can hear heart noise, after which a direction to the pediatric cardiologist, who specializes in the diagnosis and treatment of congenital heart defects and heart disease, is given.The cardiologist conducts a physical examination, listens to the heart and the lungs and makes other observations.
Heart noise is evaluated based on the pitch, volume and duration of the heart, allowing the cardiologist to create an initial idea of what kind of heart problem a child can have.
Today, various diagnostic tests for congenital heart disease are performed. The decision on the application of this or that method depends on the age and clinical condition of the child.
Instrumental methods of research at SUMP:
- X-ray of the chest. This diagnostic method uses X-rays to produce images of internal tissues, bones and organs on an X-ray film. With a defect, the heart may be enlarged due to the fact that the right ventricle processes more blood than usual. In addition, changes in the lungs may be due to increased blood flow.
- Electrocardiogram (ECG). The method that records the electrical activity of the heart, and shows abnormal rhythms (arrhythmias or extrasystoles), in addition, detects hypertrophy of the heart muscle.
- Echocardiogram (echocardiogram). The procedure evaluates the structure and function of the heart, which uses the sound waves recorded on the electronic sensor, which create a moving image of the heart valves. Echocardiography can show a picture of the blood flow through the defect of the septum and determine how large the hole is and how much blood passes through it.
Catheterization of the heart a. This invasive procedure provides very detailed information about the internal structures of the heart. At catheterization, a small, thin flexible tube (catheter) is inserted into the blood vessel in the groin, and then directed to the inner part of the heart. Measurements of arterial pressure and oxygen are carried out in four chambers of the heart, pulmonary artery and aorta. In addition, a contrast agent is introduced to more clearly visualize the structures inside the heart.
Treatment and prognosis
The doctor-cardiologist determines the specific treatment of the interventricular septal defect based on:
- The age of the child, the general state of health and the history of the disease
- The severity of the course of the disease
- Possibilities of using specific drugs, procedures and therapies
A small defect of the interventricular septum may spontaneously close as the baby grows up. A large air force usually requires surgical intervention. Regardless of the size of the interventricular septal defect, the cardiologist periodically assesses the condition of the child, which makes it possible to verify its satisfaction.
DMZhP is to be restored if it is not closed by itself. Timely treatment helps to prevent lung diseases that arise from prolonged increases in blood pressure in pulmonary vessels.
Treatment for DMZ may include:
- Drugs. Some children have no symptoms, so no drugs are needed. However, in some cases, it is necessary to take special medications to help the heart work better, due to the tension on the right side of the heart from an additional blood supply passing through the defect. Medications that can be prescribed include:
- Digoxin A medicine that helps to strengthen the heart muscle, allowing it to work more efficiently.
- DiureticsThe body's water balance may be disturbed when the heart does not function as expected.These drugs help the kidneys remove excess fluid from the body.
- ACE inhibitors. Medications that lower blood pressure in the body, which facilitates hemodynamics in the heart.
- Adequate nutrition. Babies with a big defect may get tired of feeding, so they do not eat enough food, which affects the lack of weight. Ways that provide a child with adequate nutrition include:
- High-calorie supplement or breast milk .Special food ingredients can be added to the supplement or transferred to the infant through a bottle of breast milk, which allows you to increase the amount of calories per serving. In this way, the child drinks less, but consumes enough calories for proper growth and development.
- Supplemental feeding of nutrients. Feeding through a small flexible tube that passes through the nose, down the esophagus and into the stomach can either act as an additional one, or completely replace the use of bottles. Infants who drink only part of the prescribed norm can drink the remainder through the tube. Children who are too weak to self-feed from a bottle should receive their feed or breast milk only through a tubule.
- Infectious disease control. Children with certain heart defects are at risk of developing the infection of the inner surfaces of the heart. Most often, bacterial endocarditis develops. Therefore, parents should inform any medical staff that their child has a DMZ. In this regard, antibiotics are used for some procedures.
- Radical surgical intervention. The treatment is to restore the integrity of the septum before the lungs are damaged due to excessive blood flow and pressure. The operation is performed with defects that cause symptoms in the form of poor weight gain and frequent respiration. Must be performed based on the results of the echocardiogram and cardiac catheterization. As a rule, it is performed under general anesthesia. Depending on the size of the heart defect and the recommendations of the doctor, the defect of the interventricular septum will be closed with P-shaped sutures or special patches.
- Interventional catheterization of the heart. The defect can be eliminated by the procedure of catheterization of the heart. In one method, a device called a septic occluder is used. During this procedure, the child is calm down, after which a small, thin flexible tube is inserted into the blood vessel in the groin and directed to the heart. Once the catheter is in the cardiac cavity, the cardiologist acts on the occlusion of the septum. The septal occluder closes the defect of the interventricular septum, providing normal hemodynamics in the heart.
Video An endovascular operation on the heart of a child was conducted by Odessa doctors
In most cases, nothing can be done to prevent the child from having a defect in the interventricular septum. Nevertheless, it is important to do everything possible to have a healthy pregnancy.иHere are the key recommendations:
- It is important to get early antenatal care, including the stage of pregnancy planning. Before you get pregnant, talk to your doctor about women's health and discuss any changes in the way of life that the physician can recommend to ensure a healthy pregnancy. In addition, one should not forget about the drugs that have to be taken in connection with the treatment of any illness.
- It is useful to practice a balanced diet. Vitamin supplements containing folic acid should be used. It is worth limiting caffeine.
- Exercise should be regular. You can even work with your doctor to develop a plan of exercises that would fit exactly in a particular situation.
- Harmful habits must be avoided (alcohol consumption, tobacco smoke and drug use).
- It is necessary to minimize the possibility of infection.You need to have a vaccine prophylaxis before you get pregnant. Some types of infections can harm the developing fetus.
- Keep the diabetes under control. If pregnancy develops against the background of diabetes, then at the planning stage, you need to work very carefully with your doctor to make sure that the disease is well controlled.
If parents have an unpleasant history of the disease associated with heart defects or other genetic disorders, one should think about consulting a geneticist. Then you can make the right decision about the future pregnancy.