home Audience 3 Ventricular septal defect of the heart. Ventricular septal defect (VSD): causes, manifestations, treatment

Ventricular septal defect of the heart. Ventricular septal defect (VSD): causes, manifestations, treatment

Such an anomaly of development as a defect interventricular septum occurs frequently in newborns. Modern statistics confirm that up to 40% of children with congenital heart changes suffer from a ventricular septal defect (VSD). This is a structural disorder (not an overgrown hole) that forms in the fetal heart in the first eight weeks. The size of the hole diameter can be different - from insignificant, not having such serious consequences (1 mm) to an anomaly big size- more than 30 mm. The presence of such a pathology may have a consequence in the form of pumping blood into the right section.

The anomaly can be localized in various parts of the interventricular septum. There are three parts: membranous, muscular (middle) and lower.

The most common option is the location of the violation in the middle part, membranous (large pathologies can occur here). A defect in the muscular part is much less often observed (here, the defects are small). The situation may be complicated by the fact that there may be several holes, while pathology can be observed in different parts partitions. In addition, the anomaly very often accompanies other various defects heart development.

The interventricular septum of the heart is formed very early, in the first three months. It consists of three components, which before this time are formed and connected to each other. If this process is disturbed, then one or more holes may remain in the partition.

Modern medicine names the following main reasons for the development of a defect:

maternal transmission of infectious diseases to early dates pregnancy (SARS, chickenpox, rubella may affect);
the adoption of a pregnant woman with potent drugs in the early stages;
malnutrition, starvation, unbalanced diets, lack of vitamins;
genetic mutations, bad ecology, radiation;
age (over 40 years);
the presence of serious chronic diseases;
alcohol intoxication.

NOTE! Among the causes of the defect, doctors call infections transferred in the early stages, as well as poor nutrition, alcohol use and the presence of serious chronic diseases.

Main symptoms in newborns

Defect size	Difficulties in sucking	underweight	Murmurs in the heart	Marbling of the skin	Dyspnea	sweating	developmental delay
Small (up to 1 cm in diameter)	No	Doesn't show up	Rough noise heard	Appears on the arms, legs, chest	No	No	No
Medium (from 1 to 2 cm)	Present	Manifested	Rough heart murmur	Manifested on the arms, legs, chest, limbs are cold. Pale skin	Yes	Yes	Yes, there is a lag.
Large (more than 2 cm)	Present (often off the chest)	Progressive, possible dystrophy	Rough heart murmur	Manifested on the arms, legs, chest, limbs are cold. Pale skin	Almost constant shortness of breath	Yes, increased sweating	Significant backlog

NOTE! The main symptoms of a defect of any size include a heart murmur, marbling of the skin, and reduced weight. Possible complaints of a child with a significant defect

At 3-4 years old, the baby can report the following issues well-being:

feel pain in the region of the heart;
feel short of breath when lying down;
complain of cough
complain of nosebleeds.

ATTENTION! Parents can observe fainting, flat phalanges of the fingers, a blue tint of the skin of the face and extremities, thinness, and swelling. The doctor notes a rough noise, wheezing, an enlarged liver.

Violation mechanism

Peculiarity human heart- the difference between blood pressure in the left and right ventricles. If there is a hole in the septum, this causes a malfunction of the heart. Normally, blood should enter the aorta, but due to a developmental anomaly, it is pumped into the right ventricle, causing it to overstrain. The size of the hole and its location affect the volume that enters another department. A small volume may not give distortions in the work of the heart at all. But if the anomaly is significant, then a scar appears on the wall. Another result of the process is an increase in pressure in the pulmonary circulation.

The body tries to adapt to existing conditions: there is an increase in the mass of the ventricles, the walls of the vessels thicken. This is a pathological process, because it leads to a loss of elasticity.

NOTE! The blue tone of the child's skin, anxiety, problems with shortness of breath may indicate a VSD.

Complications

The problem is aggravated by the fact that in the presence of an anomaly, various additional diagnoses are possible.

NOTE! Children with BPD often suffer from pneumonia - this is due to such a problem as blood stasis .

Thromboembolisms are of particular concern, as they are associated with a possible blockage of the vessel. This can lead to a stroke.

Diagnostics

Electrocardiography (ECG) - reveals serious violations.
Phonocardiography (recording of heart vibrations).
Echocardiography (ultrasound of the heart) - reliable way diagnostics.
X-ray of the heart. Able to identify defects in medium and large sizes.
Catheterization of the cavities of the heart.
Angiocardiography (use contrast medium).

Treatment

The main treatment for BPH is surgery. There are subtleties here: if the size of the pathology is small, then the probability of its self-restoration and closing of the holes is very high. The essence of the operation is the suturing of the hole (if possible, with a size of up to 5 mm in diameter) or the use of a patch from modern material. The origin of the material can be different - based on synthetic or biological matter.

What can serve as an indication for an operation?

For children under three years of age:

lack of weight;
problems with the general development of the child;
progression of pulmonary hypertension;
insufficient blood supply to internal organs;
persistent cases of pneumonia.

For adults and children over 3 years of age:

lack of energy, strength;
protracted SARS and pneumonia;
heart failure;
reset more than 40%.

Very often there is a situation where the operation is too risky. For example, in the age group of infants in the first months of life with serious problems due to an anomaly of large diameter, specialized treatment in two stages. The first stage: an operation to apply a special cuff to the pulmonary artery above in order to equalize the pressure. A few months later, after the situation improves and weight gain, the child undergoes a second operation - a standard one: the previously applied device is removed and the anomaly is closed.

Video - Ventricular septal defect

Manifestations in adulthood

persistent cough;
arrhythmia;
heartache;
swelling;
shortness of breath at rest.

Used drugs

It should be noted right away that the defect closes either by itself or with the help of an operation. The drugs used in this case are not aimed at closing the hole, but at removing dangerous symptoms associated with the development of the anomaly.

The main purpose of drugs is to support the heart muscle, providing more energy for weakened tissues (for example, Anaprilin, Digoxin).

Attention! Used to prevent blood clots Aspirin, which quite successfully copes with the task of thinning the blood. Vitamin preparations, medicines containing trace elements (for example, selenium, potassium).

Life expectancy forecast

The general state of health and life expectancy of the patient are directly dependent on the size of the anomaly. Other factors also play a role, such as general state vessels.

Anomaly diameter	Impact on life expectancy	Probability of natural closure	What is the risk	Lifespan (no surgery)
Small 5 1

A ventricular septal defect in children is a congenital abnormal connection between the two ventricles of the heart, which occurs as a result of underdevelopment at its different levels. This type of anomaly is one of the most common congenital heart defects in children - it occurs, according to different authors, in 11-48% of cases.

Depending on the location of the ventricular septal defect in the fetus, the following types are distinguished:

Defects in the membranous part of the septum. Their sizes are from 2 to 60 mm, the shape is different, they are observed in 90% of cases,
Defects in the muscular part of the septum. Their sizes are small (5-20 mm), and with the contraction of the heart muscle, the lumen of the defect decreases even more, they appear in 2-8% of cases.
The absence of an interventricular septum occurs in 1-2% of cases.

How does a ventricular septal defect manifest in children?

Ventricular septal defect in children is accompanied by the development of compensatory hypertrophy of the ventricular myocardium and pulmonary circulation, the severity of which depends on the age of the child and the size of the defect.

Difficulty in the movement of blood through the small and large circles of blood circulation with a ventricular septal defect in children gives the main clinical picture. Violation of hemodynamics depends on the size and direction of blood flow through the defect, which, in turn, is determined by the size and location of the defect, the vessels of the pulmonary circulation, the gradient of vascular resistance of the pulmonary and systemic circulation, the state of the myocardium and ventricles of the heart. Hemodynamic disorders are not static, but as the child grows and develops, it changes, which leads to changes clinical picture defects, their transformation into other clinical forms.

With a small ventricular septal defect in the fetus (up to 5 mm in size), the discharge of blood through it from the left ventricle to the right is small and does not cause pronounced hemodynamic disturbances. Due to the large capacity of the vessels of the pulmonary circulation, the pressure in the right ventricle does not increase, the additional load falls only on the left ventricle, which is often hypertrophied.

With a ventricular septal defect in children in the redistribution of sizes of 10-20 mm, the discharge through it reaches 70% of the blood that is discharged by the left ventricle. This causes significant volume overloads of the pulmonary circulation, which leads to low overloads of the right ventricle and then to its hypertrophy. First, under the influence of high blood pressure, the arteries of the pulmonary circulation expand, thereby facilitating the work of the right ventricle. The pressure in the vessels of the pulmonary circulation remains normal, however, a pronounced syndrome of a large volume of blood can lead to the development of increased pressure in pulmonary artery, with a large defect, the amount of blood discharge through it depends mainly on the ratio of vascular resistance of the small and large circles of blood circulation.

Systolic pressure in the pulmonary artery with a large ventricular septal defect is maintained by high level. This is due to the fact that pressure is transmitted to the pulmonary artery from the left ventricle (hydrodynamic factor). High pressure in the pulmonary artery leads to congestion and enlargement of the right ventricle. This provokes a large volume of blood discharged through the defect, which ultimately leads to overflow of the venous bed of the pulmonary circulation and causes a volume overload of the left atrium, resulting in an increase in systolic and diastolic pressure in the left ventricle, left atrium, pulmonary veins. With prolonged similar overloads, this leads to hypertrophy (increase in size) of the left ventricle and left atrium. Increased pressure in the pulmonary veins and left atrium, due to the neurohumoral mechanism of load compensation, leads to spasm, and then to sclerosis of the pulmonary arterioles. Children in the first year of life develop heart failure, and more than 50% of children die before the age of one.

Ventricular septal defect in the fetus and its types

An isolated ventricular septal defect in a fetus, depending on its size, the amount of blood shunting, is clinically divided into 2 forms.

first includes small defects of the interventricular septum in the pload, located mainly in the muscular septum, which are not accompanied by severe hemodynamic disturbances (Tolochishov-Roger disease);
to the second group include defects of the interventricular septum in the fetus of a sufficiently large size, located in the membranous part of the septum, leading to severe hemodynamic disturbances.

Clinic of Topochinov-Roger disease. The first, and sometimes the only manifestation of the defect is a systolic murmur in the region of the heart, which appears, as a rule, from the first days of a child's life. Children are growing well, there are no complaints in them. Borders of the heart within age norm. In the III-IV intercostal space to the left of the sternum, systolic trembling is heard in most patients. characteristic symptom malformation is a coarse, very loud systolic murmur that occurs when blood passes through a narrow opening in the septum under high pressure from the left ventricle to the right. Noise occupies, as a rule, the entire systole, often merges with the second tone. Its maximum sound is in the III-IV intercostal space from the sternum, it is well conducted throughout the heart, to the right behind the sternum, heard on the back near the interscapular space, well carried through the bones, transmitted through the air and heard even if you raise the stethoscope above the heart (remote noise ).

In some children, a very gentle systolic murmur is heard, which is better defined in the supine position and is significantly reduced or even completely disappears with exercise. Such a change in noise can be explained by the fact that during exercise, due to the powerful contraction of the muscles of the heart, the hole in the interventricular septum in children is completely closed, and the blood flow through it is completed. There are no signs of heart failure in Tolochinov-Roger disease.

Signs of severe ventricular septal defect

A pronounced defect of the interventricular septum in children manifests itself acutely from the first days after birth. Children are born on time, but in 37-45% there is a moderately pronounced congenital malnutrition, the cause of which is not clear.

The first symptom of defects is systolic murmur, which is heard from the neonatal period. In a number of children, already in the first weeks of life, signs of circulatory insufficiency appear in the form of shortness of breath, which occurs first with anxiety, sucking, and then in a calm state.

During the children often get sick with acute respiratory diseases, pneumonia. More than 2/3 of children lag behind in physical and psychomotor development, 30% develop hypotrophy of the II degree.

The skin is pale. The pulse is rhythmic, tachycardia is often observed. Arterial pressure is not changed. In most children, the central “heart hump” begins to form early, an abnormal pulsation appears above upper region stomach. Systolic trembling is determined in the III-IV intercostal space to the left of the sternum. The borders of the heart are slightly expanded in diameter and upwards. Pathological accent of the II tone in the II intercostal space on the left side of the sternum, which is often combined with its splitting. In all children, a typical murmur of an interventricular defect is heard - a systolic murmur, rough, which occupies the entire systole, with a maximum sound in the III intercostal space to the left of the sternum, is well transmitted to the right behind the sternum in the III-IV intercostal space, to the left auscular zone and to the back, it often "encircling" the chest. In 2/3 of children from the first months of life appear pronounced signs circulatory insufficiency, which first manifests itself in the form of anxiety, difficulty sucking, shortness of breath, tachycardia, is not always interpreted as a manifestation of heart failure, and is often regarded as accompanying illnesses(acute, pneumonia).

Ventricular septal defect in children after a year

Ventricular septal defect in children older than a year goes into decay clinical signs at the expense intensive growth and anatomical development of the baby's body. At the age of 1-2 years, the phase of relative compensation begins, which is characterized by the absence of shortness of breath, tachycardia. Children become more active, begin to put on weight better, grow better, and many of them catch up with their peers in their development, they suffer from concomitant diseases much less compared to the first year of life. An objective examination in 2/3 of children shows a centrally located "heart hump", systolic trembling is determined in the III-IV intercostal space to the left of the sternum.

The borders of the heart are slightly expanded in diameter and upwards. Apical push of medium strength and reinforced. On auscultation, there is a splitting of the II tone in the II intercostal space on the left side of the sternum and there may be its accentuation. A rough systolic murmur is heard along the left edge of the sternum with a maximum sound in the third intercostal space on the left and a large area of distribution.

In some children, diastolic murmurs of relative insufficiency of the pulmonary valve are also heard, arising from increased pulmonary circulation in the pulmonary artery and an increase in pulmonary hypertension(Graham-Still noise) or relative mitral stenosis, which occurs with a large cavity of the left atrium due to a large arteriovenous discharge of blood through the defect (Flint noise). Graham-Still's murmur is auscultated in the 2-3 intercostal space to the left of the sternum and is well conducted upward to the base of the heart. Flint's murmur is better defined at the Botkin point and conducted to the apex of the heart.

Depending on the degree of hemodynamic disturbance, there is a very large variability in the clinical course of ventricular septal defect in children, which requires a different therapeutic and surgical approach to such children.

The diagnosis of ventricular septal defect in children is based on the results of ECG, Echo-KG, catheterization of cavities.

The differential diagnosis is carried out with congenital heart defects that occur with an overload of the pulmonary circulation, as well as with acquired problems - insufficiency mitral valve. Diagnosis is difficult when a ventricular septal defect is combined with other congenital heart defects, especially at an early age.

Complications and prognosis of ventricular septal defect in children

In children of the first year of life, frequent complications are malnutrition, circulatory failure, recurrent congestive bacterial pneumonia. In older children - bacterial endocarditis. Often there are embolisms of the vessels of the pulmonary circulation, leading to the development of heart attacks and lung abscesses. In 80-90% of children with age, the defect is complicated by the development of pulmonary hypertension.

Ventricular septal defect in newborns Ventricular septal defect (VSD)- heart disease, in which holes form in the septum between the right and left ventricles.

Among congenital malformations, this is the most common, its share is 20-30%. It is equally common in girls and boys.

Features of blood circulation in ventricular septal defect in newborns

The left ventricle is much more powerful than the right ventricle, because it needs to provide blood to the whole body, and the right one only pumps blood to the lungs. Therefore, the pressure in the left ventricle can reach up to 120 mm Hg. Art., and in the right about 30 mm Hg. Art. Therefore, due to the difference in pressure, if the structure of the heart is broken and there is a message between the ventricles, then part of the blood from the left half of the heart flows into the right. This leads to stretching of the right ventricle. The vessels of the lungs overflow and stretch. At this stage, it is imperative to perform an operation and separate the two ventricles.

Then there comes a moment when the vessels of the lungs contract reflexively. They are sclerosed and the lumen narrows in them. The pressure in the vessels and in the right ventricle increases several times and becomes higher than in the left. Now the blood begins to overflow from the right half of the heart to the left. At this stage of the disease, only a heart and lung transplant can help a person.

Causes

This pathology is formed even before the birth of the child due to a violation of the development of the heart.

The following reasons contribute to its appearance:

Infectious diseases of the mother in the first three months of pregnancy: measles, rubella, chickenpox.
Use of alcohol and drugs.
Some medicines: warfarin, preparations containing lithium.
hereditary predisposition: heart disease is inherited in 3-5% of cases.

In the interventricular septum, there are different types defects:

Multiple small holes - the most mild form which has little effect on health.
Multiple large holes. The partition resembles Swiss cheese - the heaviest form.
Holes in the lower part of the septum, consisting of muscles. They most often heal on their own during the first year of a child's life. This is facilitated by the development of the muscular wall of the heart.
Holes under the aorta.
Defects in the middle part of the septum.

Symptoms and external signs

The manifestations of VSD depend on the size of the defect and the stage of development of the disease.

The size of the defect is compared with the lumen of the aorta.

Small defects - less than 1/4 of the diameter of the aorta or less than 1 cm. Symptoms can appear as early as 6 months and into adulthood.
Moderate defects are less than 1/2 of the aortic diameter. The disease manifests itself at 1-3 months of life.
Large defects - the diameter is equal to the diameter of the aorta. The disease manifests itself from the first days.

Stages of changes in the vessels of the lungs (stages of pulmonary hypertension).

The first stage is the stagnation of blood in the vessels. Accumulation of fluid in lung tissue, frequent bronchitis and pneumonia.
The second stage is vasospasm. The phase of temporary improvement, the vessels narrow, but the pressure in them increases by 30 to 70 mm Hg. Art. Counts the best period for the operation.
The third stage is sclerosis of the vessels. It develops if the operation was not performed on time. Pressure in the right ventricle and pulmonary vessels from 70 to 120 mm Hg. Art.

Child's well-being

With a large ventricular septal defect in newborns, the state of health worsens from the first days.

bluish skin tone at birth;
the baby gets tired quickly and cannot breastfeed normally;
restlessness and tearfulness due to hunger;
sleep disorders;
poor weight gain
early pneumonia, which are difficult to treat.

Objective signs

elevation chest in the area of \u200b\u200bthe heart - a heart hump;
during the contraction of the ventricles (systole), trembling is felt, which creates a flow of blood, passing through the hole in the interventricular septum;
when listening with a stethoscope, a noise is heard, which is caused by insufficiency of the valves of the pulmonary artery;
whistling wheezing and hard breathing are heard in the lungs, associated with the release of fluid from the vessels into the lung tissue;
when tapping, an increase in the size of the heart is revealed;
an increase in the liver and spleen is associated with stagnation of blood in these organs;
in the third stage, the appearance of a bluish tint of the skin (cyanosis) is characteristic. First on the fingers and around the mouth, and then all over the body. This symptom appears due to the fact that the blood is not sufficiently enriched with oxygen in the lungs and the cells of the body experience oxygen starvation;
in the third stage, the chest is swollen, has the appearance of a barrel.

Diagnostics

To diagnose a ventricular septal defect in newborns, radiography, electrocardiography, and two-dimensional Doppler echocardiography are used. All of them are painless and the child tolerates them well.

Radiography

Painless and informative examination of the chest using x-rays. The stream of rays passes through the human body and forms an image on a special sensitive film. The picture allows you to assess the condition of the heart, blood vessels and lungs.

With VSD in newborns, the following are detected:

an increase in the boundaries of the heart, especially its right side;
enlargement of the pulmonary artery, which carries blood from the heart to the lungs;
overflow and spasm of the vessels of the lungs;
fluid in the lungs or pulmonary edema, shown as a darkening on the picture.

Electrocardiography

This study is based on the registration of electrical potentials that occur during the work of the heart. They are written in the form of a curved line on a paper tape. According to the height and shape of the teeth, the doctor assesses the condition of the heart. The cardiogram may be normal, but more often there is an overload of the right ventricle.

Doppler ultrasound of the heart

Examination of the heart with ultrasound. Based on the reflected ultrasound wave, a real-time image of the heart is created. This type of ultrasound allows you to identify the features of the movement of blood through the defect.

With VSD are visible:

hole in the septum between the ventricles;
its size and location;
the red color reflects the flow of blood that moves towards the sensor, and the blue color reflects the blood that flows in the opposite direction. The lighter the shade, the higher the speed of blood movement and the pressure in the ventricles.

Instrumental examination data in newborns

X-ray examination chest

In the first stage:
- enlarged heart, it is round, without narrowing in the middle;
- the vessels of the lungs look fuzzy and blurry;
- there may be signs of pulmonary edema - darkening over the entire surface.
In transitional stage:
- heart has normal sizes;
- vessels look normal.
The third stage is sclerotic:
- the heart is enlarged, especially with right side;
- enlarged pulmonary artery;
- only large vessels of the lungs are visible, and small ones are invisible due to spasm;
- the ribs are horizontal;
- diaphragm is down.

Electrocardiography

The first stage may not manifest itself in any changes, or it appears:
- overload of the right ventricle;
- enlargement of the right ventricle.
Second and third stage:
- overload and enlargement of the left atrium and ventricle.
- violations of the passage of biocurrents through the tissue of the heart.

2D doppler echocardiography - one of the types of ultrasound of the heart

reveals the location of the defect in the septum;
defect size;
direction of blood flow from one ventricle to another;
pressure in the ventricles of the first stage is not more than 30 mm Hg. Art., in the second stage - from 30 to 70 mm Hg. Art., and in the third - more than 70 mm Hg. Art.

Treatment

Medical treatment with a ventricular septal defect in newborns and older children, it is aimed at normalizing the outflow of blood from the lungs, reducing edema in them (accumulation of fluid in the pulmonary alveoli), and reducing the amount of blood circulating in the body.

Diuretics: Furosemide (Lasix)

They help to reduce the volume of blood in the vessels and get rid of pulmonary edema. The drug is prescribed to children at the rate of 2-5 mg / kg. It should be taken once a day, preferably before lunch.

Cardiometabolic agents: Phosphaden, Cocarboxylase, Cardonat

They improve the nutrition of the heart muscle, fight oxygen starvation of cells and improve the metabolism in the body. If the doctor prescribed Cardonat to a child, then the capsule must be opened and its contents dissolved in sweetened water (50-100 ml). Take 1 time per day after meals. The course is from 3 weeks to 3 months.

Cardiac glycosides: Strofantin, Digoxin

They help the heart contract more powerfully and pump blood more efficiently through the vessels. A 0.05% solution of strophanthin is prescribed at the rate of 0.01 mg / kg of body weight or digoxin 0.03 mg / kg. In this dose, the drug is administered for the first 3 days. Then its amount is reduced by 4-5 times - a maintenance dose.

To relieve bronchospasm: Eufillin

It is prescribed for pulmonary edema and bronchospasm, when it is difficult for a child to breathe. A solution of aminophylline 2% is administered intravenously or in the form of microclysters, 1 ml per year of life.

Taking medication will help reduce the symptoms of the disease and buy time to give the defect a chance to close on its own.

Types of operations for ventricular septal defect

At what age should the operation be done?

If the child's condition allows, it is advisable to perform the operation between 1 and 2.5 years. During this period, the baby is already strong enough and will best tolerate such an intervention. In addition, he will soon forget the period of treatment and the child will not have a psychological trauma.

What are the indications for surgery?

The presence of a hole in the interventricular septum.
Enlargement of the right side of the heart.

Contraindications for the operation

The third degree of development of the disease, irreparable changes in the vessels of the lungs.
Blood poisoning - sepsis.

Operation types

Pulmonary artery narrowing surgery for VSD

The surgeon uses a special braid or thick silk thread to tie up the artery that carries blood from the heart to the lungs so that less blood flows into them. This operation is a preparatory stage before the complete closure of the defect.

Indications for surgery

Increased pressure in the vessels of the lungs.
Return of blood from the left ventricle to the right.
The child is too weak to undergo surgery to repair a defect in the interventricular septum.

Advantages of the operation

Reduces blood flow to the lungs and reduces pressure in them.
The child becomes easier to breathe.
It makes it possible to postpone the operation to eliminate the defect for 6 months and allow the child to get stronger.

Disadvantages of the operation

The child and parents will have to undergo 2 operations.
The load on the right ventricle increases, as a result it stretches and increases.

Operation on open heart.

This type of treatment requires opening the chest. An incision is made along the sternum, the heart is disconnected from the vessels. For a while, it is replaced by an artificial circulation system. The surgeon makes an incision in the right ventricle or atrium. Depending on the size of the defect, the doctor chooses one of the treatment options.

Sewing up the defect. If its size does not exceed 1 cm and it is located at a distance from important vessels.
The doctor places an airtight patch on the septum. It is cut to fit the hole and sterilized. Payments are of two types:
- from a piece outer shell heart (pericardium);
- from artificial material.

After that, the tightness of the patch is checked, blood circulation is restored and a suture is applied to the wound.

Indications for open surgery

It is impossible to improve the condition of the child with the help of medicines.
Changes in the vessels of the lungs.
overload of the right ventricle.

Advantages of the operation

Allows you to simultaneously remove blood clots that could form in the heart.
Allows you to eliminate other pathologies of the heart and its valves.
It makes it possible to correct defects at any location.
Available for children of all ages.
Allows you to get rid of heart problems once and for all.

Disadvantages of open surgery

It is quite traumatic for a child, lasts up to 6 hours.
Requires a long recovery period.

Low-traumatic surgery with an occluder

The essence of the operation is that the defect in the interventricular septum is closed using a special device that is inserted into the heart through large vessels. The device resembles interconnected buttons. It is installed in the hole and blocks the flow of blood through it. The procedure is carried out under X-ray control.

Indications for closing the defect with an occluder

The defect is located at least 3 mm from the edge of the interventricular septum.
Signs of stagnation of blood in the vessels of the lungs.
Return of blood from the left ventricle to the right.
Age over 1 year and weight over 10 kg.

Advantages of the operation

Less traumatic for the child - there is no need to cut the chest.
Recovery takes 3-5 days.
Immediately after the operation, improvement occurs and blood circulation in the lungs normalizes.

Disadvantages of the operation

It is used only to close defects of small size, which are located in the central part of the septum.
Closure cannot be performed if the vessels are narrow, there is a thrombus in the heart, valve problems or persistent disorders heart rate.
There is no way to correct other heart disorders.

Treatment of ventricular septal defect

the only effective method treatment of medium and large ventricular septal defects is open heart surgery. Surgeons of large cardiological centers perform this operation quite often and have extensive experience in this matter. Therefore, you can be sure of a successful outcome.

Indications for surgery

defect in the interventricular septum;
reflux of blood from the left ventricle to the right;
signs of enlargement of the right ventricle;
heart failure - the heart cannot cope with the function of the pump and poorly supplies blood to the organs;
signs of circulatory disorders in the lungs: shortness of breath, moist rales, pulmonary edema;
ineffectiveness of medical treatment.

Contraindications

reflux of blood from the right ventricle to the left;
an increase in pressure in the vessels of the lungs by 4 times and sclerosis of small arteries;
severe exhaustion of the child;
severe concomitant diseases of the liver and kidneys.

At what age is it better to have surgery?

The urgency of the operation depends on the size of the defect.

Minor defects, less than 1 cm - the operation can be postponed up to 1 year, and if there are no circulatory disorders, then up to 5 years.
Moderate defects, less than 1/2 of the aortic diameter. It is necessary to operate the child in the first 6 months of life.
Large defects, the diameter is equal to the diameter of the aorta. An urgent operation is needed before irreversible changes in the lungs and heart develop.

Operation steps

Remember, a child's body is better equipped to fight for survival and is able to recover much faster than an adult. Therefore, your baby will quickly get back on his feet, especially if you take proper care of him.

Child care after heart surgery

You and the baby will be discharged home when the doctors make sure that the child is on the mend.

At this time, it is advisable to carry the child more in her arms - this is called position massage. It develops, soothes and improves blood circulation. Do not be afraid to accustom a child to hands - health is more expensive than pedagogical principles.

Protect your child from infections: Avoid going to crowded places. Do not hesitate to take him away if a person with signs of illness appears nearby, take care of the baby from hypothermia. If there is a need to visit the clinic, then lubricate the child's nose Oxolinic ointment or use sprays for the prevention of Euphorbium Compositum, Nazaval.

Scar care. The wound will heal in about 4 weeks. At this time, lubricate the seam with tincture of calendula and protect from sunlight. To avoid scar formation, there are special creams - Contractubex, Solaris. Ask your doctor which one is right for your child.

After the stitches are completely healed, you can bathe the child in the bath. It is better if the first time the water is boiled with the addition of potassium permanganate. The water temperature is 37°C and the bathing time should be kept to a minimum. For an older child, a shower is ideal.

Sternum- this is a bone, it will heal for about 2 months. During this period, you can not pull the child by the arms, raise the armpits, lay it on the stomach, give him a massage, and in general, physical exertion should be avoided in order to prevent deformation of the chest.

After fusion of the sternum, there is no particular reason to restrict the child in physical development. But still try to avoid the first six months serious injury, so do not let your child ride a scooter, bike or rollerblade.
Taking medication prescribed by a doctor: Veroshpiron, Digoxin, Aspirin. They will help to avoid the accumulation of fluid in the lungs, improve heart function and prevent blood clots. In the future, they will be canceled, and your baby will live like a normal child.

The first six months you will need take the temperature morning and evening and record the results in a special diary.

Tell your doctor about these symptoms:

temperature rise above 38°C;
the seam is swollen and fluid will begin to flow out of it;
chest pain;
pale or bluish skin tone;
swelling of the face, around the eyes, or other swelling;
shortness of breath, fatigue, refusal to play;
dizziness, loss of consciousness.

Communication with doctors

Urine analysis for the first month will have to be taken every ten days. And the next six months 2 times a month.
An electrocardiogram, phonoradiogram, echocardiography will need to be done once every three months for the first six months. Thereafter twice a year.
After some time, it is advisable to go with the child to a special sanatorium for 1-3 months.
Vaccinations will have to be postponed for six months.
In total, the child will remain registered with cardiologists for 5 years.

Nutrition

A complete and high-calorie diet should help the child recover quickly after surgery and gain weight.
The best choice for children under one year old is breast milk. It is necessary to introduce complementary foods in a timely manner: fruits, vegetables, meat and fish.

Older children eat according to their age. The menu should include:

Fresh fruits and juices.
Fresh and cooked vegetables.
Meat dishes, boiled, baked or stewed.
Dairy products: milk, cottage cheese, yogurt, sour cream. Curd casserole with dried fruits will be especially useful.
Eggs boiled or scrambled.
Various soups and cereal dishes.

Restrict:

margarine;
fatty pork;
duck and goose meat;
chocolate, strong tea.

To summarize: although the operation is considered quite traumatic and causes fear among parents and the child, but only it can give a chance for healthy life. The percentage of adverse outcomes is very low. Doctors can restore health to absolutely everyone, from premature babies weighing about a kilogram to adults who had this pathology previously hidden.

Ventricular septal defect (VSD) is a congenital heart disease characterized by a defect in the muscular septum between the right and left ventricles of the heart. VSD is the most common congenital heart disease in newborns, accounting for approximately 30-40% of all congenital heart defects. This defect was first described in 1874 by P. F. Tolochinov and in 1879 by H. L. Roger.

According to the anatomical division of the interventricular septum into 3 parts (upper - membranous, or membranous, middle - muscular, lower - trabecular), they also give names to defects in the interventricular septum. In approximately 85% of cases, the VSD is located in the so-called membranous part of it, that is, immediately under the right coronary and non-coronary cusps of the aortic valve (when viewed from the left ventricle of the heart) and at the point of transition of the anterior cusp of the tricuspid valve into its septal cusp (when viewed from side of the right ventricle). In 2% of cases, the defect is located in the muscular part of the septum, and there may be several pathological holes. A combination of muscular and other VSD localizations is quite rare.

The size of ventricular septal defects can range from 1 mm to 3.0 cm or even more. Depending on the size, large defects are distinguished, the size of which is similar to or greater than the diameter of the aorta, medium defects, having a diameter of ¼ to ½ of the aorta diameter, and small defects. Defects of the membranous part, as a rule, have a round or oval shape and reach 3 cm, defects in the muscular part of the interventricular septum are most often round and small.

Quite often, in about 2/3 of cases, VSD can be combined with another concomitant anomaly: atrial septal defect (20%), open ductus arteriosus(20%), coarctation of the aorta (12%), congenital mitral valve insufficiency (2%), stenosis of the aorta (5%) and pulmonary artery.

Schematic representation of a ventricular septal defect.

Causes of VSD

Ventricular septal defects have been found to occur during the first three months of pregnancy. The interventricular septum of the fetus is formed from three components, which during this period must be compared and adequately connected to each other. Violation of this process leads to the fact that a defect remains in the interventricular septum.

The mechanism of development of hemodynamic disorders (blood movement)

In a fetus located in the mother's uterus, blood circulation is carried out in the so-called placental circle (placental circulation) and has its own characteristics. However, soon after birth, the newborn establishes normal blood flow in the systemic and pulmonary circulation, which is accompanied by a significant difference between the blood pressure in the left (higher pressure) and right (lower pressure) ventricles. At the same time, the existing VSD leads to the fact that blood from the left ventricle is pumped not only into the aorta (where it should normally flow), but also through the VSD into the right ventricle, which should not be normal. Thus, with each heartbeat (systole) there is a pathological discharge of blood from the left ventricle of the heart to the right. This leads to an increase in the load on the right ventricle of the heart, as it produces extra work pumping additional blood back to the lungs and left side of the heart.

The volume of this pathological discharge depends on the size and location of the VSD: in the case of a small defect, the latter practically does not affect the work of the heart. On the opposite side of the defect in the wall of the right ventricle, and in some cases on the tricuspid valve, a cicatricial thickening may develop, which is the result of a reaction to injury from an abnormal ejection of blood spurting through the defect.

In addition, due to pathological discharge, an additional volume of blood entering the vessels of the lungs (pulmonary circulation) leads to the formation of pulmonary hypertension (increased blood pressure in the vessels of the pulmonary circulation). Over time, compensatory mechanisms are activated in the body: there is an increase muscle mass the ventricles of the heart, the gradual adaptation of the vessels of the lungs, which first take in the incoming excess volume of blood, and then pathologically change - a thickening of the walls of the arteries and arterioles is formed, which makes them less elastic and more dense. An increase in blood pressure in the right ventricle and pulmonary arteries occurs until, finally, pressure equalization occurs in the right and left ventricles in all phases cardiac cycle, after which the pathological discharge from the left ventricle of the heart to the right one stops. If, over time, the blood pressure in the right ventricle is higher than in the left, there is a so-called "reverse reset", in which deoxygenated blood from the right ventricle of the heart through the same VSD enters the left ventricle.

VSD symptoms

The timing of the appearance of the first signs of VSD depends on the size of the defect itself, as well as the magnitude and direction of the pathological discharge of blood.

Small defects V lower sections interventricular septum in the vast majority of cases do not have a significant impact on the development of children. These children are doing well. Already in the first few days after birth appears moderate intensity heart murmur rough, scraping timbre, which the doctor listens to in systole (during heart contraction). This noise is better heard in the fourth-fifth intercostal space and is not conducted to other places, its intensity in the standing position may decrease. Since this noise is often the only manifestation of a small VSD that does not have a significant impact on the well-being and development of the child, this situation is medical literature was called "much ado about nothing".

In some cases, in the third or fourth intercostal space along the left edge of the sternum, you can feel a trembling at the moment of heart contraction - systolic trembling, or systolic "cat's purr".

At large defects membranous (membranous) section of the interventricular septum, the symptoms of this congenital heart disease, as a rule, do not appear immediately after the birth of the child, but after 12 months. Parents begin to notice difficulties in feeding the child: he has shortness of breath, he is forced to pause and breathe, because of which he can remain hungry, anxiety appears.

born with normal weight, such children begin to lag behind in their physical development, which is explained by malnutrition and a decrease in the volume of blood circulating in the systemic circulation (due to pathological discharge into the right ventricle of the heart). Severe sweating, pallor, marbling of the skin, slight cyanosis of the final parts of the arms and legs (peripheral cyanosis) appear.

Characterized by rapid breathing with the involvement of the auxiliary respiratory muscles, paroxysmal cough that occurs when changing body position. Recurrent pneumonias (pneumonia) develop and are difficult to treat. To the left of the sternum there is a deformation of the chest - a heart hump is formed. The apex beat shifts to left side and down. Systolic trembling is felt in the third or fourth intercostal space at the left edge of the sternum. Auscultation (listening) of the heart is determined by a rough systolic murmur in the third or fourth intercostal space. In older children age group the main clinical signs of the defect persist, they complain of pain in the region of the heart and palpitations, the children continue to lag behind in their physical development. With age, the well-being and condition of many children improves.

Complications of VSD:

Aortic regurgitation observed among patients with VSD in about 5% of cases. It develops if the defect is located in such a way that it also causes sagging of one of the aortic valve cusps, which leads to a combination of this defect with aortic valve insufficiency, the addition of which significantly complicates the course of the disease due to a significant increase in the load on the left ventricle of the heart. Among clinical manifestations the expressed short wind prevails, the acute left ventricular insufficiency sometimes develops. During auscultation of the heart, not only the above-described systolic murmur is heard, but also diastolic (in the phase of cardiac relaxation) murmur at the left edge of the sternum.

Infundibular stenosis observed among patients with VSD also in about 5% of cases. It develops if the defect is located in the back of the interventricular septum under the so-called septal leaflet of the tricuspid (tricuspid) valve below the supraventricular crest, which causes the passage through the defect a large number blood and traumatization of the supraventricular crest, which consequently increases in size and scars. As a result, there is a narrowing of the infundibular section of the right ventricle and the formation of subvalvular pulmonary artery stenosis. This leads to a decrease in the pathological discharge through the VSD from the left ventricle of the heart to the right one and unloading of the pulmonary circulation, however, there is also a sharp increase in the load on the right ventricle. The blood pressure in the right ventricle begins to increase significantly, which gradually leads to an abnormal shunt of blood from the right ventricle to the left. With severe infundibular stenosis, the patient develops cyanosis (cyanosis of the skin).

Infectious (bacterial) endocarditis- damage to the endocardium (the inner lining of the heart) and heart valves caused by infection (most often bacterial). In patients with VSD, the risk of developing infective endocarditis is approximately 0.2% per year. It usually occurs in older children and adults; more often with small sizes of the VSD, which is due to endocardial injury with high speed jets of pathological discharge of blood. Endocarditis can be caused dental procedures, purulent skin lesions. Inflammation first occurs in the wall of the right ventricle, located on the opposite side of the defect or along the edges of the defect itself, and then the aortic and tricuspid valves spread.

Pulmonary hypertension – high blood pressure blood in the vessels of the pulmonary circulation. In the case of this congenital heart disease, it develops as a result of an additional volume of blood entering the vessels of the lungs, due to its pathological discharge through the VSD from the left ventricle of the heart to the right. Over time, there is an aggravation of pulmonary hypertension due to the development of compensatory mechanisms - the formation of thickening of the walls of arteries and arterioles.

Eisenmenger syndrome- subaortic location of the ventricular septal defect in combination with sclerotic changes in the pulmonary vessels, expansion of the pulmonary artery trunk and an increase in muscle mass and size (hypertrophy) of the predominantly right ventricle of the heart.

Recurring pneumonia- due to stagnation of blood in the pulmonary circulation.
Heart rhythm disturbances.

Heart failure.

Thromboembolism- acute blockage of a blood vessel by a thrombus that has detached from the place of its formation on the wall of the heart and entered the circulating blood.

Instrumental diagnosis of VSD

1. Electrocardiography (ECG): In the case of a small VSD, significant changes in the electrocardiogram may not be detected. As a rule, the normal position of the electrical axis of the heart is characteristic, but in some cases it may deviate to the left or right. If the defect is large, it is reflected more significantly in electrocardiography. With a pronounced pathological discharge of blood through a defect from the left ventricle of the heart to the right without pulmonary hypertension, the electrocardiogram reveals signs of overload and an increase in the muscle mass of the left ventricle. In the case of the development of significant pulmonary hypertension, symptoms of overload of the right ventricle of the heart and the right atrium appear. Heart rhythm disturbances are rare, as a rule, in adult patients in the form of extrasystole, atrial fibrillation.

2. Phonocardiography(recording of vibrations and sound signals emitted during the activity of the heart and blood vessels) allows instrumental recording of pathological murmurs and altered heart sounds caused by the presence of VSD.

3. echocardiography(ultrasound examination of the heart) allows not only to detect a direct sign birth defect– interruption of the echo signal in the interventricular septum, but also accurately determine the location, number and size of defects, as well as determine the presence indirect signs this defect (an increase in the size of the ventricles of the heart and the left atrium, an increase in the wall thickness of the right ventricle, and others). Doppler echocardiography reveals another direct sign of malformation - abnormal blood flow through the VSD into systole. In addition, it is possible to assess the blood pressure in the pulmonary artery, the magnitude and direction of the pathological discharge of blood.

4.Chest X-ray(heart and lungs). With small sizes of VSD, pathological changes are not determined. With a significant size of the defect with a pronounced discharge of blood from the left ventricle of the heart to the right, an increase in the size of the left ventricle and left atrium, and then the right ventricle, and an increase in the vascular pattern of the lungs are determined. As pulmonary hypertension develops, the expansion of the roots of the lungs and the bulging of the arch of the pulmonary artery are determined.

5. Cardiac catheterization is performed to measure the pressure in the pulmonary artery and in the right ventricle, as well as to determine the level of blood oxygen saturation. More high degree oxygen saturation (oxygenation) in the right ventricle than in the right atrium.

6. Angiocardiography- the introduction of a contrast agent into the cavity of the heart through special catheters. With the introduction of contrast into the right ventricle or pulmonary artery, their repeated contrasting is observed, which is explained by the return of contrast to the right ventricle with pathological discharge of blood from the left ventricle through the VSD after passing through the pulmonary circulation. With the introduction of water-soluble contrast into the left ventricle, the flow of contrast from the left ventricle of the heart to the right through the VSD is determined.

VSD treatment

With a small VSD, no signs of pulmonary hypertension and heart failure, normal physical development, in the hope of spontaneous closure of the defect, it is possible to refrain from surgical intervention.

In children of early preschool age, indications for surgical intervention are early progression of pulmonary hypertension, persistent heart failure, recurrent pneumonia, marked lag in physical development, and underweight.

Indications for surgical treatment in adults and children over the age of 3 years are: fatigue, frequent acute respiratory viral infections leading to the development of pneumonia, heart failure and a typical clinical picture of the defect with a pathological discharge of more than 40%.

Surgical intervention is reduced to plastic VSD. The operation is performed using a heart-lung machine. With a defect diameter of up to 5 mm, it is closed by suturing with U-shaped sutures. With a defect diameter of more than 5 mm, it is closed with a patch made of synthetic or specially processed biological material, which in a short time is covered with its own tissues.

In cases where an open radical operation is not immediately possible due to the high risk of surgical intervention using cardiopulmonary bypass in children in the first months of life with large VSDs, underweight, with intractable medical correction severe heart failure, surgical treatment is carried out in two stages. First, a special cuff is applied to the pulmonary artery above its valves, which increases the resistance to ejection from the right ventricle, thereby leading to equalization of blood pressure in the right and left ventricles of the heart, which helps to reduce the volume of pathological discharge through the VSD. A few months later, the second stage is carried out: removal of the previously applied cuff from the pulmonary artery and closure of the VSD.

Prognosis for VSD

The duration and quality of life with a ventricular septal defect depend on the size of the defect, the condition of the vessels of the pulmonary circulation, and the severity of developing heart failure.

Small ventricular septal defects do not significantly affect the life expectancy of patients, however, they increase the risk of developing infective endocarditis by up to 1-2%. If a small defect is located in the muscular area of the interventricular septum, it can close on its own before the age of 4 years in 30-50% of such patients.

In the case of a medium-sized defect, heart failure develops already in early childhood. Over time, the condition may improve, due to some decrease in the size of the defect, and in 14% of such patients, an independent closure of the defect is observed. At an older age, pulmonary hypertension develops.

In the case of a large VSD, the prognosis is serious. In such children, severe heart failure develops at an early age, and pneumonia often occurs and recurs. Approximately 10-15% of such patients develop Eisenmenger's syndrome. Most of patients with large ventricular septal defects without surgery die already in childhood or adolescence from progressive heart failure more often in combination with pneumonia or infective endocarditis, pulmonary thrombosis or rupture of its aneurysm, paradoxical embolism in the brain vessels.

The average life expectancy of patients without surgery in the natural course of VSD (without treatment) is approximately 23-27 years, and in patients with a small defect - up to 60 years.

Surgeon Kletkin M.E.

In children after birth, a serious pathology of the heart can be detected - a malformation of its development. These include ventricular septal defect - a diagnosis that requires confirmation and early treatment. But in many situations, the problem is solved by itself, since there is a high probability of closing the defect without surgery. What threatens the pathology, how it manifests itself and when it is necessary to urgently conduct an examination - we will consider in the article.

Features of the disease

The interventricular septum forms the inner wall of the ventricles of the heart and takes part in the contraction and relaxation of the organ. In the fetus, the septum is formed by 4-5 weeks of development, but sometimes it is not completely tightened. VSD (ventricular septal defect) is a heart disease that has been present in a person since birth, which occurs more often than other defects and often develops in combination with other diseases of the heart and blood vessels (coarctation of the aorta, mitral valve insufficiency, pulmonary artery stenosis, etc.).

At birth defect heart (CHP) of this type between the right and left ventricles there is a defect - an open hole. Among all heart defects, pathology is, according to various sources, 30-42%, while in boys and girls it is diagnosed with equal frequency.

There are several classifications of VSD. According to the type of localization, in accordance with the location on a particular section of the interventricular septum, VSD happens:

defect of the membranous part (high VSD);
muscle defect;
supracrestal defect.

The vast majority of VSDs are perimembranous (they are located at the top of the interventricular septum, directly below the aortic valve and the septal leaflet of the cardiac tricuspid valve), and no more than 20% fall on the muscular and epicrestal. Among perimembranous defects, subaortic and subtricuspid defects are distinguished.

Defects are also classified by size into medium, small, large, for which they are compared with the aortic diameter, indicating the size as ¼, ½ of the caliber of the aorta, etc. Usually the defects are 1mm. - 3 cm or more, their shape is round, oval, occasionally slit-like. If the VSD in a newborn is small, it is called Tolochinov-Roger disease. When a minor defect causes no symptoms, there is a high chance that it will close on its own. On the contrary, if the child has several minor defects, surgical treatment he needs as soon as possible in connection with the unfavorable independent prognosis of the disease.

If a child has a violation of the interventricular septum, this may adversely affect hemodynamics due to a change in the difference in pressure in the right and left ventricles (normally, the left ventricle has 5 times more high pressure than the right one during the systole period). With VSD, there is a left-right shunt of blood, while the volume of blood will directly depend on the size of the defect.

Small defects, as already noted, have almost no effect on hemodynamics, so the patient's condition remains normal. With a significant volume of blood that returns to the left side of the heart, there is an overload of the ventricles. With a severe defect of the interventricular septum, pulmonary hypertension develops.

Causes of pathology

In some cases, there is a connection between the occurrence of pathology in a child, when it has already taken place in the next of kin. Therefore, some experts note the possibility of hereditary transmission of VSD, although such cases account for no more than 4% of the total. In addition, the causes of the disease may be due to gene mutations, and in such a situation, in addition to heart disease, the baby has other abnormalities - Down's disease, anomalies in the structure of the kidneys, large vessels, etc.

For the most part, VSD appears at the stage of embryogenesis, when during the laying of the organs of the fetus, any factors have a teratogenic effect and lead to the appearance of a defect. Such consequences can be observed due to the influence in the first trimester of the following factors:

infections transferred during pregnancy, for example, influenza, rubella, herpes;
taking certain medications, alcohol, drugs;
adherence by the mother to a strict diet with a lack of the necessary vitamins;
late pregnancy (after 40 years);
early toxicosis and frequent threats of miscarriage;
the presence of severe somatic diseases in the mother - diabetes, heart failure, endocrine pathologies etc.;
undergoing an X-ray examination.

Occasionally, an acquired VSD appears in adults. An incomplete septum in the ventricle of the heart may remain after a myocardial infarction.

Symptoms of the disease

The symptom complex of the disease, as well as the age at which the first clinical manifestations appear, directly depends on the size of the defect. The symptoms of small and large defects vary greatly, since the amount of pathological blood shedding is not the same. Small VSDs (up to 1 cm in diameter) may not at all affect the well-being of a child who grows and develops along with peers. However, when listening to the heart, the doctor determines heart murmurs - low, rough, scraping during systole (heart contraction).

When the child is standing, the noise becomes somewhat quieter due to compression of the defect by the heart muscle, sometimes it is supplemented by a slight trembling, vibration of the left edge of the sternum at the time of heart contraction. Other clinical signs and objective data may not be at all. Medium defects can be expressed by such symptoms:

shortness of breath on exertion;
slightly increased fatigue of the child;
slight protrusion of the chest in the form of a dome (the so-called "heart hump");
marbling of the skin of the arms, legs, chest part of the body, which does not disappear with age;
rough systolic murmur already from the first week of a child's life, which is clearly heard in the region of the heart.

Large defects of the perimembranous type (other types of defects are usually small) usually make themselves felt immediately after birth, or within a few weeks or months. Symptoms may be as follows:

difficulty feeding due to shortness of breath;
anxiety, frequent capriciousness of the baby;
hyperhidrosis in combination with pallor, cyanosis of the skin;
marble pattern on the skin; Also read about marble skin color in adults
cold hands and feet;
lag in physical development against the background of a decrease in the amount of circulating blood in the systemic circulation;
low body weight up to severe underweight and dystrophy;
often - quickening of breathing;
shortness of breath when lying down;
marble-colored skin in adults, coughing attacks, especially when changing body position;
chest deformity;
systolic vibration at the left edge of the sternum in the area of 3-4 intercostal space;
coarse systolic murmurs in the same area;
moist rales at the bottom of the lungs;
enlargement of the liver, spleen.

In children with large ventricular septal defects, clinical improvement is still possible if subpulmonary (infundibular) stenosis develops by the age of 1-2 years, but such an improvement is only temporary and masks the development of complications. For the most part, symptoms increase with age. Often, hypertrophy of the upper basal part of the interventricular septum, or its other parts, develops rapidly. On the part of the lungs, recurrent pneumonias are observed, which are difficult to cure. Older children (3-4 years old) often pay attention to chest pain on the left, increased heart rate. There may be bleeding from the nose, fainting, cyanosis of the fingers, expansion and flattening of the phalanges. Up to ¼ of children must be urgently operated on at an early age due to the high risk of death.

In adults who develop acquired VSD after myocardial infarction, signs of heart failure come to the fore. These include pain in the heart during exercise and at rest, shortness of breath, heaviness and pressure in the chest, cough, arrhythmia. Often there are attacks of angina pectoris, during which dyskinesia of the interventricular septum develops with a shift of the right ventricle in the direction of the sternum. The disease requires emergency treatment, since only 7% of patients remain alive without surgery per year. Unfortunately, about 15-30% of patients die during the operation to eliminate postinfarction VSD.

Possible Complications

Small defects can close with age and, as a rule, do not lead to the development of certain complications. However, if there is communication between the ventricles of the heart during life, there is a risk of infective endocarditis - bacterial infection inner lining of the heart and heart valves. This risk is up to 0.2% annually, and may increase over time. Endocarditis usually develops in older children or adults. The disease is associated with trauma to the endocardium against the background of pathological shunting of blood, and its immediate causes are due to any transferred bacterial disease and even dental procedures.

A much greater danger is an untreated large VSD. Even if the child survives, and the severity of the clinic falls, this does not mean recovery. A decrease in the intensity of symptoms is observed due to the development of obstructive lesions of large pulmonary vessels. When delaying the operation, irreversible, constantly progressive pulmonary hypertension may occur - an increase in pressure in the pulmonary circulation. Against the background of pulmonary hypertension, the walls of arteries and arterioles thicken, which sometimes cannot be corrected even by surgical intervention.

By the age of 5-7 years, pulmonary hypertension manifests itself in the form of Eisenmenger's syndrome (subaortic VSD, supplemented by vascular sclerosis in the lungs).

The patient has an enlarged trunk of the pulmonary artery, hypertrophied right (rarely - left) ventricle of the heart. Both diseases usually lead to severe ventricular failure and death before the age of 20, and sometimes before the age of one.

Other severe complications VSD without timely surgery, which can lead to disability and death of a person:

aortic regurgitation - a combination of blood reflux with aortic valve insufficiency, while seriously increasing the load on the left ventricle;
infundibular stenosis - traumatization of the supraventricular ridge, its hypertrophy and scarring, as a result of which the infundibular section of the right ventricle narrows and pulmonary artery stenosis develops;
thromboembolism - blockage of blood vessels by a detached thrombus, which forms in the heart and enters the circulating bloodstream. More about postoperative thromboembolic complications

Carrying out diagnostics

After birth, children are always carefully examined by a special specialist - a neonatologist. He must have a lot of experience in searching congenital diseases By outward signs and data objective examination. At the age of 1 month, all babies should be examined by a number of narrow specialists, as well as undergo instrumental examinations and perform blood tests. If there are suspicions of heart defects, various examinations of the child are carried out, which will confirm, exclude or clarify the diagnosis. Often, small defects are found at an older age, however, the diagnostic program will be approximately the same:

Frontal chest x-ray. Cardiomegaly and an increase in the chambers of the heart, an increase in the vascular pattern of the lung tissue are revealed. In the presence of complications from the lungs, changes such as an increase in the size of the trunk, as well as branches of the pulmonary artery, may appear.
ECG. Shows overload of the right atrium and one ventricle, heart rhythm and conduction disturbances.
Ultrasound of the heart with dopplerography. It reflects a pathological discharge of blood through an existing defect, an increase in the cavities of the heart, an increased thickness of the heart muscle, etc.
Phonocardiography. Helps to record heart murmurs.
Complete blood count, blood gases. As a rule, these tests are normal.
Angiocardiography with cardiac catheterization. Needed to measure the pressure in the chambers of the heart and pulmonary artery, as well as the level of oxygen saturation. This method allows you to determine the severity of tissue hypoxia, as well as to identify hypertension of the pulmonary artery.

The disease should be differentiated with a common arterial trunk, stenosis of the pulmonary artery or aorta, an open artrioventricular canal, aortopulmonary septal defect, thromboembolism, mitral valve insufficiency. Treatment Methods

Conservative therapy is necessary for any size and type of heart disease if there are signs of heart failure. It may include such drugs:

All medicines should be prescribed only by a doctor, as well as the selection of their dosage and duration of administration. If the course of the disease is asymptomatic in the presence of a small defect, this will limit the maintenance therapy and conduct regular examinations and examinations of the child's heart. Often there is a spontaneous closure of the defect by 4-5 years of age. However, for large defects around the age of 3 years, the child usually needs surgery.

In some cases, palliative operations are performed on an infant, which will improve the quality of life, reduce the amount of pathological blood loss and help him wait for a radical intervention to eliminate the defect before the development of irreversible changes. During a palliative operation, an artificial stenosis of the pulmonary artery is created using a cuff (Müller's pulmonary artery narrowing operation).

At an older age, radical operations are performed, but sometimes this type of intervention is forced to be performed in children under one year old. Indications for surgery:

rapid progression of pulmonary hypertension;
intense symptoms of heart failure;
recurrent pneumonia;
a serious lag in body weight and development of the child.

Currently, all types of operations to eliminate VSD are well developed and give 100% efficiency with a mortality rate of no more than 1-3%. Depending on the type of defect and its size, the operation may be as follows:

Plastic defect with a special patch from the pericardial sheet. The operation is performed under conditions of hypothermia, cardioplegia, cardiopulmonary bypass. Patches made of synthetic materials are also used - Teflon, Dacron, etc. Typically, such operations are prescribed for large VSDs.
Sewing up the defect with a U-shaped suture. Recommended for defects less than 5 mm. size.
Occlusion with the Amplatzer device. Small defects are easily removed in such a minimally invasive way as the introduction of an Amplatzer occluder into the heart, which opens in the opening of the interventricular septum like an umbrella. Thus, the defect is completely closed.

In the postoperative period, a child or an adult needs regular inspection by a cardiologist at least once every six months, then once a year.

Complications of surgery, including AV blockade, are most often observed in late operated patients. In such patients, among other things, pulmonary hypertension may persist against the background of irreversible vascular damage.

Pregnancy and childbirth with illness

Many women with a ventricular septal defect can carry and give birth to a child, but only if the hole is small. The situation is an order of magnitude more complicated if the defect is of considerable size, and the woman has symptoms of heart failure, or other complications of the disease. The risk for the fetus and the pregnant woman herself is especially high in the presence of arrhythmia, pulmonary hypertension. If Eisenmenger's syndrome is diagnosed, the pregnancy is terminated at any time, as this threatens the death of the mother.

Women with heart disease need to plan pregnancy in advance, and also take into account that there is a risk of having a child with the same disease, or with other congenital heart diseases. Before conception, you should drink a course of special drugs to support cardiac activity, and during the gestation of the fetus, most medications will have to be stopped. The management of pregnancy in women with VSD requires the close attention of doctors, as well as the participation of a cardiologist. Childbirth with small defects is independent, in the presence of complications - by caesarean section.

What not to do with VSD

Do not miss visits to the pediatrician or cardiologist for dynamic observation for the sick.
Remember to report any changes in behavior and symptoms to your doctor.
Avoid excessive physical activity child, but, nevertheless, not to force him to lead a passive life.
Do not take part in competitions, do not perform hard physical work.
Do not ignore exercise therapy.
Do not hold your breath (for example, do not dive).
Avoid sudden changes in ambient temperature.
Do not go to the bath, sauna, do not sunbathe for a long time.
Avoid ARVI, flu, colds against the background of hypothermia.
Treat all foci of chronic infection.
Eliminate stress and anxiety in the patient.

Prognosis for ventricular septal defect

A favorable prognosis in the natural course of VSD is not common, of course, if the defect does not spontaneously close (this happens in 25-40% of cases). Life expectancy without surgery is 20-30 years, and with large defects, up to 50-80% of children die before the age of one year due to complications (thromboembolism, pulmonary hypertension, heart failure). In 15% of them, Eisenmenger's syndrome is formed, and therefore babies can die already during the first six months of life.

With small defects that do not lead to the development of a clinical picture, but, nevertheless, do not close on their own, life expectancy is on average 60 years. That's why surgical intervention it is better to carry out even in adulthood to prevent the gradual wear of the heart. In pregnant women with untreated VSD, mortality reaches 50%, and the woman and the child die especially often in the second half of gestation.