Ventricular septal defect

Ventricular septal defect (VSD) is the most common congenital heart malformations and can exist as isolated vicijum, or associated with other defects, as part of complex congenital heart defects. Usually there is an opening, located basal, level membranous part of the septum.

The cause of

Congenital heart defects occur in a complex interaction of genetic factors and environmental factors. It is rare to find the cause of congenital cardiac malformations such as, for example, maternal rubella or chronically excessive abuse of alcohol in the mother during embryogenesis. Various factors such as hypoxia, ionizing radiation, certain drugs have teratogenic effects. The risk of congenital heart defects in children of parents with congenital heart malformation is low, 2-5%, and should not be an obstacle in the planning of the offspring.

The clinical picture

The clinical picture depends on the size of the ventricular septal defect. Small defect is usually not accompanied by symptoms. Significant septal defect with left - right shunt causes a moderate degree of poor tolerance. Recirculation of blood in the pulmonary circulation reduced cardiac reserve, and the effort quickly and leads to weakness and fatigue. Large VSD leads to slowing growth and physical development of the child, the appearance of frequent respiratory infections, and can lead to cardiac failure due to high loads of left ventricular volume. After the second decade of life, there is a manifestation of pulmonary vascular obstructive disease with pulmonary hypertension and reduced left - right shunt. Bidirekcionog occurrence and, later, the right-to-left shunt causes cyanosis (bruised, blue discoloration) and causes a polycythemia (increased number of blood cells). Vascular obstructive pulmonary disease restricts blood flow increase in the effort and adequate increase in cardiac output as needed to load quickly and leads to fatigue and weakness, and may lead to the occurrence of syncope (transient loss of consciousness). Hypoxemia and inadequate increase in coronary flow during the effort, considering the needs of right ventricular hypertrophy, can trigger myocardial ischemia in the effort, and the occurrence of anginal chest pain. Pulmonary vascular obstructive disease and pulmonary hypertension can cause development of hemoptysis (coughing up blood).

Diagnosis

It is based on review (noise), ECG, x-ray, ultrasound and cardiac catheterization.

Treatment

VSD belongs to a group of congenital heart disease with a relatively high risk of bacterial endocarditis.Antibiotic prophylaxis of bacterial endocarditis is necessary in the case of interventions that could lead to bakteriemije (dental procedures, bronchoscopy, placement of urethral catheters, abortion, etc.).

Surgical treatment of VSD - also indicated in situations where a significant left to right shunt. In situations of existence odmaklih pulmonary vascular obstructive changes with markedly increased resistance and the emergence of reversion shunt surgical intervention is contraindicated septal defect closure. Alternative to surgical closure in some cases could be placed centrally Transcatheter closure of defects by using a special shutter as a double umbrella (clamshell). The optimal time for surgery has disadvantages preschool children, but the results are good, and operational risk is low even in patients older than 40 years if no pulmonary hypertension.