The most common form of atrium septum defect lectual presence ostium secundum type defects in the middle of the septum, while less common ostium primum type (which is lower in the septum) and in these cases there are abnormalities in the mitral and tricuspid valves and.In both cases, normal oxygen saturated blood from the left atrium into the right atrium passes d thus increasing cardiac output and right ventricular pulmonary flow. The primum defect, mitral insufficiency causes left ventricular strain.
The clinical picture
A. Symptoms and signs: the largest number of patients with moderate atrial septum defect is asymptomatic. In the event that there is a large shunt and leads to dyspnea prizamoru or cardiac decompensation. Visible sui palpable right ventricular pulsations. In II IIII intercostals space to the left of the sternum to hear a moderate systolic murmur that jerezultat increased flow through the pulmonary valve. Or at the top of the heart or in the area of continuing ksifoidnog hear high diastolic mekšum, which is the result of increased flow kroztrikuspidalne valve, especially in the inspiration. Trillo is not common. The second tone is widely torn and does not change in relation to respiration.
B. Radiographic findings: large pulmonary arteries with strong pulsations, increased pulmonary vascular pattern, enlarged right atrium and iventrikl small aortic knob.
C. ECG: electrical axis deviation or right ventricular hypertrophy right in the case of the ostium secundum defekta.Inkompletan or a complete block of the right granese luck in most cases. Kodostium primum defect exists devijacijaelektrične axis to the left with a rotation in the frontal plane, the opposite of the movement kazaljkena clock.
D. Special tests: cardiac catheterization ze possible to calculate the amount of blood that šantira between the left and right atria, followed Intracardiac and pulmonary pressures and pulmonary vascular resistance. The catheter can pass through the defect into the left atrium. Angiokardiografijom can odkriti whether the ostium primum comes defect or mitral regurgitation.
Treatment
Male strijalne septum defects should not be treated surgically. Surgical treatment they require lump atrium septum defects Whose is levodesni shunt (2 or 3 times the systemic flow) with mild or no increase in pulmonary resistance. Operational risk is small so you need to operate on patients whose ratio between pulmonary and systemic flow 1.5:1.
Surgical intervention is indicated in cases of pulmonary hypertension and santa reverse because of the risk of acute cardiac decompensation.
Forecast
Patients with small SANTO can live a normal life, with a greater SANTO experience medieval age or later before it comes to the appearance of pulmonary hypertension or cardiac decompensation. Later usually lead to atrial fibrillation and pulmonary vascular resistance. Floe lead to physical disability in 40tim age. Increased pulmonary vascular resistance caused by pulmonary hypertension rarely encountered in childhood or mladićstva when it comes to the atrial septum defect type secundum, but is common in the case of the septum primum defect; 40tih after years of existence and the atrium septum defect lectual secundum type can be develop pulmonary hypertension.
Operative mortality with the use of the machine for extracorporeal circulation is low (<1%) in patients under 45 years of age, who are not and have decompensated pressure in a. pulmonic <60 mm Hg.Increases 6-10% in patients over 40 years of age, they also have heart decompensation and increased pressure in a. pulmonic> 60 mm Hg. The largest number of survivors show marked improvement.
The clinical picture
A. Symptoms and signs: the largest number of patients with moderate atrial septum defect is asymptomatic. In the event that there is a large shunt and leads to dyspnea prizamoru or cardiac decompensation. Visible sui palpable right ventricular pulsations. In II IIII intercostals space to the left of the sternum to hear a moderate systolic murmur that jerezultat increased flow through the pulmonary valve. Or at the top of the heart or in the area of continuing ksifoidnog hear high diastolic mekšum, which is the result of increased flow kroztrikuspidalne valve, especially in the inspiration. Trillo is not common. The second tone is widely torn and does not change in relation to respiration.
B. Radiographic findings: large pulmonary arteries with strong pulsations, increased pulmonary vascular pattern, enlarged right atrium and iventrikl small aortic knob.
C. ECG: electrical axis deviation or right ventricular hypertrophy right in the case of the ostium secundum defekta.Inkompletan or a complete block of the right granese luck in most cases. Kodostium primum defect exists devijacijaelektrične axis to the left with a rotation in the frontal plane, the opposite of the movement kazaljkena clock.
D. Special tests: cardiac catheterization ze possible to calculate the amount of blood that šantira between the left and right atria, followed Intracardiac and pulmonary pressures and pulmonary vascular resistance. The catheter can pass through the defect into the left atrium. Angiokardiografijom can odkriti whether the ostium primum comes defect or mitral regurgitation.
Treatment
Male strijalne septum defects should not be treated surgically. Surgical treatment they require lump atrium septum defects Whose is levodesni shunt (2 or 3 times the systemic flow) with mild or no increase in pulmonary resistance. Operational risk is small so you need to operate on patients whose ratio between pulmonary and systemic flow 1.5:1.
Surgical intervention is indicated in cases of pulmonary hypertension and santa reverse because of the risk of acute cardiac decompensation.
Forecast
Patients with small SANTO can live a normal life, with a greater SANTO experience medieval age or later before it comes to the appearance of pulmonary hypertension or cardiac decompensation. Later usually lead to atrial fibrillation and pulmonary vascular resistance. Floe lead to physical disability in 40tim age. Increased pulmonary vascular resistance caused by pulmonary hypertension rarely encountered in childhood or mladićstva when it comes to the atrial septum defect type secundum, but is common in the case of the septum primum defect; 40tih after years of existence and the atrium septum defect lectual secundum type can be develop pulmonary hypertension.
Operative mortality with the use of the machine for extracorporeal circulation is low (<1%) in patients under 45 years of age, who are not and have decompensated pressure in a. pulmonic <60 mm Hg.Increases 6-10% in patients over 40 years of age, they also have heart decompensation and increased pressure in a. pulmonic> 60 mm Hg. The largest number of survivors show marked improvement.
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