18:23,22,Jul,2010 | (496/0/0) | Original

malaligned ventricular septal defect


Type of disease according to the location of defects can be divided into five types: â–² supraventricular crest defects: in the right ventricular outflow tract, and the main room on the ridge above the pulmonary valve under the main merge small number of cases, pulmonary valve regurgitation. â–² next supraventricular crest defects: in the membranous septum, the most common type, accounting for about 60-70%. â–² septal leaflet defect after: in the right ventricular inflow tract and tricuspid valve septal leaflet rear, about 20%. â–² muscular defect: at the apex, muscular trabecular defects, systolic time interval systolic to smaller defects, so little left to right shunt. â–² common ventricle: membranous and muscular ventricular septal no development, or for multiple defects, rare. Graphic 1 Pathology isolated ventricular septal defect means that the left and right ventricular (lower heart chamber two) interval appeared defect. This will lead to left ventricular heart defects in the oxygen-rich blood into the right ventricle into the aorta instead of the normal.
Normal heart compared with ventricular septal defect of the heart the heart map A normal blood flow structure and its internal situation. Determined to Figure B shows two common locations ventricular septal defect, and ventricular septal defect (VSD) has led to left ventricular and right ventricular blood oxygen-rich blood oxygen mixture. VSD is large and small. Small VSD does not cause any problems and may even be self-closing. The large VSD will not only lead to left ventricular overload, and because the right ventricle the blood too much, leading to right heart and pulmonary blood pressure is too high. This will increase the workload of the heart, causing heart failure and cardiac hypoplasia. If the VSD is not closed at this time, it may cause damage to delicate lung artery, forming the so-called pulmonary hypertension. This is when you need heart surgery to repair the VSD. Heart valve stenosis. Simple congenital heart disease including heart valve stenosis. The so-called "heart valves" refers to the control of blood flow from the atrium to the ventricle (or from the ventricle to the aorta or pulmonary artery blood flow) of the "valve." Heart valve defects can be categorized as follows: ★ narrow. At this time valve can not be completely open to let blood through the heart, to be overloaded with work. ★ atresia. Valve growth is not normal, resulting in blood did not channel. ★ heart mitral valve regurgitation of blood. Valve can not close completely, causing part of the blood return. "Pulmonary stenosis" is the most common valve defect. Valve will be here right ventricular blood to the pulmonary artery, and then to the lungs to get oxygen. The severity of pulmonary stenosis is also divided into mild to severe at all levels. Most children with this defect have no other symptoms except the heart murmur. If the situation is more narrow slightly,
then do not have treatment. Pulmonary valve stenosis for infants, and its heart into the blood to the pulmonary artery pressure when its workload will be seriously overloaded. Hypoxia the blood will reach the heart from the right side of the left side of the heart, causing "cyanosis." Cyanosis refers to the skin, lips and nails occurring at the blue purple. This is due to low levels of oxygen in the blood, leading to the heart of the work status is not normal. Other children with pulmonary valve stenosis is particularly in the heavy exercise fatigue. Valvular pulmonary stenosis by cardiac catheterization for treatment. Produced at the level of symptoms and signs of ventricular shunt left to right, depending on the number of sub-flow defect size. Defect is greater pulmonary blood flow increased significantly, into the left atrium, room, in the ventricular level by defects mouth and into the right ventricle into the pulmonary circulation, and thus the right and left ventricular load increase, the left and right ventricle increased pulmonary blood flow increased lead to increased pulmonary artery pressure, right ventricular systolic load also increased, ultimately into the obstruction of pulmonary hypertension, there may be bidirectional or right to left shunt. Symptoms of small defects can be asymptomatic. Defect is greater, and the apparent early onset of symptoms, which affects development. Asthma have palpitations, weakness and easy to lung infections. Severe heart failure can occur. Significant pulmonary hypertension, cyanosis can appear, the disease often suffer from infective endocarditis. Signs of increased apex beat displaced to the left, under the expansion of the left heart border, the typical signs of the left sternal border Ⅲ - Ⅳ intercostal 4-5 grade rough systolic murmur, the precordial conduction, with systolic fine tremor. If the shunt is heavy, may have functional apical diastolic murmur. Hyperthyroidism and pulmonary valve split second sound. Severe pulmonary hypertension, pulmonary valve area has relatively pulmonary valve insufficiency of the diastolic murmur, systolic murmur original septal defect can be reduced or lost. Diagnostic X-ray film with moderate impairment of mild to moderate expansion of the heart, the left extending down the left Xinyuan, pulmonary cone Long out smaller aortic, hilar congestion. Severe obstructive pulmonary hypertension heart shadow but no significant expansion of the right pulmonary artery thick, remote mutation is small, the branch was rat-tailed, wild week of lung texture sparse. Precordial cardiac examination often slightly elevated. Intercostal space left sternal border 3,4 palpable systolic thrill to, and hear the whole class Ⅳ Ⅲ a systolic murmur; high infundibular defects were tremor and noise in the intercostal 2. Pulmonary valve area second sound hyperthyroidism. Split a large quantity, the apex can still hear the soft mid-diastolic murmur functional. Lead to sub-flow reduction of pulmonary hypertension cases, systolic murmur gradually reduce, or even disappear, while the pulmonary valve area is the second tone was hyperthyroidism, split, and pulmonary valve regurgitation associated with diastolic murmur. ECG showed normal or small defect left axis deviation. Larger defects, with the sub-flow and pulmonary artery pressure and left ventricular high voltage show, hypertrophy or left ventricular hypertrophy. Severe pulmonary hypertension who are shown with right ventricular hypertrophy or strain. A, X ray: heart defects affect more than small ones did not change. Moderately large defect, the heart shadow increased in varying degrees to the right ventricle based. Defect is greater, the left and right ventricle were increased, pulmonary artery bulge, increase pulmonary vascular shadow, severe pulmonary hypertension, the lung field but outside the zone clear. Echocardiographic left atrium, left and right ventricular internal diameter increases, there is a continuous interrupt ventricular septal echo, Doppler ultrasound: the missing hole defect for right ventricular and left ventricular surface tracking can be measured to the maximum of deep turbulence. Right ventricular cardiac catheterization oxygen content level of 0.9% higher than the volume above the right atrium, and occasionally reach the left ventricular catheter through the defect. According to the number of sub-flow, pulmonary artery or right ventricular pressure increased in varying degrees. Main control medical therapy treatment of infective endocarditis, pulmonary infection and heart failure. Open heart surgical repair of descending defect, small defect, X-ray and electrocardiogram normal without surgery, if / or without pulmonary hypertension, mainly by left to right shunt, surgery is best, to 4-10 years as should, if the early symptoms or heart failure, but also in infant surgery, significant pulmonary hypertension, a two-way or right to left shunt-based, should not surgery. Surgical principles (1) there is a natural ventricular septal defect closure in view of the possibility of, and thus defect is small, younger children can be followed up for observation of patients to 2-3 years. (2) a very small ventricular septal defect, symptoms, chest radiograph, electrocardiogram are normal, generally do not need surgery. But it should be on regular referral. (3) no healing possible, nor pulmonary hypertension in ventricular septal defect sick child, but each can be 1 to 4 elective surgery. Operation Main method: can be used in the treatment or intervention under cardiopulmonary bypass in open heart repair of ventricular septal defect. (4) infundibular defect, especially the dual flap artery defect, should be radical in the 2 years before the heart to prevent the occurrence of aortic valve prolapse. (5) of large ventricular septal defect, recurrent pneumonia, heart failure, active treatment controlled by medicine not satisfied, regardless of age, weight restrictions should be the early surgical treatment. As a result of technology, equipment, inadequate conditions, can first pulmonary artery banding surgery to relieve symptoms. To be radical surgery 3-6 months later. (6) serious resistance pulmonary hypertension, cyanotic children with clinically has to be a contraindication for the surgery. (7) The ventricular septal defect intervention details, see Section 4 of the interventional treatment of congenital heart disease part. (8) patients were followed up regularly, pay attention to whether the residual shunt and cardiac function recovery. 1. Large ventricular septal defect surgical indications, 25% -50% at 1-year-old internal pneumonia, heart failure and death. Therefore, heart failure, recurrent treatment of the baby should be held in defect repair. About half of the small defects may be self-closing, in addition to bacterial endocarditis complicated, but can be observed that the age of 10 consider surgery. Small defects can be life without surgery. More than 50% or fractional flow associated with increased pulmonary artery pressure in infants for early surgery to prevent pulmonary hypertension continues to rise. Such as the giants of severe obstructive pulmonary hypertension, compared with surgical anti-indications. 2. Surgical approach under general anesthesia, median sternotomy incision line, the establishment of cardiopulmonary bypass. Block the cardiac cycle, cut the anterior wall of right ventricular outflow tract, although various types of ventricular septal defect can be revealed, but there are some myocardial damage. Right heart function and injury of the right bundle branch. Currently use more open ways through the right atrium, which revealed membranous defect better. High defect, places appropriate way by the pulmonary artery. Fibrous tissue on the edge of the smaller defects can be directly sutured defect> lcm who are sewing with polyester knitting. Tracts by the membrane defect by taking the lower edge, sew septal leaflet defect are susceptible to accidental injury after, should be avoided, sewing by the septal leaflet root is appropriate. Traditional cardiovascular surgery, the use of sternal incision, some with posterolateral left chest incision, with the safety of cardiovascular surgery increasing, the appearance of incision trauma surgery and other issues have become an increasing attention, in recent years, minimally invasive small incision surgery patients increasingly favored by the majority of beauty. Knowledge briefly described below. (1) Conventional incision 1. Sternotomy incision, the skin incision in the chest center, about 20 ~ 25cm long, and all the split sternum, postoperative prone to liquefaction or incision infection, poor wound healing, easy and left a knife scar chicken and other deformities. 2. Posterolateral left chest incision, the incision usually from the posterior spinous process and the midpoint of the shoulder blade to move downward angle around the subscapularis 2cm, continue to move forward to the anterior axillary line, about 15 ~ 20cm incision, trauma, postoperative wound pain of clear liquid part of the surgery or infection of incision healing is easy. (2) minimally invasive surgical approach for small incision means the incision length 6 ~ 10cm, incision in the chest is relatively hidden location. A right chest incision 1.1 right axillary incision: Take the second right rib midaxillary line intersection point of intersection with the anterior axillary line connecting the fifth intercostal incision line 5 ~ 9cm in length depending on age, height, depending on the fourth rib in the anterior axillary line thoracic, thoracic approach less muscle damage. Generally used for children under 15 years of age, pediatric chest is relatively small. Rib elastic, and can be completed more safely a few simple surgical correction of congenital cardiac malformations, such as atrial septal defect, ventricular septal defect repair. Can also be triatriatum, pulmonary venous drainage, mitral regurgitation repair and valve replacement and other surgery. Of severe pulmonary hypertension exist dysplasia or pulmonary infections and birth <4 months in children with severe pulmonary hypertension, tetralogy of Fallot lung vascular development and other complex congenital heart disease by poor or no preoperative diagnosis specifically try not to use this incision in children. 1.2 The right anterior lateral incision: from armpit to the mid clavicular line 5 rib asked to do arc incision, about 8 ~ 12cm, women do along the lower edge of the breast skin incision, and the serratus anterior muscle along the incision between the pectoralis major, the first 3 or 4 intercostal thoracic. Indications with the former, adult thorax large, poor flexibility, deep surgical field in general should be selected before the lateral incision. 2. Left axillary incision, the exact location of the right arm with a small incision, just to the left, for the surgical treatment of patent ductus arteriosus, complete hemostasis, may hold the chest drainage tube, greatly reducing the patient's postoperative pain. 3. Sternotomy incision lower sternal skin incision in the lower 1 / 2 to the xiphoid, the incision is about 7 ~ 10cm, split the middle and lower sternum 1 / 2 to 2 / 3, and revealed problems such as prolonged chest up when necessary relative safety. The incision wound, less bleeding, and the stability of the thorax has not been completely destroyed, is conducive to resumption of respiratory function after surgery. Lower sternal incision adapted as atrial septal defect, ventricular septal defect repair. Can also be triatriatum, pulmonary venous drainage, mitral regurgitation repair and valve replacement and other surgery. In short, the characteristics of small incision is cut in appearance, cover addiction, trauma, less bleeding, faster recovery, better healing, deformity less, cost less and so on; but for patients with complex disease, and flat chest or obese adults, we must according to the disease and the doctor carefully chosen. 3. After treatment ① significant preoperative pulmonary hypertension who, after application of mechanical ventilation should be continued the next day morning, as after 48 hours still not weaned from the ventilator, tracheotomy should be done to replace the endotracheal tube. ② postoperative circulation pulmonary hypertension are often unstable and required inotropic drugs to maintain blood pressure. ③ postoperative Ⅲ ° atrioventricular block, should ensure that the pacing performance of systems tracts some cases a transient damage, a few days will be automatically restored conduction. 4. ① effect of surgery depends on the severity of the patient, stage of disease sooner or later, and the extent of surgery and postoperative management of the perfect propriety and so on. No significant pulmonary hypertension, surgical mortality rates within 2% ② before surgery secondary to severe pulmonary vascular lesions, post-operative respiratory, circulatory complication rate, mortality rate was significantly higher, depending on the situation of pulmonary rehabilitation extent of the vascular lesions, such as those lesions has become an irreversible, the prognosis is poor. Complications (a) of infective endocarditis in infants under 1 year of age is rare. Corone a group of such patients to 15 to 29 years of age the highest incidence. In general, the longer the survival, infective endocarditis complicated by much higher. According to the literature, the occurrence rate of 25% to 40%. However, extensive application of antibiotics and chemotherapy, the incidence has been greatly reduced, about 5 to 6%, 3.7% lower to 2. Occurred in their patients, but remain at 0.15% to 0.3%. (B) of the aortic valve insufficiency in the right ventricular septal defects and ventricular outflow tract on the ridge below, are prone to associated with aortic valve regurgitation. Nodas reported incidence of 4.6%, Tatsuno reported as 8.2%. Regurgitation caused by two reasons: ① defect in the ring just below the aortic valve, valve ring the lack of sufficient support. High speed when the spray from left to right shunt, the aortic valve leaflets pulled to the bottom, first to extend, and then produce prolapse, the formation of regurgitation. If we do not repair defects, regurgitation will gradually increase. ② some defect edge thickening, machines of contraction, or even the formation of fibrous band, stretching the aortic valve, resulting in regurgitation. (C) block the edge of the membrane defect by endocardial fibrosis secondary, oppression neighboring tracts, resulting in complete or incomplete block. ◆ congenital heart disease care points should be a fair way of life of children, it is necessary to enhance training, improve the body's resistance, but also proper rest and avoid overwork. If children can be competent, and healthy children should be living and studying together, but should avoid vigorous activity. Also, children should be educated to have confidence in the treatment of diseases and reduce the pessimistic fear. ◆ indoor air to circulate. Should open the windows in winter time, to enhance the air convection. A sustained bruising in children, should avoid the indoor temperature is too high, resulting in children with sweating, dehydration. ◆ given high-protein, high-calorie, vitamin-rich diet to enhance physical fitness. Avoid eating too full. Cyanotic heart disease on to be give children adequate drinking water, to avoid dehydration caused by thrombosis. Infants with congenital heart disease, feeding difficulty, shortness of breath and weak sucking often easy to stop sucking, and easy to vomiting and profuse sweating, it is available when feeding dropper infusion, to reduce physical exertion in children. Breast-side down gently to prevent inhalation of vomit pick up choking. ◆ Avoid emotional children, try not to make children cry, to reduce unnecessary stimulation, should not increase the burden on the heart. ◆ maintain smooth stool. Cyanotic children with attention on the stool not too hard, should not increase the burden on the heart. If two days of no bowel movements, laxative enema can be used. ◆ against a large number of congenital heart disease transfusion, such as the need transfusion, the speed to be slow drip to prevent the increasing burden on the heart, causing heart failure. ◆ tetralogy of Fallot in children to take on more squat position, often walking or playing active squat for a while. This is because the squat after the symptoms of hypoxia can be mitigated if the phenomenon of children, parents and children must not be forced to pull up. ◆ normal heart function and activities of endurance are good children, should be vaccinated at that time, but after vaccination, should be more systemic and local reactions observed for timely processing. ◆ physical weakness in children with congenital heart disease, susceptibility to diseases, especially respiratory disease is more common, and complicated by heart failure, care should therefore be careful, as the seasons change, and change into the clothes. Such as family members were upper respiratory tract infection, isolation measures should be taken, should be minimized with the children usually go to public places, a good season in infectious diseases, especially should take early preventive measures. Once the infection in children, should actively control the infection. ◆ found in children with shortness of breath, irritability, rapid heart rate, breathing difficulties and other symptoms of heart failure may occur, should be sent to the hospital. 2
malaligned ventricular septal defect

Ventricular septal defect (VSD) causes symptoms of complications of diagnostic tests recommended by experts in preventive health care treatment is ventricular septal defect ventricular hypoplasia caused by abnormal traffic, causing blood flow from left to right shunt, leading to abnormal hemodynamic . Ventricular septal defect can exist alone, but also a part of complex cardiovascular malformations. According to defects in different anatomical locations, divided into membranous defect, defect and muscular infundibulum three types of defects and a number of subtypes, of which membranous defects the most common, followed by infundibular defects, muscular defects were less common. Most ventricular septal defect as a single defect, sometimes for multiple muscular defects. For more information into the heart surgery I want to consult the cause of ventricular septal defect in embryos 5 to 7 weeks, respectively from bottom to top ventricular apex, the formation of the heart muscle the ball crest of interval from top to bottom, from the room by the Room flap at the Department of endocardial cushion of the membrane fusion between the interval and the former two, form a complete ventricular septum, the left ventricular cavity completely separated, if in the course of this unusual development, which will cause the corresponding parts of the ventricular septal defect . General Department of a single defect, occasionally multiple persons. >>> Back to the top of the details for free doctor symptoms of ventricular septal defect symptoms of small, asymptomatic. Defect is greater, and the apparent early onset of symptoms, which affects development. Asthma have palpitations, weakness and easy to lung infections. Severe heart failure can occur. Significant pulmonary hypertension, cyanosis can appear, the disease often suffer from infective endocarditis. Signs of increased apex beat displaced to the left, under the expansion of the left heart border, the typical signs of the left sternal border â…¢ - â…£ intercostal 4-5 grade rough systolic murmur, the precordial conduction, with systolic fine tremor. If the shunt is heavy, may have functional apical diastolic murmur. Hyperthyroidism and pulmonary valve split second sound. Severe pulmonary hypertension, pulmonary valve area has relatively pulmonary valve insufficiency of the diastolic murmur, systolic murmur original septal defect can be reduced or lost. Free consult a doctor diagnosis of ventricular septal defect Top precordial examination medical examination often slightly elevated. Intercostal space left sternal border 3,4 palpable systolic thrill to, and hear the whole class â…£ â…¢ a systolic murmur; high infundibular defects were tremor and noise in the intercostal 2. Pulmonary valve area second sound hyperthyroidism. Split a large quantity, the apex can still hear the soft mid-diastolic murmur functional. Lead to sub-flow reduction of pulmonary hypertension cases, systolic murmur gradually reduce, or even disappear, while the pulmonary valve area is the second tone was hyperthyroidism, split, and pulmonary valve regurgitation associated with diastolic murmur. >>> Details of the doctor free to return at the top of the complications of ventricular septal defect (a) of infective endocarditis in infants under 1 year of age is rare. Corone a group of such patients to 15 to 29 years of age the highest incidence. In general, the longer the survival, infective endocarditis complicated by much higher. According to the literature, the occurrence rate of 25% to 40%. However, extensive application of antibiotics and chemotherapy, the incidence has been greatly reduced, about 5 to 6%, 3.7% lower to 2. Occurred in their patients, but remain at 0.15% to 0.3%. >>> Details of the doctor free to return at the top of the treatment of ventricular septal defect major combat medical treatment of infective endocarditis, pulmonary infection and heart failure. Open heart surgical repair of descending defect, small defect, X-ray and electrocardiogram normal without surgery, if / or without pulmonary hypertension, mainly by left to right shunt, surgery is best, to 4-10 years as should, if the early symptoms or heart failure, but also in infant surgery, significant pulmonary hypertension, a two-way or right to left shunt-based, should not surgery. >>> More free doctor back to top chamber of the lack of preventive health care as a congenital disease, no effective preventive measures, early detection and early diagnosis should be done early treatment. For patients with ventricular septal defect defect prognosis is not good, or even of its natural life span of up to 70 years of age; small could even turn itself off before the age of 10. Large defect in 1 to 2 years old to heart failure, pulmonary hypertension who have a poor prognosis. Prompt surgical treatment can be achieved and normal same general effect. Top free doctor recommended experts Shanghai Grand Cardiothoracic Surgery, Heart Hospital team of experts for free back to top doctor lofty mind Hospital Shanghai Tips: 1. More information purposes only, not as a basis for diagnosis and treatment. 2. For the convenience of patients and people in need, I set up hospital services in particular, by the authority of experts to answer your questions related to heart diseases, and the condition of patients with the most professional treatment. Click the online consultation. 3. For from the field to our hospital patients, we will send a shuttle bus, and give some fare subsidy. View traffic guide. 4. Notice: Surgical treatment of isolated congenital heart disease called poverty, the top 20 can be reduced 5000-15000 yuan. Click the Event Registration. 5. Our hospital into the designated hospitals for medical insurance in Shanghai, welcome to free online registration, phone :021 -64829999.
Ventricular septal defect and patent ductus arteriosus, atrial septal defect, just as a common congenital heart disease. The essence of this disease in the fetus, the diaphragm separating the left and right ventricular defect occurs. Left ventricular blood flow after birth, right ventricular, and atrial septal defect is different, due to left ventricular and right ventricular pressure vary widely, so sub-flow is also large, the impact on patients is much greater than the atrial septal defect. In childhood or in early childhood symptoms appeared. If a large ventricular septal defect in infants are particularly vulnerable to flu or pneumonia, and difficult to treat them big, long course, easy to repeat. To childhood, children and easy fatigue, poor endurance. Some children in early childhood susceptibility to pneumonia, but rarely to suffer from respiratory diseases in childhood, when parents mistakenly believe that reducing the child's condition is actually the child's condition worse. The reason is the right time a lot of blood the left ventricle caused by ventricular shunt to increase pulmonary vascular resistance, pulmonary blood reduced the chance of lung disease reduction.

Because the majority of ventricular septal defect more obvious symptoms, less chance of misdiagnosis. Infancy, most children go to hospital for treatment for pneumonia, doctors have easy to find children with ventricular septal defect, the third left sternal border, fourth intercostal can hear a rough systolic murmur. Then according to a cardiac X-ray film, color B to do a heart ultrasound, can make the correct diagnosis.

Ventricular septal defect and surgery are also involved in two ways. Trauma intervention, spending relatively large, with septal occluder to 25000-30000 yuan, imported occluder need 35000-45000 yuan. Surgical methods and traditional thoracoscopic surgery in two ways. Need to use cardiopulmonary bypass. The former trauma, cost slightly higher, about 25,000 yuan, which is trauma, spent 9000-10000 yuan.
The treatment of ventricular septal defect best age roughly as follows: small, asymptomatic ventricular septal defect more appropriate to do 3-5 years of age; large ventricular septal defect younger to do better in the 2-3 months do. Frequent episodes of pneumonia for infants and young children, suffering from pneumonia in the two intervals do. Children with large ventricular septal defect, surgery as soon as possible if you do not, to a certain age as a result of severe pulmonary hypertension, the risk of surgery will greatly increase long-term effect is not good, even more serious is that some childre
n lose the chance of operation. Only 2-3mm for the small ventricular septal defect, can wait until 5-6 years old before deciding whether to deal with. Because there is a small ventricular septal defect in children that can be naturally closed and is no longer needed surgery. In general, more than 5 years of age, the likelihood of natural closure is quite small. For patients who have concurrent pulmonary hypertension, ventricular septal defect surgery can, we must find experienced cardiac surgeons to decide. Older patients with ventricular septal defect, most still surgery, cardiac surgery should be to find a physician for treatment.
These simple congenital heart disease, high security operation for an experienced cardiac surgeons, and better teams, the mortality rate is almost zero. In the event of death or serious complications are due to unforeseen circumstances. Surgery the patient's long-term effects of such well, almost the same as the normal growth and development of children
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