Ventricular septal defect
The ventricular septal defect (VSD ) is a hole in the septum, which is the most common malformation with about 30 % of all congenital heart defects. In the embryonic stage of heart development, the upper and lower portions of the septum between the ventricles grow ( ventricles ) to each other. Is this growth at birth not quite completed or previously disturbed, there is a more or less large defect in the muscular or membranous portion of the ventricular septum. For complex cardiac malformations is in about 50 % of the cases a VSD, but which is then to be valued differently than the isolated VSD present described here.
Variants
- Perimembranöser VSD: opening ( s) in the membranous ventricular septum near the tricuspid valve and / or aortic valve
- Muscular VSD: single or multiple (Swiss -cheese- defect) occurring defect, purely muscular limited ( centrally or apically located )
- Suction. " Doubly committed VSD ": opening below the aortic and pulmonary valve
- AV channel type ( inlet type ): Opening in the area of Einlaßseptums the right ventricle
Effects on the cardiovascular system
The pressure in the left ventricle ( systemic circulation ) is about 4 - to 5 -fold higher than the pressure in the right ventricle ( the pulmonary circulation ). Depending on the size of the defect - - more or less arterial ( oxygenated ) blood is pumped through the hole in the right ventricle ( pulmonary circulation ) through the VSD is why. This conversion is called left-right shunt and loaded the lung vasculature. If there is a large, hemodynamically significant VSD for a long time, a Pulmonary hypertension can form. Depending on the size of the left- to-right shunt may lead to heart failure (heart underachievement ) or by congestion of the increased blood flow in the lung to increased fluid retention in tissues - in the case of acute pulmonary edema.
Clinical signs
The children often fall on by increased respiration. Drinking them is difficult due to the increased heart and lung capacity. The increase in weight can be difficult in normal linear growth. Therefore VSD children are often very slim.
Diagnostics
The precise diagnosis is carried out today (after a screening detected when monitoring heart murmur ) using echocardiography. A cardiac catheterization is more accurate values and is performed when the return will result in not enough information for the operation.
Shutter
A small muscular VSD may close in the first years of life spontaneously.
Larger defects, which are also high in the vicinity of the heart valve (and thus the conduction system ) or lie deep in the vicinity of the apex of the heart, or in which the defect is composed of several holes are closed surgically, with about 26% of the defects directly by a seam can be closed and 74 % with a patch ( patch of pericardium = pericardial tissue or Dacron / Goretex ).
90 % of VSD closures can access route to be operated on a " transatrial ". The right atrium is opened and performed the operation through the tricuspid valve ( between the right atrium and right ventricle ). Only in 1% of cases a transpulmonary access path is selected and about 9 % of the cases the right ventricle is opened for surgery.
The operation is using the heart -lung machine performed via a sternotomy (opening of the sternum ), which can vary minimally invasive ( small) by now.
The interventional closure of perimembranous VSDs using the cardiac catheter can currently be made in some specialized pediatric cardiology centers in children from 8 kg of body weight. Only in the long term, the results must be measured with the surgical closure. The time ( 2005) of the surgical fastener is considered, especially in children less than 8 kg of body weight, still the gold standard.
Results
After the operation, which today is mostly done in the first year of life, children are completely healthy, develop normally and bring her eventual weight deficit quickly. After about a year after surgery no longer endocarditis needs are met. Control studies, however, are displayed in increasing distance further.