Ventricular septal defect (VSD) is a hole located in the wall that serves to separate the cavities of the right and left ventricles.
General information
This condition results in abnormal mixing (shunting) of the blood. In cardiology practice, such a defect is the most common congenital heart disease. Critical conditions with VSD develop at a frequency of twenty-one percent. Both male and female babies are equally susceptible to the occurrence of this defect.
VSD in the fetus can be isolated (that is, the only existing anomaly in the body) or part of complex defects (tricuspid valve atresia, transposition of vessels, common arterial trunks, tetralogy of Fallot).
In some cases, the interventricular septum is completely absent, such a defect is called the only ventricle of the heart.
VSD Clinic
Symptomatic of a ventricular septal defect often manifests itself in the first days or months after the birth of a baby.
The most common manifestations of vice include:
- dyspnea;
- cyanosis of the skin (especially fingertips andlips);
- loss of appetite;
- palpitations;
- fatigue;
- swelling in the abdomen, feet and legs.
VSD at birth can be asymptomatic, if the defect is small enough, and appear only at a later date (six or more years). Symptoms directly depend on the size of the defect (hole), however, the doctor should be alerted by noises heard during auscultation.
VSD in the fetus: causes
Any congenital heart defects appear due to disturbances in the development of the organ in the early stages of embryogenesis. An important role is played by external environmental and genetic factors.
With VSD in the fetus, an opening is determined between the left and right ventricles. The muscular layer of the left ventricle is more developed than in the right one, and therefore the oxygen-enriched blood from the cavity of the left ventricle penetrates into the right ventricle and mixes with oxygen-depleted blood. As a result, less oxygen enters the organs and tissues, which ultimately leads to chronic oxygen starvation of the body (hypoxia). In turn, the presence of an additional volume of blood in the right ventricle entails its dilatation (expansion), myocardial hypertrophy and, as a result, the occurrence of right heart failure and pulmonary hypertension.
Risk factors
The exact causes of VSD in the fetus are unknown, but an important factor is aggravated heredity (that is, the presence of a similar defect in the next of kin).
In addition, factors that are present during pregnancy also play a huge role:
- Rubella. It is a viral disease. If during a real pregnancy (especially in the first trimester) a woman had rubella, then the risk of various anomalies of the internal organs (including VSD) in the fetus is very high.
- Alcohol and some drugs. Taking such drugs and alcohol (especially in the first weeks of pregnancy) significantly increases the risk of developing various anomalies in the fetus.
- Inadequate treatment of diabetes. An uncorrected glucose level in a pregnant woman leads to fetal hyperglycemia, which can eventually lead to a variety of congenital anomalies.
Classification
There are several options for the location of the VSD:
- Conoventricular, membranous, perimembranous VSD in the fetus. It is the most common location of the defect and accounts for approximately eighty percent of all such defects. A defect is found on the membranous part of the septum between the ventricles with a probable spread to the output, septal and its input sections; under the aortic valve and tricuspid valve (its septal leaflet). Quite often, aneurysms occur in the membranous part of the septum, which subsequently causes the closure (complete or partial) of the defect.
- Trabecular, muscular VSD in the fetus. It is found in 15-20% of all such cases. The defect is completely surrounded by muscles and canlocated in any of the sections of the muscular part of the septum between the ventricles. Several such pathological holes can be observed. Most often, these fetal LBMs close spontaneously.
- Infrapulmonary, subarterial, infundibular, outflow tract foramina account for approximately 5% of all such cases. The defect is localized under the valves (semilunar) of the outlet or cone-shaped sections of the septum. Quite often, this VSD due to prolapse of the right leaflet of the aortic valve is combined with aortic insufficiency;
- Defects in the area of the incoming tract. The hole is located in the region of the inlet section of the septum, directly under the area of attachment of the ventricular-atrial valves. Most often, pathology accompanies Down syndrome.
Most often single defects are found, but there are also multiple flaws in the septum. VSD may be involved in combined heart defects such as tetralogy of Fallot, vascular transposition, and others.
In accordance with the size, the following defects are distinguished:
- small (no symptoms);
- medium (the clinic occurs in the first months after childbirth);
- large (often decompensated, with vivid symptoms, severe course and complications that can lead to death).
Complications of VSD
If the defect is small, clinical manifestations may not occur at all, or the holes may spontaneously close immediately after birth.
For larger defects, maythe following serious complications occur:
- Eisenmenger syndrome. It is characterized by the development of irreversible changes in the lungs as a result of pulmonary hypertension. This complication can develop in both young and older children. In such a state, part of the blood moves from the right to the left ventricle through a hole in the septum, because due to hypertrophy of the myocardium of the right ventricle, it is "stronger" than the left one. Therefore, blood depleted of oxygen enters the organs and tissues, and, as a result, chronic hypoxia develops, manifested by a bluish tinge (cyanosis) of the nail phalanges, lips and skin in general.
- Heart failure.
- Endocarditis.
- Stroke. May develop with large septal defects due to turbulent blood flow. It is possible to form blood clots, which can subsequently clog the vessels of the brain.
- Other pathologies of the heart. Arrhythmias and valvular pathologies may occur.
Fetal VSD: what to do?
Most often, such heart defects are detected at the second scheduled ultrasound. However, don't panic.
- You need to lead a normal life and not be nervous.
- The attending physician should carefully observe the pregnant woman.
- If a defect is detected during the second scheduled ultrasound, the doctor will recommend waiting for the third examination (at 30-34 weeks).
- If the defect is detected on the third ultrasound, another examination is prescribed before delivery.
- Small (eg, 1 mm VSD in the fetus) openings may close spontaneously before or after birth.
- Neonatologist consultation and fetal ECHO may be required.
Diagnosis
You can suspect the presence of a defect during auscultation of the heart and examination of the child. However, in most cases, parents learn about the presence of such a defect even before the birth of the baby, during routine ultrasound studies. Sufficiently large defects (for example, VSD 4 mm in the fetus) are detected, as a rule, in the second or third trimester. Small ones can be detected after birth by chance or when clinical symptoms appear.
A newborn or older child or adult can be diagnosed with JMP based on:
- Complaints of the patient. This pathology is accompanied by shortness of breath, weakness, pain in the heart, pallor of the skin.
- Amnesis of the disease (time of onset of the first symptoms and their relationship with stress).
- History of life (burdened heredity, mother's illness during pregnancy, and so on).
- General examination (weight, height, age-appropriate development, skin tone, etc.).
- Auscultation (noises) and percussion (expansion of the boundaries of the heart).
- Blood and urine tests.
- ECG data (signs of ventricular hypertrophy, conduction and rhythm disturbances).
- X-ray examination (altered heart shape).
- Vetriculography and angiography.
- Echocardiography (that is, ultrasound of the heart). Giventhe study allows you to determine the location and size of the defect, and with dopplerometry (which can be performed even in the prenatal period) - the volume and direction of blood through the hole (even if CHD - VSD in the fetus is 2 mm in diameter).
- Catheterization of cardiac cavities. That is, the introduction of a catheter and the determination with its help of pressure in the vessels and cavities of the heart. Accordingly, a decision is made on the further tactics of managing the patient.
- MRI. Assigned in cases where the Echo KG is not informative.
Treatment
When VSD is detected in the fetus, expectant management is followed, since the defect can spontaneously close before birth or immediately after birth. Subsequently, while maintaining the diagnosis, cardiologists are involved in the management of such a patient.
If the defect does not disturb the circulation and the general condition of the patient, they are simply observed. With large holes that violate the quality of life, a decision is made to perform an operation.
Surgical interventions for VSD can be of two types: palliative (restriction of pulmonary blood flow in the presence of combined defects) and radical (complete closure of the opening).
Operation methods:
- Open heart (e.g. tetralogy of Fallot).
- Cardiac catheterization with controlled patching of the defect.
Prevention of ventricular septal defect
There are no specific preventive measures for VSD in the fetus, however, in order to prevent CHD, it is necessary:
- Contact antenatal clinic before twelve weeks of pregnancy.
- Regular visits to the LC: once a month for the first three months, once every three weeks in the second trimester, and then once every ten days in the third.
- Stay he althy and eat right.
- Limit the influence of harmful factors.
- No smoking and alcohol.
- Take medication only as directed by your doctor.
- Give the rubella vaccine at least six months before the planned pregnancy.
- With aggravated heredity, carefully monitor the fetus for the earliest possible detection of CHD.
Forecast
With small VSDs in the fetus (2 mm or less), the prognosis is favorable, since such holes often close spontaneously. In the presence of large defects, the prognosis depends on their localization and the presence of a combination with other defects.
