Ventricular septal defect. Benign fetal hypertrophy: causes, diagnosis and consequences

A ventricular septal defect (DMS) is a hole located in the wall that serves to separate the cavities of the right and left ventricles.

General information

This condition leads to abnormal mixing (bypass) of blood. In cardiological practice, such a defect is the most common congenital pathology of the heart. Critical conditions in DMS develop with a frequency of twenty-one percent. Equally, the onset of this defect affects both male and female babies.

The fetal benign prostatic hypertrophy can be isolated (that is, the only existing abnormality in the body) or part of complex defects (atresia of the tricuspid valve, transposition of blood 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.

Clinic DMZHP

The symptomatology of an interventricular septal defect is often manifested in the first days or months after the birth of the baby.

The most common manifestations of the defect include:

• shortness of breath
• skin cyanosis (especially fingertips and lips);
• decreased appetite;
• heart palpitations;
• fatigue;
• swelling in the abdomen, feet and legs.

At birth, benign prostatic hypertrophy can be asymptomatic if the defect is small enough and only appear at a later date (six or more years). Symptoms are directly dependent on the magnitude of the defect (hole), however, doctors should alert the noise heard during auscultation.

Benign fetal hypertrophy: causes

Any congenital heart defects appear due to violations in the development of the organ in the early stages of embryogenesis. An important role in this is played by external environmental and genetic factors.

In case of benign prostatic hypertrophy, the opening between the left and right ventricles is determined in the fetus. The muscle layer of the left ventricle is more developed than in the right, and therefore blood enriched with oxygen from the cavity of the left ventricle penetrates into the right 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 cardiac right ventricular failure and pulmonary hypertension.

Risk factors

The exact causes of the fetal hypertrophy of the fetus are unknown, but an important factor is burdened heredity (that is, the presence of a similar defect in the next of kin).

In addition, factors that are present during pregnancy play a huge role:

• Rubella. It is a viral disease. If during a real pregnancy (especially in the first trimester) a woman suffered rubella, then the fetus has a very high risk of various abnormalities of the internal organs (including DI).
• Alcohol and some medicines. Taking such drugs and alcohol (especially in the first weeks of pregnancy) significantly increases the risk of developing various abnormalities in the fetus.
• Inadequate treatment for diabetes. An unadjusted glucose level in a pregnant woman leads to fetal hyperglycemia, which may ultimately lead to a variety of congenital malformations.
  

Classification

There are several options for the location of breast cancer:

• Conventricular, membranous, perimembranous benign fetal hypertrophy. It is the most common location of the defect and accounts for approximately eighty percent of all such defects. A defect is detected on the membranous part of the septum between the ventricles with a probable spread to the output, septal and input sections of it; under the aortic valve and tricuspid valve (its septal valve). Quite often, aneurysms occur in the membranous part of the septum, which subsequently causes the closure (full or partial) of the defect.
• Trabecular, muscular benign prostatic hyperplasia in the fetus. It is found in 15-20% of all such cases. The defect is completely surrounded by muscles and can be located in any part of the muscle part of the septum between the ventricles. There are several similar pathological holes. Most often, such JMP in the fetus closes spontaneously spontaneously.
• Pulmonary, posterior, infundibular, ridge openings of the outflow tract account for approximately 5% of all such cases. A defect is located under the valves (semilunar) of the outlet or cone-shaped divisions of the septum. Quite often, this DMS due to prolapse of the right valve of the aortic valve is combined with aortic insufficiency;
• Defects in the area of ​​the bringing tract. A hole is located in the area of ​​the entrance section of the septum, directly below the area of ​​attachment of the ventricular-atrial valves. Most often, pathology accompanies Down syndrome.

Single defects are most often detected, however, multiple defects are found in the septum. ZHMP can participate in the combined heart diseases such as tetralogy of Fallot, vascular transposition and others.

In accordance with the dimensions, the following defects are distinguished:

• small (symptomatology is not expressed);
• medium (the clinic occurs in the first months after childbirth);
• large (often decompensated, with vivid symptoms, severe course and complications, which can lead to death).

Complications of DMZhP

With a small size of the defect, clinical manifestations may not occur at all or the holes may spontaneously close immediately after birth.

With larger defects, the following serious complications can occur:

• Eisenmenger syndrome. It is characterized by the development of irreversible changes in the lungs as a result of pulmonary hypertension. A similar complication can develop in both young and older children. In this condition, part of the blood moves from the right to the left ventricle through an opening in the septum, because due to hypertrophy of the myocardium of the right ventricle, it is “stronger” than the left. Therefore, oxygen depleted blood enters the organs and tissues, and, as a result, chronic hypoxia develops, manifested by a cyanotic shade (cyanosis) of the nail phalanges, lips and skin integument as a whole.
• Heart failure.
• Endocarditis.
• Stroke. It can develop with large defects of the septum due to turbulent blood flow. Blood clots are possible, which can subsequently clog brain vessels.
• Other pathologies of the heart. Arrhythmias and valve pathologies may occur.

Fetal breast cancer: what to do?

Most often, such heart defects are found on a second planned ultrasound. However, you should not panic.

• It is necessary to lead an ordinary lifestyle and not be nervous.
• The attending physician should carefully monitor the pregnant woman.
• If the 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 (for example, 1 mm in the fetus), openings may spontaneously close before or after birth.
• Neonatologist consultation and fetal ECHO may be required.

Diagnostics

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 before the birth of the baby, during routine ultrasound studies. Sufficiently large defects (for example, 4 mm DF of the fetus) are detected, as a rule, in the second or third trimester. Small ones can be detected after birth by accident or with the appearance of clinical symptoms.

The diagnosis of JMP for a newborn or an older child or adult can be made based on:

• Complaints of the patient. This pathology is accompanied by shortness of breath, weakness, pain in the heart, pallor of the skin.
• An anamnesis of the disease (the time of onset of the first symptoms and their connection with the loads).
• An anamnesis of life (burdened by heredity, illness of the mother during pregnancy and so on).
• General examination (weight, height, developmental compliance with age, skin tone and others).
• Auscultation (noise) and percussion (expansion of the borders 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 (i.e. an ultrasound of the heart). This study allows us to determine the location and size of the defect, and with dopplerometry (which can be done even in the prenatal period), the volume and direction of blood through the hole (even if CHD - DFM in the fetus is 2 mm in diameter).
• Cardiac catheterization. That is, the introduction of a catheter and the determination with its help of pressure in the vessels and cavities of the heart. Accordingly, the decision is made on further tactics of patient management.
• MRI Assign in cases if the Echo of the CG is uninformative.

Treatment

When a fetal heart failure is detected, they follow expectant tactics, 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 blood circulation and the general condition of the patient, they simply observe him. With large holes that violate the quality of life, they decide on the operation.

Surgical interventions for benign prostatic hypertrophy can be of two types: palliative (restriction of pulmonary blood flow in the presence of combined defects) and radical (complete closure of the opening).

Operational techniques:

• On an open heart (for example, with tetralogy of Fallot).
• Cardiac catheterization with controlled patching of the defect.

Ventricular septal defect prophylaxis

The fetus does not have specific prophylactic measures for breast cancer, however, in order to prevent CHD, it is necessary:

• Consult a antenatal clinic before twelve weeks of pregnancy.
• Regularly visit the LCD: 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.
• Follow the regimen and adhere to proper nutrition.
  
• Limit the effects of harmful factors.
• Exclude smoking and alcohol.
• Take the medicine strictly as directed by your doctor.
• Get a rubella vaccine at least six months before your planned pregnancy.
• With burdened heredity, carefully monitor the fetus for the earliest possible detection of CHD.

Forecast

With small fetal heart failure (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 location and the presence of a combination with other defects.