Ventricular septal nkwarụ. VSD na nwa ebu n'afọ: akpata, nchoputa na ya pụta

Ventricular septal nkwarụ (VSD) - a onu, bụ nke dị na mgbidi na-eje ozi iji na-ekewapụ ndị cavities nke ziri ezi na n'aka ekpe ventricles.

Isi

Nke a ọnọdụ na-eduga ná ndiiche Ịgwakọta (shunting) ọbara. Na omume, dị a gbasara obi ntụpọ - kasị nkịtị congenital ọrịa obi. Critical ọnọdụ na a ugboro ole nke VSD ịzụlite iri abụọ na otu percent. Dokwara, ntoputa nke ntụpọ isiokwu ka ụmụaka, ma nwoke na nwanyị.

VSD nwa ebu n'afọ nwere ike dịpụrụ adịpụ (i.e., naanị ugbu a anomaly ke idem) ma ọ bụ dị ka akụkụ nke mgbagwoju ntụpọ (trehstverchatogo valvụ atresia, vaskụla transposition nkịtị ọbara Kporo, tetralogy nke Fallot).

N'ọnọdụ ụfọdụ septum anọghị kpamkpam, a ntụpọ na-akpọ otu ventricle nke obi.

VSD ọgwụ

Symptomatology ventricular septal nkwarụ a na-gosipụtara n'ụbọchị ndị mbụ ma ọ bụ ọnwa mgbe a mụrụ nwa ọhụrụ.

The kasị ngosipụta nke ntụpọ na-agụnye:

• iku ume ọkụ ọkụ;
• cyanosis nke anụ (karịsịa aka na egbugbere ọnụ);
• ọnwụ nke agụụ;
• obi palpitations;
• ike ọgwụgwụ;
• ọzịza na afo, ụkwụ na ụkwụ.

VSD na nwa nwere ike asymptomatic, ọ bụrụ na ntụpọ bụ obere ezu, na-erukwa na a gasịrị ụbọchị (afọ isii ma ọ bụ karịa). Symptomatology bụ kpọmkwem dabere na ịdị ukwuu nke ntụpọ (oghere), ma nche dọkịta kwesịrị noises na-nụrụ na auscultation.

VSD na nwa ebu n'afọ: akpatara

Ọ bụla congenital obi ntụpọ bụ n'ihi nsogbu na mmepe nke ahụ ná mmalite nkebi nke embryogenesis. Ọrụ dị mkpa ebe a bụ nke mpụga gburugburu ebe obibi na mkpụrụ ndụ ihe nketa na ihe.

Mgbe VSD nwa ebu n'afọ na-kọwaa oghere n'etiti n'aka ekpe na nri ventricles. Ekpe ventricular muscle oyi akwa bụ ihe mepere karịa nri, ya mere ọbara, enriched na oxygen si ekpe ventricle n'ime nri oghere penetrates na mixes na oxygen-depleted ọbara. N'ihi ya, ka akụkụ na anụ ahụ na-ọnọ obere oxygen nke mechara na-eduga ná ala ala hypoxia ahu (hypoxia). N'aka nke ya, ọnụnọ nke ọzọ ọbara olu nri ventricle gụnyere ya dilation (mgbasa), myocardial hypertrophy, na dị ka a N'ihi ya, omume nke gbasara obi nri ventricular odida na akpa ume ọbara mgbali.

ihe ize ndụ ihe

The kpọmkwem akpata ihe VSD na nwa ebu n'afọ na-amaghị ama, ma ihe dị mkpa bụ a akụkọ ezinụlọ (ie, ọnụnọ nke ndị dị otú ahụ ntụpọ dị na nso ikwu).

Ke adianade do, nnukwu ọrụ na-egwuri site ihe na-bụ ugbu n'oge ime:

• Rubella. Ọ bụ a malitere ịrịa ọrịa. Ọ bụrụ na nke ugbu a ime (karịsịa ke akpa trimester), a nwaanyị ahụhụ Rubella, ihe ize ndụ nke dị iche iche esịtidem akụkụ abnormalities (gụnyere VSD) nke nwa ebu n'afọ bụ nnọọ elu.
• Mmanya na-aṅụ ọgwụ ụfọdụ. Ịnakwere ndị a ọgwụ ọjọọ na ịṅụbiga mmanya (karịsịa akpa izu nke afọ ime) budata enwekwu ihe ize ndụ nke na-emepe emepe a dịgasị iche iche nke abnormalities na nwa ebu n'afọ.
• Erughị eru ọgwụgwọ nke ọrịa shuga. Uncorrected glucose na ime akpata nwa ebu n'afọ na hyperglycemia, nke n'ikpeazụ pụrụ iduga a dịgasị iche iche nke congenital anomalies.

nhazi ọkwa

E nwere ọtụtụ nhọrọ maka ọnọdụ nke VSD:

• Konoventrikulyarny, membranous, perimembranozny VSD na nwa ebu n'afọ. Ọ bụ ihe kasị nkịtị ntụpọ na ọnọdụ na bụ mkpokọta iri asatọ percent nke ndị nile dị otú omume ọjọọ. Achọpụta a nkwarụ na membranous akụkụ nke septum n'etiti ventricles na o kwere omume mgbasa nke mmepụta, na input septal ya ngalaba; n'okpuru aortic valvụ na tricuspid valvụ (septal ya flaapu). Ọtụtụ mgbe ibili aneurysm na membranous akụkụ nke itunanya, n'ihi ihe ekemende eme mmechi (full ma ọ bụ ele mmadụ anya n'ihu) nkwarụ.
• Trabecular muscular VSDs na nwa ebu n'afọ. Ọ dị n'ime 15-20% niile dị otú ahụ ikpe. Nkwarụ kpamkpam gbara ya gburugburu uru na ike ga-dị na bụla nke muscular òkè septum n'etiti ventricles. Ndị dị otú ahụ enweghị nchịkwa oghere nwere ike hụrụ a ole na ole. Ọtụtụ mgbe, ndị a DZHMP nwa ebu n'afọ spontaneously emechi spontaneously.
• Podlegochnye, podarterialnye, infundibulyarnye, nagrebnevye outflow tract oghere mejupụtara ihe dị 5% nke niile dị otú ahụ ikpe. Metụtara nanị akụkụ ụfọdụ nkwarụ site valves (semilunar) mmepụta ma ọ bụ conical itunanya ngalaba. Ọtụtụ mgbe, VSD ruru prolapse nke nri aortic valvụ mpempe akwụkwọ jikọtara na aortic insufficiency;
• Ntụpọ na-eweta tract. Bụ a onu input kaadị nkebi ebe, nri n'okpuru ebe nke na-ekekọta nke ventricular-atrial valvụ. Ọtụtụ mgbe esokwa daa ọrịa nke Down syndrome.

The ọtụtụ ugboro ugboro hụrụ otu ntụpọ, ma e nwekwara ọtụtụ flaws na nkebi. VSD nwere ike isonye na Nchikota obi ntụpọ, dị ka tetralogy nke Fallot, transposition arịa ndị ọzọ.

Na dị na size nke ntụpọ bụ ndị na-esonụ:

• obere (mgbaàmà na-adịghị owụt);
• nkezi (ọgwụ e ke akpa ọnwa mgbe amuchara nwa);
• nnukwu (ọzọ dekompensirovnnye, na-enwu gbaa mgbaàmà, oké ahụ na nsogbu na nwere ike igbu).

VSD nsogbu

Na obere akụkụ nke ntụpọ nwere ike ịbụ na-adakarị ngosipụta n'ozuzu ime spontaneously ma ọ bụ oghere nwere ike a ga-emechi ya ozugbo mgbe amuchara nwa.

Mgbe ibu ntụpọ esonụ dị oké njọ nsogbu nwere ike ime:

• Eisenmenger syndrome. Ji mmepe nke irreversible mgbanwe ngụgụ dapụtara akpa ume ọbara mgbali. Dị otú ahụ nsogbu nwere ike ịzụlite dị ka na-eto eto na ndị okenye ụmụ. Mgbe a na ala nke ọbara Nkea si nri na n'aka ekpe ventricle site onu septum, dị ka a n'ihi nke myocardial hypertrophy nke nri ventricle ọ bụ "ike" nke dị n'aka ekpe. N'ihi na akụkụ na anụ ahụ nke ọbara Falls, oxygen-depleted, na N'ihi, amalite-adịghị ala ala hypoxia, gosipụtara a bluish tint (cyanosis) phalanges ntu, egbugbere ọnụ na akpụkpọ n'ozuzu.
• Heart ọdịda.
• Endocarditis.
• Ọrịa strok. Ọ pụrụ ịzụlite na isi ntụpọ nke nkebi ruru ka ọgba aghara ọbara. Ikekwe guzobe egbochi mkpụkọ nke ọbara na mechara clog arịa nke ụbụrụ.
• Ọzọ ọrịa obi. Ị nwere ike arrhythmias na valvụ pathologies.

VSD na nwa ebu n'afọ: Gịnị na-eme?

Ọtụtụ mgbe a obi ntụpọ ahụrụ na abụọ ndokwa ultrasound. Otú ọ dị, ihe ya masịrị ya.

• Ọ dị mkpa ịnọgide na-enwe kwesịrị ndụ na-abụ ụjọ na-atụ.
• The ịga dibịa ga-akpachara anya nyochaa ime.
• Ọ bụrụ na a nkwarụ achọpụtara n'oge nke abụọ na-eme ultrasound, dọkịta ga nwere ike ikwu na-eche maka nke atọ e mere na (na 30-34 izu).
• Ọ bụrụ na a nkwarụ na-ahụrụ na-atọ ultrasound, inye ọzọ nnyocha tupu nnyefe.
• Fine (e.g., 1 mm VSD nwa ebu n'afọ) oghere nwere ike a ga-emechi spontaneously tupu ma ọ bụ mgbe a mụrụ ya.
• Ị nwere ike mkpa gakwuru neonatologist ma na-eduzi nwa ebu n'afọ na-ekwughachi.

nchọpụta nsogbu

Chee ọnụnọ nke osote nwere ike auscultation obi na nwa nnyocha. Otú ọ dị, ọtụtụ mgbe, ndị nne na nna ga-amụta banyere ọnụnọ nke ndị dị otú a nkwarụ tupu mụrụ nwa ọhụrụ, n'oge na-eme ultrasound ọmụmụ. Zuru ezu nnukwu ntụpọ (e.g., 4 mm VSD nwa ebu n'afọ) na-ahụrụ, na-emekarị nke abụọ ma ọ bụ atọ trimester. Obere dịkwa ike ịchọpụta ihe ahụ mechara ọmụmụ ma ọ bụ ọdịdị nke na-adakarị mgbaàmà.

Diagnosis "DZHMP" nwa ọhụrụ ma ọ bụ okenye nwata ma ọ bụ okenye pụrụ enịm, dabeere na:

• ndidi mkpesa. Nke a daa ọrịa na-esonyere mkpụmkpụ nke ume, adịghị ike, ihe mgbu na obi, anụ pallor.
• History of ọrịa (oge nke mmalite nke mgbaàmà na ha mmekọrita ibu).
• Life akụkọ ihe mere eme (akụkọ ezinụlọ, nne nwa ọrịa n'oge ime na na).
• General nnyocha (arọ, ogo ya, akara nke afọ, ụcha akpụkpọ ahụ, wdg).
• Auscultation (mkpọtụ) na percussion (ịmụba ọnụ ọgụgụ nke obi ókè).
• The ọmụmụ nke ọbara na mmamịrị.
• ECG data (ihe ịrịba ama nke ventricular hypertrophy, conduction ntụpọ na n'afọ iri na ụma).
• Rengenologicheskogo ọmụmụ (a gbanwetụrụ ụdị nke obi).
• Vetrikulografii na angiography.
• Echocardiography (ultrasound nke obi nke na-). Nke a na-amụ bụ iji chọpụta na ọnọdụ na size nke ntụpọ, na mgbe doplerometrii (nke nwere ike rụrụ ke utero) - ego na direction ọbara site na oghere (ọbụna ma ọ bụrụ na AMS - VSD na nwa ebu n'afọ 2 mm n'obosara).
• Gbasara obi catheterization cavities. I.e. ntinye nke catheter na mkpebi siri ike na enyemaka nke mgbali arịa na obi cavities. Ntem, dị ka a mkpebi na ọdịnihu management nke ọrịa.
• MR. Họpụtara otu ebe echocardiography uninformative.

ọgwụgwọ

N'elu nchọpụta nke a nwa ebu n'afọ VSD rube isi na-eche nche nchere, n'ihi na ntụpọ nwere ike spontaneously nso tupu ọmụmụ nwa ma ọ bụ ozugbo a mụrụ ya. Gasịrị, mgbe nọgide na-enwe ihe ọmụma nke nchoputa nke onye ọrịa aka cardiologists.

Ọ bụrụ na ntụpọ adịghị ichegbu na ọbara na mkpokọta ọnọdụ onye ọrịa, ndị dị nnọọ na-ekiri. N'ihi na nnukwu oghere, na-agbasa na àgwà nke ndụ, ime mkpebi nwere n'ịwa ahụ.

Ịwa ahụ na VSD nwere ike ịbụ nke abụọ na ụdị: palliative (amachi akpa ume ọbara na ọnụnọ nke metụtara malformations) na buu (full oghere mmechi).

Method nke ọrụ:

• Open ịwa obi (atụ, tetralogy nke Fallot).
• Gbasara obi catheterization na-achịkwa imposition nke a kwachie n'elu ntụpọ.

Prevention of ventricular septal nkwarụ

Specific mgbochi VSD na nwa ebu n'afọ bụ Otú ọ dị, iji gbochie CHD, ị ga-:

• Chọọnụ antenatal-elekọta iri na abụọ izu nke afọ ime.
• Agachi LCD: otu ugboro a ọnwa mbụ ọnwa atọ, ozugbo ọ bụla izu atọ na abụọ trimester, na mgbe ahụ ozugbo ọ bụla ubọchi iri na atọ.
• Edebe mode na rube isi kwesịrị ekwesị oriri na-edozi.
• Ibelata mmetụta ndị na-emerụ ihe.
• Kwụsị ise siga na-aba n'anya.
• Were ọgwụ nditịm kenyere onye dọkịta.
• Tinye ọgwụ mgbochi ọrịa megide Rubella dịkarịa ala ọnwa isii tupu zubere ime.
• Mgbe akụkọ ezinụlọ nlezianya nyochaa mkpụrụ ma na mbụ nchọpụta nke CHD nwere ike ịbụ.

ele ihe anya

Mgbe VSD nwa ebu n'afọ na obere (2 mm ma ọ bụ obere), mma prognosis, dị ka ndị a oghere na-abụkarị nso spontaneously. Ọ bụrụ na e nwere isi ntụpọ prognosis na-adabere na ha na ọnọdụ na ọnụnọ nke a Nchikota na ndị ọzọ malformations.