Ventricular isici septal. VSD ku-fetus: izimbangela, ukuxilongwa kanye nemiphumela

Ventricular isici septal (VSD) - umgodi, elisetendeni odongeni elikhonza ukuhlukanisa izimbotshana kwelungelo futhi ventricles ngakwesokunxele.

Uhlolojikelele

Lesi simo kuholela kuhlangana okungavamile (shunting) kwegazi. Ekusebenteni, isici okufana inhliziyo - okuvame kakhulu yesifo senhliziyo azalwa naso. usesimweni esibucayi ngesikhathi imvamisa VSD ukuthuthukisa amaphesenti amabili nanye. Ngokulinganayo, ukuvela isihloko isici ukuba izingane, abesilisa nabesifazane.

VSD umbungu kungenzeka isehlane (ngamanye amazwi, kuphela anomaly zamanje emzimbeni) noma njengengxenye ukukhubazeka eziyinkimbinkimbi (trehstverchatogo valve atresia, transposition semithambo ezivamile iziqu lwemithambo, tetralogy of Fallot).

Kwezinye izimo septum engekho ngokuphelele, isici okuthiwa ventricle eyodwa ngokusuka enhliziyweni.

VSD umtholampilo

Symptomatology septal ventricular isici Ngokuvamile ubonakaliswa isimo sengqondo ngezinsuku zokuqala noma izinyanga esezele ingane.

I ukubonakaliswa ezivamile icala zihlanganisa:

• iphika;
• cyanosis kwesikhumba (ikakhulukazi kalula futhi izindebe);
• ukungakuthandi ukudla;
• palpitations inhliziyo;
• ukukhathala;
• nokuvuvuka esiswini, izinyawo nemilenze.

VSD ngesikhathi sokuzalwa kungenzeka asymptomatic, uma isici singesabo sincane ngokwanele, ngisho kwenzeka ngolunye usuku (iminyaka eyisithupha noma ngaphezulu). Symptomatology kuyinto encike ngqo kwi ubukhulu isici (imbobo), kodwa abatshele ukuthi kumele udokotela imisindo zibe nezwi auscultation.

VSD ku-fetus: Izimbangela

Noma yimuphi inhliziyo yayo yayinezinkinga ezicini azalwa naso kukhona ngenxa yokuphazamiseka ukuthuthukiswa yomzimba kusaqalwa embryogenesis. Indima ebalulekile lapha kungokwalabo izici zangaphandle kwemvelo kanye zofuzo.

Lapho VSD fetus kuchazwe wokuvula ozobe uphakathi kwesokunxele bese ventricles kwesokudla. Kwesobunxele ventricular imisipha ungqimba atfutfuke kakhulu kunemakhono ngakwesokudla, ngakhoke igazi, ahlanganiswe oksijini evela ventricle engakwesobunxele ku ilungelo ingaphakathi Bufinyelela futhi Ihlangana ngegazi elingenawo umoya-mpilo. Ngenxa yalokho, ukuba kwezitho nezicubu ihlinzekwa mpilo omncane eyagcina kuholela ezingamahlalakhona hypoxia umzimba (hypoxia). Ngakwelinye ihlangothi, khona ezengeziwe igazi nomthamo i-ventricle yangakwesokudla akuhileli Ukuvuleka komlomo walo (ukunwetshwa), hypertrophy esivimba amanzi, futhi ngenxa yalokho, okuvela kuyo inhliziyo kwesokudla ventricular ukwehluleka kanye nomfutho wegazi ophezulu yamaphaphu.

engcupheni

Imbangela ye-VSD ku-fetus awaziwa, kodwa into okuyiyona ebaluleke kakhulu umlando umndeni (ie, khona ukukhubazeka okunjalo e eziseduze).

Ngaphezu kwalokho, indima enkulu eyadlalwa izici ukuthi zikhona ngesikhathi sokukhulelwa:

• Rubella. Lesi isifo ezibangelwa amagciwane. Uma ukukhulelwa wamanje (ikakhulukazi senyanga yokuqala), owesifazane wahlupheka rubella, ingozi ahlukahlukene yangaphakathi izitho kwezinso (kuhlanganise VSD) umbungu kuphezulu kakhulu.
• Utshwala futhi kunemithi noma amaphilisi owaphuzayo. Ukwamukela lezi izidakamizwa notshwala (ikakhulukazi emasontweni okuqala okukhulelwa) kakhulu kwandisa ingozi yokuba ezihlukahlukene kwezinso ku-fetus.
• ukuphathwa Imphumelelo sikashukela. glucose Uncorrected ekukhulelweni kubangela Hyperglycemia fetus okwagcina kungaholela ezihlukahlukene anomalies azalwa naso.

ngezigaba

Kunezindlela eziningana ongakhetha kuzona ngoba indawo VSD:

• Konoventrikulyarny, membranous, VSD perimembranozny ku-fetus. Kuyinto ezivamile isici indawo futhi cishe ayisishiyagalombili amaphesenti zonke izinto ezimbi ezifana. Kuthola isici ukuba sibe ingxenye membranous we septum phakathi ventricles ne ukusabalala kungenzeka nomkhiqizo, nokokufaka septal neminyango yayo; ngaphansi valve yomthambo i-aorta ne-valve tricuspid (septal ichopho yayo). Kaningi kuphakama useshonile engxenyeni membranous we ahlula, ngenxa yalokho kamuva kwenzeka Ukuvalwa (ngokugcwele noma kancane) ukungasebenzi kahle.
• Trabecular VSDs kwemisipha ku-fetus. Sitholakala 15-20% azo zonke izimo ezinjalo. Isici uzungezwe ngokuphelele kwemisipha kungenziwa etholakala noma iyiphi ingxenye izingxenye kwemisipha septum phakathi ventricles. izimbobo okunjalo sokugembula kungabonwa ambalwa. Ngokuvamile, lezi DZHMP-fetus angesabi ivaliwe angesabi.
• Podlegochnye, podarterialnye, infundibulyarnye, izimbobo ipheshana outflow nagrebnevye bakha cishe 5% we zonke izimo ezinjalo. Kuhunyushelwe isici by valve (semilunar) okukhipha noma ahlula oyindilinga izigaba. Kaningana, VSD ngenxa prolapse kwelungelo yomthambo i-aorta ne-valve amapheshana kuhlangene esingamahlalakhona yomthambo i-aorta;
• Kwekhono ngokuletha ipheshana. Ingabe imbobo ikhadi okokufaka ukwahlukanisa ndawo, ilungelo ngaphansi endaweni ukunamathela valve ventricular-atrial. Ngokuvamile esihambisana zokugula we-Down syndrome.

The njalo kunazo wathola ukukhubazeka olulodwa, kodwa futhi kukhona amaphutha eziningi kungxenye. VSD iqhaza inhlanganisela ukukhubazeka inhliziyo, ezifana tetralogy of Fallot, transposition imithambo nabanye.

Ngokuhambisana Usayizi ukukhubazeka kukhona okulandelayo:

• ezincane (izimpawu kungukuthi uzwakalise);
• isilinganiso (umtholampilo khona ezinyangeni zokuqala ngemva kokuzalwa);
• ezinkulu (dekompensirovnnye nokuningi, izimpawu elikhanyayo, ezinzima futhi nezinkinga ezingase zibe yingozi).

yezinkinga VSD

Nge Ubukhulu encane yokuphambana kungenzeka ingabi ukubonakaliswa emitholampilo ngokuvamile kwenzeka angesabi noma ukuvuleka kungenzeka ivalwe ngokushesha emva kokuzalwa.

Lapho ukukhubazeka emikhulu elandelayo eziyingozi singenzeka:

• Eisenmenger syndrome. Libhekene ukuthuthukiswa izinguquko ezingenakuhlehliswa emaphashini okuholela nomfutho wegazi ophezulu yamaphaphu. yezinkinga okunjalo ingaqala njengasezulwini abasha futhi izingane ezindala. Ngalesi isimo uhamba igazi ilungelo i-ventricle engakwesobunxele ngembobo ku septum, ngenxa hypertrophy esivimba amanzi ka-ventricle yangakwesokudla kuba "namandla" ngakwesokhohlo. Ngoba kwezitho nezicubu Ukuwa igazi, umoya-mpilo, futhi ngenxa yalokho, eba hypoxia okungamahlalakhona, yabonisa tint bluish (cyanosis) phalanges nail, izindebe kanye isikhumba ngokuvamile.
• ukuhluleka Inhliziyo.
• Endocarditis.
• Stroke. Kungaba ngezinye izici eziyinhloko ukwahlukanisa ngenxa yezinxushunxushu ukugeleza kwegazi. Mhlawumbe kumiswa amahlule ezingaba ekugcineni clog imithambo zobuchopho.
• Okunye isifo senhliziyo. Ungezwa arrhythmias kanye valve pathologies.

VSD ku-fetus: Yini okumele uyenze?

Ngokuvamile lezi ukukhubazeka inhliziyo sitholakale yesibili ultrasound okuhleliwe. Nokho, ningatatazeli.

• Kuyadingeka ukuba silondoloze ukuphila okuvamile hhayi kube novalo.
• Udokotela ukuba khona kufanele ukuqapha ngokucophelela sokukhulelwa.
• Uma isici itholwa phakathi nekhulu lesibili ultrasound isimiso, udokotela uyoncoma ukulinda inhlolovo yesithathu (emasontweni 30-34).
• Uma isici itholwa kwi ultrasound lwesithathu, liqoke omunye ukuhlolwa ngaphambi kokubeletha.
• Fine (isib 1 mm VSD fetus) Ukuvuleka kungenziwa ivaliwe angesabi ngaphambi noma ngemva kokuzalwa.
• Ungase udinge uthintane neonatologist nokuqhuba izifundo ECHO fetus.

ukuhlola

Usola khona okuphambene kungaba auscultation ezisekujuleni kwenhliziyo futhi wokuhlola ingane. Nokho, ezimweni eziningi, abazali uzofunda khona isici okufana ngaphambi kokuzalwa komntwana, phakathi nesimiso izifundo ultrasound. Ngokwanele ukukhubazeka enkulu (isib 4 mm VSD fetus) kutholwa, ngokuvamile senyanga yesibili noma yesithathu. Small zingenza ukuthola ngemuva kwengozi lokuzalwa noma ukubukeka izimpawu zokwelashwa.

Sifo "DZHMP" osanda kuzalwa noma kwengane amadala noma omdala zingafakwa, okusekelwe:

• izikhalazo nesineke. Lokhu zokugula kuhambisana iphika, ubuthakathaka, ubuhlungu enhliziyweni, isikhumba pallor.
• Umlando lesi sifo (isikhathi lapho kuqala izimpawu nobudlelwane phakathi umthwalo).
• umlando Life (umlando womndeni, ukugula komama ngesikhathi sokukhulelwa nokunye).
• luhlolo Jikelele (isisindo, ubude, umugqa ubudala, ibala lesikhumba, njll).
• Auscultation (umsindo) kanye eshaywayo (kweNdikimba imingcele inhliziyo).
• Ucwaningo egazi noma omchamo.
• idatha ECG (izimpawu ventricular hypertrophy, conduction zikhubazeke futhi isigqi).
• cwaningo Rengenologicheskogo (ifomu sokulungisa inhliziyo).
• Vetrikulografii futhi angiography.
• Echocardiography (ultrasound inhliziyo okungukuthi). Lolu cwaningo ukuze kutholakale indawo kanye nosayizi yokungafaneleki, nalapho doplerometrii (okuyinto engenziwa utero) - lemali futhi isiqondiso wegazi ngembobo (ngisho noma AMS - VSD ku-fetus 2 mm ububanzi).
• Senhliziyo catheterization izimbotshana. Okuyi ukufakwa ipayipi nokuzimisela ngosizo izitsha ingcindezi kanye izimbotshana inhliziyo. Ngakho, ngokuvumelana isinqumo ekuphathweni esizayo iziguli.
• MR. Esimisiwe ezimweni lapho echocardiography uninformative.

ukwelashwa

Phezu ukuthola umntwana VSD abanamathela sokulinda elindile, ngoba isici may angesabi eduze ngaphambi kokuzalwa noma ngokushesha emva kokuzalwa. Ngemva kwalokho, ebe egcina ulwazi sitholakele isiguli abathintekayo nangodokotela bababhekene nezifo zenhliziyo.

Uma isici akusho ziphazamisa kwegazi igazi isimo jikelele isiguli, kulandele nje ukubukela. Ukuze izimbobo ezinkulu, breaking izinga lempilo, wenze isinqumo ahlinzwe.

Ukuhlinza at VSD kungaba ezimbili zama: okuthuthukisa (nomkhawulo yamaphaphu ukugeleza kwegazi ebukhoneni kombungu ezihambisana) kanye olukhulu (lokuvala umnyuziki ukuvulwa).

Indlela operation:

• Vula ukuhlinzwa kwenhliziyo (isibonelo, tetralogy of Fallot).
• catheterization senhliziyo ne ukunqunywa elawulwa of isichibi phezu engasebenzi.

Ukuvimbela ventricular septal isici

izinyathelo Specific zokuvimbela VSD ku-fetus Nokho, akukhona, ukuze kuvinjelwe CHD, kumele:

• Kuthola usizo sekuhambe amasonto nambili yokukhulelwa.
• Njalo khona LCD: kanye ngenyanga ezinyangeni ezintathu zokuqala, kanye njalo emavikini amathathu senyanga yesibili, bese njalo ngemva kwezinsuku eziyishumi wesithathu.
• Bagcine imodi nokubambelela umsoco ofanele.
• Olugcwele umphumela zici eziyingozi.
• Ukuphungula ukubhema kanye notshwala.
• Thatha imithi ngokuqinile udokotela.
• Beka zigonyelwe rubella okungenani ezinyangeni eziyisithupha ngaphambi sokukhulelwa okuhleliwe.
• Lapho umlando womndeni ukuqapha ngokucophelela izithelo kokubili ukuthola ezandulele CHD kungenzeka.

ukuba nombono ongafani ngeke

Lapho VSD fetus ezincane (2 mm noma ngaphansi), onalesi sifo evumayo, njengoba lezi izimbobo ngokuvamile eduze angesabi. Uma kukhona ukukhubazeka ezinkulu Izibikezelo incike indawo yabo futhi khona lihambisana namanye kombungu.