Ventricular septal urema. VSD ari mudumbu: zvinokonzera, kuongorora chirwere uye migumisiro

Ventricular septal urema (VSD) - buri, riri parusvingo inotarisira yokuparadzanisa in the kurudyi uye rworuboshwe ventricles.

tsananguro

Izvi ezvinhu kunotungamirira zvemamiriro vaiitawo (shunting) ropa. In tsika, munhu cardiac kuremara yakadaro - rakajairika vachiberekwa mwoyo chirwere. Critical ezvinhu ari kakawanda VSD kuva pazana. Zvakaenzana, kuti chidzoke pamusoro kuremara pasi nembudzana, vanhurume.

VSD mudumbu anogona dzoga (i.e., chete kuitika anomaly mumuviri) kana sechikamu kunzwisisa urema (trehstverchatogo vharafu Surgery, vascular transposition zvakajairika arterial hunde dzacho, tetralogy pamusoro Fallot).

Mune zvimwe zviitiko septum vasipo zvachose, zvakakanganisika rinonzi chete ventricle mwoyo.

VSD kiriniki

Symptomatology ventricular septal urema zvinowanzooneka richiratidzwa pamazuva okutanga kana mwedzi pashure pokuberekwa kwomwana.

Vakawanda kuratidzirwa kuremara dzinosanganisira:

• kupfupika mweya;
• cyanosis ganda (kunyanya nyore uye miromo);
• kurasikirwa havi;
• mwoyo palpitations;
• nekuneta;
• kuzvimba ari mudumbu, tsoka uye makumbo.

VSD pakuzvarwa angava asymptomatic, kana kuremara diki zvakakwana, uye kunyange kuitika musi papera (makore matanhatu kana kupfuura). Symptomatology iri zvakananga novimba kukura kuremara (mugomba), asi pasvika chiremba vanofanira ruzha zviri kunzwiwa auscultation.

VSD ari mudumbu: Zvinokonzera

Chero mwoyo vakaremara inokonzerwa vachivavhiringidza kukura mumuviri pakutanga zvokukura embryogenesis. An rinokosha pano ndohwaJehovha kwokunze nezvakatipoteredza uye masero okutodza.

Apo VSD fetus chinorondedzerwa buri pakati kuruboshwe uye ventricles zvakanaka. Kusiyiwa ventricular tsandanyama rukoko zvikuru dzakabudirira kupfuura zvakanaka, uye saka ropa, muchifumiswa pamwe okisijeni kubva ventricle rworuboshwe kupinda zvakanaka mhango Chinopinda uye mixes neropa okisijeni-kwezvinoshandiswa. Somugumisiro, kuti mapazi uye nyama iri akapa zvishoma okisijeni iyo pakupedzisira inotungamirira chisingaperi hypoxia muviri (hypoxia). Zvadaro, pamberi zvimwe vhoriyamu ropa zvakarurama ventricle rinobatanidza dilation wayo (kukura), myocardial hypertrophy, uye somugumisiro, panowanikwa cardiac rworudyi ventricular kukundikana uye pulmonary neBP.

zvinokonzera njodzi

The chikonzero chaiyo pakati VSD ari mudumbu vasingazivikanwi, asi chinokosha ndechokuti nhoroondo yemhuri (kureva, kuvapo urema yakadaro pedyo nehama).

Mukuwedzera, guru basa reDare zvinoita kuti varipo panguva pamuviri:

• Rubella. Chinhu nemavhairasi chirwere. Kana pari pamuviri (kunyanya wokutanga trimester), mumwe mukadzi akatambura rubella, mukana siyana zvomukati abnormalities (kusanganisira VSD) ari mudumbu chaizvo.
• Doro uye nemimwe mishonga. Kubvuma zvinodhaka izvi uye doro (kunyanya mumavhiki pamuviri rokutanga) Sezvineiwo kunowedzera ngozi yokuva zvakasiyana siyana abnormalities ari mudumbu.
• Rwakakwana pakurapwa kwechirwere cheshuga. Zvaiitika shuga iri pamuviri kunokonzera fetus hyperglycemia, izvo pakupedzisira zvinogona kutungamirira dzakasiyana-siyana vachiberekwa anomalies.

kupatsanura

Pane nzira dzakawanda kwazvo nzvimbo VSD:

• Konoventrikulyarny, membranous, perimembranozny VSD ari mudumbu. Ndicho inonyanya kuremara nzvimbo uye anenge makumi masere muzana zvakaipa zvose zvakadaro. Anoona urema iri membranous chikamu septum pakati ventricles pamwe zvinokwanisika kuparadzirwa goho, uye wedzera septal madhipatimendi dzayo; pasi kutsemuka vharuvhu uye tricuspid vharuvhu (septal kurova-rova kwayo). Kazhinji simuka aneurysm ari membranous chikamu kanganisa, nokuti chii vakazoroorwa zvinoitika kuvhara (zvizere kana kukwana) kuremara.
• Trabecular tsandanyama VSDs ari mudumbu. Rinowanikwa 15-20% vose nyaya dzakadaro. Kuremara akapoteredzwa zvachose tsandanyama uye rinogona riri chero chikamu migove tsandanyama septum pakati ventricles. makomba pathological kwakadaro kunogona kuonekwa zvishoma. Kakawanda, izvi DZHMP fetus nomuzvarirwo yakavharwa nomuzvarirwo.
• Podlegochnye, podarterialnye, infundibulyarnye, nagrebnevye water drainage makomba turakiti kunobvumirwa anenge 5% vose nyaya dzakadaro. Vemunyika urema ne mavharuvhu (semilunar) goho kana conical kanganisa zvikamu. Kazhinji, VSD nokuda prolapse rwerudyi kutsemuka vharuvhu mapepa nezvaaiitawo kutsemuka insufficiency;
• Kuremara kuunza turakiti. Ko gomba mazano kadhi partition nharaunda, chaipo pasi nzvimbo kuda yacho ventricular-atrial vharafu. Most chinowanzoguma zvokurwara pamusoro Down syndrome.

Inonyanyoshandiswa akawana urema chete, asi panewo zvakawanda zvikanganiso zviri partition. VSD anogona mubasa wemishonga mwoyo urema, akadai tetralogy pamusoro Fallot, transposition midziyo uye nevamwe.

Maererano ukuru zviparare ndedzinotevera:

• diki (Zviratidzo asina akaratidza);
• paavhareji (kiriniki ikoko pakutanga kwemwedzi pashure pokuberekwa);
• guru (more dekompensirovnnye, inopenya zviratidzo, zvakakomba uye nemamwe matambudziko chingaisa).

VSD yematambudziko

With miganhu duku ndiko kuremara Angasava kuratidzwa zvekuchipatara kazhinji zvaitika kana mawindo anogona kuvharwa pakarepo pashure pokuberekwa.

Kana makuru zvikanganiso anotevera zvakakomba yematambudziko anogona kuitika:

• Eisenmenger syndrome. Dzinoratidzwa kukura kusingarapiki kuchinja mumapapu zvichiguma pulmonary neBP. yematambudziko kwakadaro kunogona kuva muna vaduku uye nevana vakura. Panguva mamiriro ichi ropa anotama kodzero ventricle rworuboshwe kuburikidza buri septum, somugumisiro myocardial hypertrophy rwerudyi ventricle zviri "akasimba" kubva kuruboshwe. Nokuti nhengo uye nyama ropa mapopoma, okisijeni-kwezvinoshandiswa, uye somugumisiro, anova chisingaperi hypoxia, akaratidzawo rinokwanisa kucheneruka tint (cyanosis) phalanges mbambo, miromo uye ganda kazhinji.
• Heart kukundikana.
• Endocarditis.
• Nevanga. Inogona kuva panguva huru kuremara ari partition nokuda ropa riyerere inonetsa. Zvichida paumbwe clots ropa kuti pakupedzisira anogona kuzadza nhumbi wouropi.
• Other mwoyo chirwere. Unogona kuona arrhythmias uye vharafu pathologies.

VSD ari mudumbu: Chii kuita?

Kakawanda izvi mwoyo zvikanganiso dzakaonekwa pamusoro yakarongwa Ultrasound wechipiri. Zvisinei, musavhunduka.

• Zvakakosha kuramba zvakajairika upenyu uye kwete kuva huta.
• The kupinda Chiremba vanofanira kunyatsoongorora kuongorora pamuviri.
• Kana chakaremara iri kuona panguva dzose Ultrasound wechipiri, chiremba achaita yemutemberi kumirira wechitatu kuongorora (mu mavhiki 30-34).
• Kana chakaremara iri dzakaonekwa nezuva retatu Ultrasound, kugadza mumwe kuongorora pamberi pakukurukura.
• Fine (semuenzaniso, 1 mm VSD mudumbu) mawindo zvinogona kuvharwa nomuzvarirwo asati kana azvarwa.
• Ungafanira kubvunza neonatologist uye kuitisa fetus tinodzokorora.

Diagnostics

Chifungidziro kuvapo mutevedzeri anogona auscultation mwoyo uye mwana kuongorora. Zvisinei, kazhinji, vabereki vachadzidza kuvapo kuremara kudaro pamberi mwana aberekwa, panguva dzose Ultrasound zvidzidzo. Zvakakwana urema guru (semuenzaniso, 4 mm VSD mudumbu) aonekwa, kazhinji trimester yechipiri kana yechitatu. Small ndechokuti zvinogona kuona mushure tsaona rokuzvarwa kana chitarisiko yokuora zviratidzo.

Chirwere "DZHMP" achangoberekwa kana yakwegura mwana kana akura anogona kuiswa, kunobva:

• tsungirirai kugunun'una. zvokurwara Izvi pamwe kupfupika mweya, simba, kurwadziwa mumwoyo, ganda pallor.
• History of chirwere (nguva kutanga zviratidzo uye ukama hwavo mutoro).
• Nhoroondo Life (nhoroondo yemhuri, rwaamai chirwere panguva yepamuviri uye zvichingodaro).
• General kuongororwa (uremu, urefu, dzinza zera, ruvara rweganda, etc.).
• Auscultation (ruzha) uye percussion (akawedzera mwoyo miganhu).
• Kudzidza ropa uye weti.
• ECG Data (zviratidzo ventricular hypertrophy, conduction zvikanganiso uye mutinhimira).
• Rengenologicheskogo kudzidza (a dzakachinja chimiro mwoyo).
• Vetrikulografii uye angiography.
• Echocardiography (Ultrasound mwoyo ndiko). Kudzidza uku ndiko kuziva nzvimbo uye kukura kuremara, uye kana doplerometrii (chinogona kuitwa mu utero) - mari uye mirayiridzo ropa kuburikidza yokutanga (kunyange kana AMS - VSD ari mudumbu 2 mm mu dhayamita).
• Cardiac catheterization in. I.e. kupinza of anobudisa mushonga zvishoma nezvishoma uye kutsunga tichibatsirwa kufurirwa midziyo uye mwoyo in. Saka, maererano chisarudzo pamusoro yeramangwana kurapa varwere.
• MR. Vakagadzwa zviitiko apo echocardiography uninformative.

mabatiro

Pamusoro kuonekwa munhu mudumbu VSD vanoomerera takarinda nokumirira, nokuti kuremara arege nomuzvarirwo pedyo asati aberekwa kana pakarepo pashure pokuberekwa. Naizvozvo, apo kuramba zivo nechirwere murwere vanobatanidzwa cardiologists.

Kana chakaremara asingadi kunokanganisa ropa kuparadzirwa uye tikwanise ezvinhu omurwere, achiteverwa kungoona. For mumakomba guru, anotyora mararamiro, kusarudza kuvhiyiwa.

Kuvhiya pana VSD rinogona mhando mbiri: palliative (tikadzivisa pulmonary ropa riyerere pamberi akabatanidza malformations) uye kukuru (zvizere wokugumisa yokutanga).

Nzira oparesheni:

• Open Kuvhiya mwoyo (somuenzaniso, tetralogy pamusoro Fallot).
• Cardiac catheterization pamwe aidzora nokuiswa chigamba pamusoro kuremara.

Kudzivirira ventricular septal kuremara

Chaiwo matanho VSD ari mudumbu haasi Zvisinei, kuitira kudzivirira CHD, unofanira:

• Tsvaka antenatal uchenjerere vhiki gumi pamuviri.
• Gara vanopinda LCD: kamwe pamwedzi mitatu yokutanga, kamwe ose nhatu yechipiri trimester, uye ipapo kamwe ose mazuva gumi ari wechitatu.
• Cherechedza nzira uye vanoomerera kudya zvinovaka muviri.
• Kuderedza mugumisiro inokuvadza zvinhu.
• Kubvisa kusvuta uye doro.
• Tora mishonga zvachose ushandiswe nachiremba.
• Isa nhomba pamusoro rubella mwedzi dzinenge mitanhatu asati vakaronga pamuviri.
• Kana nhoroondo yemhuri kunyatsoongorora kuongorora zvibereko zvose kwokutanga kuziva miedzo CHD angava.

mataridzikiro

Apo VSD fetus diki (2 mm zvichidzika), wakakodzera fungidziro, sezvo makomba aya kazhinji pedyo nomuzvarirwo. Kana pane urema zvikuru fungidziro kunobva nzvimbo dzavo uye kuvapo mubatanidzwa nevamwe malformations.