Ventricular septal kina. VSD i loko o ka fetus: kumu,ʻike, a me ka hopena

Ventricular septal kina (VSD) - i ka puka, i mea i loko o ka pā i ka lawelawe 'ana e hookaawale i ka cavities o ka akau a me ka hema ventricles.

Overview

Keia ano hiki aku ai i ka'āno'ē paʻipaʻiʻia ai e (shunting) o ke koko. I ka mea, e like me ka cardiac kina - ka loa, he pono ole congenital naʻau maʻi. Noho pilikia ano ma ke alapine (frequency) o VSD hoʻomōhala iwakalua-kekahi pakeneka. Like, i ka muli o ke kina kumuhana i na keiki, o ke kane a me ka wahine.

VSD fetus i ke kaʻawale (a laila, wale ka he anomaly i loko o ke kino) a me hapa o ka luna 'mā (trehstverchatogo kiwikā atresia, vascular transposition, he pono ole arterial nui ilpko o, tetralogy o Fallot).

Ma kekahi hihia i ka septum ua kahi e loa, he kina i kapaia hookahi ventricle o ka naau.

VSD? aaieou

Symptomatology ventricular septal kina ua pinepine hoikeia'ku auanei i ka lā mua paha mahina ma hope o ka hanau ana o ke keiki.

Ka loa e like me ka hoike ana mai o ka hewa ma nā:

• pokole o ka hanu;
• cyanosis o ka ili (oi fingertips a me nā lehelehe);
• kahe o ka ikaika loa ka makemake;
• naau palpitations;
• luhi;
• haanou ana i loko o ka abdomen, na wawae a me nā wāwae.

VSD i hanau i e asymptomatic, ina ke kina mea uuku lawa, a e hana ana ma ka hope o ka lā (eono makahiki a oi). Symptomatology mea pololei e kaukaʻi ma o ka nui o ke kina (lua), akā, Alert i ke kauka pono e lohe ino ma auscultation.

VSD i loko o ka fetus: 'ehaʻeha ka

Kekahi congenital naau mā i aie i ka haunaele ma ka ulu ana o ke kino i loko o ke kahua o ka hoʻonaʻauao kakahiaka o ka embryogenesis. An nui kūlana 'aneʻi e pili ana i ka mawaho? Aneie, a aaiaoe aʻe.

A lohe o VSD fetal i ho'ākāka 'weheʻana ma waena o ka hema a me ka akau ventricles. Haʻalele ventricular Muscle, ahu iho Ua oi? Acaeoey oo mua ma ka pono, a no ia mea, i ke koko, lako oukou me ka o oxygen, mai ka ventricle hema i loko o ka akau lua komo iloko, a ua hui me ke koko i oxygen-depleted. E like me ka hopena, i nā loko a me nā'aʻaʻa ua lako emi ka oxygen i ho'ōla hiki aku ai i ka maʻi hypoxia kino (hypoxia). I huli ai oe, i ke alo o nā koko ka leo i loko o ka ventricle akau entails kona dilation (ke? Anoe?), Myocardial hypertrophy, a me ka hopena, i ka hanana o cardiac pono ventricular ka hoʻokō 'ole a me ka pulmonary hypertension.

kamepiula kumumea

Ke mau kumu o ka VSD i loko o ka fetus i ike ole ia, akā, nui ka ololi o kaʻohana mōʻaukala ( 'o ia hoʻi, ke alo o ia mā i kokoke loa hoahanau).

Eia hou, ke kūlana nunui pâʻani 'o ia ma kumumea i nā makana i hāpai keiki:

• Rubella. He He mea hoʻomaʻi maʻi. Inā kaʻikena hāpai keiki (oi loa i loko o ka trimester mua), he wahine i ae rubella, ka pilikia o nā kūloko ma nā loko abnormalities (me VSD) o ka fetus ka loa kiʻekiʻe.
• Alcohol a me kekahi lapaʻauʻia. Ae o kēia mau ai 'a me ka waiʻona (oi loa i loko o ka mua pule o ka hāpai keiki) me ka nui loa maoli ka pilikia o ka ulu i keʻano o nā abnormalities i loko o ka fetus.
• Lawa ponoʻole kanaka o ka mimikō. Uncorrected monakō koko ma ka hāpai keiki a nā fetal hyperglycemia, i ultimately ke alakai i kekahiʻano o congenital anomalies.

Mea Maluna

Aia i kekahi mau koho no ka wahi o ka VSD:

• Konoventrikulyarny, membranous, perimembranozny VSD ma ka fetus. He ka loa, he pono ole kina wahi a mea o ka hola kanawalu pakeneka o nā mea a pau ia mau hewa. Huai ae he kina ma ka membranous hapa o ka septum ma waena o nā ventricles me ka hiki hohola ana o ka auoiaea, a me ka hoʻokomo o septal kona Oihana; ma lalo o ka aortic kiwikā a me ka tricuspid kiwikā (septal kona puapua). Muli o kona kulana pinepine e ala aneurysm i loko o ka membranous hapa o ka baffle, no ka mea, o ka mea a laila hana panina (piha paha ka helehelena) kina.
• Trabecular muscular VSDs i loko o ka fetus. Ua ua loaʻa i loko o 15-20% o nā mea a pau ia mau hihia. Kina pau hoʻopuniʻia e nāʻiʻo a me ka hiki ke noho i loko o kekahi hapa o ka muscular'āpana septum ma waena o nā ventricles. Oia pathological lua hiki ke ike i kekahi mau. Loa pinepine, mau DZHMP ka fetus spontaneously papani spontaneously.
• Podlegochnye, podarterialnye, infundibulyarnye, nagrebnevye outflow'āpana lua hoolilo ka hola 5% o nā mea a pau ia mau hihia. IIeEeAIEUIeXAIIUE hewa ma ka nohona kiwikā (semilunar) auaiaea ole conical baffle pauku. Muli o kona kulana pinepine, i ka VSD ma muli o ka prolapse o ka akau aortic kiwikā leaflets hui me aortic insufficiency;
• Mā i ka lawe ana mai'āpana. Ua ka puka i loko o ka hoʻokomo o kāleka paku āpana, pono ma lalo o ka wahi o ka IeIIeYOA o ka ventricular-atrial kiwikā. Loa pinepine accompanies pathology o Down maʻi pale.

Ka loa pinepine loaʻa hookahi mā, akā, he mea no hoi flaws lehulehu i loko o ka paku. VSD ke komo i loko o ka hui malu pu ana o ka naau mā, e like me tetralogy o Fallot, transposition o na moku a me na mea e ae.

I kulike ai me ka nui o na mā i ka penei:

• uuku (symptoms ka mea, i kāheaʻia);
• awelike (? aaieou ma laila i loko o ka mahina mua ma hope o ka hānau);
• nui (hou dekompensirovnnye, me ka aahu symptoms, loa a me ka complications i hiki e ona).

VSD complications

Me Ana uuku o ke kina i ole ia i ka lapaʻau hoikeana nui ana spontaneously paha i ka weheʻana paha e paa koke ma hope o ka hanau ana.

I ka nui mā kēia mau complications nui ke ana:

• Eisenmenger maʻi pale. Wehewehe aku ma ka hooulu ana o irreversible loli ma na maʻiʻaʻai kūpono ma pulmonary hypertension. Oia complications hiki hoʻomōhala me ka opiopio, a me ka mua keiki. Ma keia wahi o ka neʻe aku i ke koko mai ka akau a hiki i ka ventricle hema ma ka puka i loko o ka septum, like me ka hopena o myocardial hypertrophy o ka ventricle'ākau ia o "ikaika" o ka hema. No ka mea, na nā loko a me nā'aʻaʻa o na, Kaneohe koko, o oxygen-depleted, a nolaila, e hoʻomōhala ana i maʻi hypoxia, hoikeia mai i ka bluish tint (cyanosis) phalanges kui, mau lehelehe, a me ka ili nui.
• Heart ole.
• Endocarditis.
• Hahau ana. Ua hiki hoʻomōhala i ka nui mā o ka paku ma muli o ka māpuna koko pele. Paha i ke kahua o ke koko clots i hiki e ho'ōla clog i nā ipu o ka lolo.
• Other naʻau maʻi. Oe i 'ike arrhythmias a me ka nohona kiwikā pathologies.

VSD i loko o ka fetus: He aha e hana ai?

Loa pinepine mau naau mā 'akomi i ma luna o ka lua o ka pae' ultrasound. Eia naʻe, mai panic.

• He pono e malama maʻamau ola, aʻaʻole e ko mākou hopohopo.
• Ka hele kauka E akahele kanaka hoʻoponopono i ka hāpai keiki.
• Inā he kina ua 'akomi i ka lua o ka oaeouee? Ultrasound, ke kauka, e paipai aku, e kali no ka mea kolu o ka anamanaʻo (i loko o 30-34 pule).
• Inā he kina ua 'akomi i ma luna o ke kolu o ka ultrasound, e hoonoho i kekahi nana mua haawi.
• Paheona (e laʻa me, 1 mm o VSD fetus) puka hiki ke paa spontaneously mua ma hope o ka hānau paha.
• Oe e Pono e kukakuka neonatologist, a e mālama nei fetal küpinaʻi.

lapaʻau '

Manao i ke alo o ka hope ke auscultation o ka naau, a me ka keiki nana. Eia naʻe, i loko o ka hapanui hoopii, na makua, e aʻo e pili ana i ke alo o ia i ka hewa ma mua o ka pēpē ua hanau, oaeouee? Ultrasound haʻawina i. Lawa ka nui mā (e laʻa me, 4 mm o VSD fetus) e ia akulla, i hookuu i ka lua a me ke kolu trimester. Small mea i hiki, e huai ae ma hope o ka ulia o ka hānau a me ka helehelena o ka lapaʻau symptoms.

ʻike, "DZHMP" keiki 'ole he keiki mua a he kanaka makua hiki ke kauʻia, ma muli ia:

• hoʻomanawanui hoopii. Kēia pathology ua pu ma ka pokole o ka hanu, nawaliwali,ʻeha ma ka naʻau, ili pallor.
• Mōʻaukala o ka maʻi (manawa o ka hoouka kaua ana o symptoms a me kā lākou pili i ka haawe).
• Life mōʻaukala (ohana mōʻaukala, maternal maʻi i hāpai keiki, a no laila, ma luna).
• General ninaninau (ke kaupaonaʻana, kiʻekiʻe, laina o ka makahiki, ili kala like 'ole, etc.).
• Auscultation (halulu) a me ka percussion (hoʻonui o ka naau palena).
• Ka like ana o ke koko a me ka mimi.
• ECGʻikepili (na hoailona o ka ventricular hypertrophy, conduction mā a me pāpana).
• Rengenologicheskogo like (ka Hoʻololi 'ano o ka naʻau).
• Vetrikulografii a me ka angiography.
• Echocardiography (ultrasound o ka naau i mea). Kēia like mea e hooholo i ka henua a me ka nui o ke kina, a me ka wā doplerometrii (i hiki ke hana ia ma utero) - i ka nui a me ka olelo o ke koko ma ka puka (a hiki ina AMS - VSD ma ka fetus 2 mm o loko o ke anawaena).
• Cardiac catheterization cavities. A laila hookomo o ka catheter a me ka manao paa a me ka kōkua o na moku puʻe a me ka naau cavities. Alaila, e like me ka hoʻoholo 'ana ma luna o ka wā e hiki mai ana o nā mea maʻi.
• MR. I hoonoho ia ma na wahi echocardiography uninformative.

lapaʻau

Ma ka loaʻaʻana o ka fetus VSD hoopili aku i ka makaala e kali ana, no ka mea, ka mea kina e spontaneously kokoke ma mua hanau ai koke ma hope o ka hanau ana. A laila, oiai e malama ana i ka ike o kaʻike, o ka hoʻomanawanui 'ole cardiologists.

Inā ke kina, aole ia e hoopilikia i ke koko holo a me ka nohona ma ke ano o ka hoomanawanui, ukali ma ka pono e kiaʻi ana. No ka nui lua, ka uhaʻiʻana i ka pono o ke ola, e ke hoʻoholo i ka iʻoki kino.

Surgeries ma VSD hiki e ana o ÿelua: palliative (kaupalena pulmonary koko i loko o ka alo o ka pili malformations) a me ka'ano'ē (piha puka panina).

Ano o ka hana:

• Open naauʻoki kino (no ka laʻana, tetralogy o Fallot).
• Cardiac catheterization me ka lāʻau ka hoʻokō 'ana i ke one ma luna o ke kina.

Kāohiʻana o ka ventricular septal kina

I Kekahi Mau kāohi ana VSD i loko o ka fetus mea ole, aka, i mea e pale aku CHD, oe e:

• Eʻimi antenatal malama i umikumamalua pule o ka hāpai keiki.
• Mau hele LCD: koke i ka mahina o ka mua na malama ekolu, hookahi manawa i kela ekolu pule ma ka lua o ka trimester, a laila, koke kela umi lā i loko o ke kolu.
• Malama aaeei, a hoopili aku i ka pono no kou kino.
• Hou kanawai o nā palapala aʻe.
• Hoʻopau pūnuku puhi a me ka waiʻona.
• E lapaʻauʻia pololei i hoakaka ia ma kekahi kauka.
• E kau vaccinated ku rubella ma ka liʻiliʻi loa eono mahina ma mua o ka n ieaie? Hāpai keiki.
• I ka ohana mōʻaukala akahele kanaka hoʻoponopono i ka hua no nā mua ka loaʻaʻana o CHD i ia.

Outlook

A lohe o VSD fetal liʻiliʻi (2 mm o a emi), maikaʻi prognosis, e like me kēia mau puka i pinepine pili spontaneously. Inā he mea nui mā prognosis hilinaʻi nui ma luna o lākou wahi, a me ka alo o ka hoʻohui pū 'ia me nā malformations.