Heart disease: defect of interventricular septum
The defect of the interventricular septum of the heart in children is a congenital anomalous connection between the two ventricles of the heart, which arises from underdevelopment at different levels. This type of anomaly refers to the most frequent congenital heart disease in children – it occurs, according to different authors, in 11-48% of cases.
Depending on the location of the defect of the interventricular septum, the fetus has the following types:
- Defects of the membrane part of the septum. Their sizes from 2 to 60 mm, the shape is different, are observed in 90% of cases,
- Defects of the muscular part of the septum. Their dimensions are small (5-20 mm), and with the reduction of the heart muscle, the lumen of the defect is further reduced, manifesting themselves in 2-8% of cases.
- The absence of interventricular septum occurs in 1-2% of cases.
How is the defect of the interventricular septum in children manifested?
Defect of the interventricular septum in children is accompanied by the development of compensatory hypertrophy of the ventricular myocardium and a small circle of blood circulation, the severity, which depends on the child’s age and the magnitude of the defect.
Difficulty in the movement of blood through the small and large circle of blood circulation in case of an interventricular septal defect in children gives the main clinical picture. The disturbance of hemodynamics depends on the magnitude and direction of the blood flow through the defect, which in turn is determined by the magnitude and location of the defect, the vessels of the small circle of blood circulation, the gradient of the vascular resistance of the small and large circles of the circulation, the state of the myocardium and the ventricles of the heart. The disturbance of hemodynamics is not static, but as the child grows and develops it changes, which leads to changes in the clinical picture of vices, transforming them into other clinical forms.
Some children listen to very gentle systolic noise, which is better determined in the prone position and significantly reduced or even completely disappears with physical exertion. Such a change in noise can be explained by the fact that when the load is due to a powerful contraction of the heart muscles, the opening in the interventricular septum in children is completely closed, and the flow of blood through it is completed. There are no signs of heart failure in the case of Tolochinov-Roger's disease.
Symptoms of a pronounced defect of the interventricular septum
The pronounced defect of the interventricular septum in children is acute from the first days after birth. Children are born on time, but in 37-45% there is a moderately expressed congenital hypotrophy, the cause of which is not clear.
The first symptom of vices is systolic murmur, which is heard from the period of newborn. In a number of children already in the first weeks of life there are signs of circulatory failure in the form of dyspnea, which occurs at first with anxiety, sucking, and then in a calm state.
During the first year of life, children often suffer from acute respiratory diseases, bronchitis, pneumonia. More than 2/3 of children lag behind in physical and psychomotor development, in 30% develops grade II hypotrophy.