Inkohlakalo ye-septum interventricular. I-DMF yesisu: izizathu, ukuxilongwa kunye nemiphumo

Inkolelo ye-septum interventricular (VSD) yindawo evulekileyo eludongeni, olungiselela ukuhlula iindawo zokungena kunye nezasekhohlo.

Ulwazi jikelele

Le meko ibangela ukuxuba okungaqhelekanga (ukutshintsha) kwegazi. Kwindlela yokuziphatha, isisiphako esinjalo sisifo esasifanelekileyo sokubeleka kwentliziyo. Iingxelo eziphambili ngeVSD zikhula ngezinga lama-20 ekhulwini. Ngokufanayo, ukubonakala kwesi siko kuchaphazeleka ngabantwana babini nabasetyhini.

I-VSD ebusweni ingaxhomekeka (oko kukuthi, i-anomaly kuphela ekhona emzimbeni) okanye inxalenye yeziphene ezinzima (i-atresia yesirveji esithathu, ukuguqulwa kwemithambo yegazi, iinqwelo eziqhelekileyo, i-tetralogy ye-Fallot).

Kwezinye iimeko, i-septum ye-interventricular ayikho ngokupheleleyo, i-vice ibizwa ngokuba yi-ventricle kuphela yentliziyo.

Iklinikhi ye-DMZHP

I-symptomatology ye-defalular septal defect ibonakala rhoqo kwiintsuku zokuqala okanye kwiinyanga emva kokuzalwa komntwana.

Ubonakaliso obuninzi ngokuphindaphindiweyo kwee-vice:

• Ukuphefumula;
• I-Cyanosis yolusu (ikakhulukazi iminwe kunye nemilomo);
• Ukunciphisa ukutya;
• Iintliziyo zentliziyo;
• Ukukhathala okukhawulezayo;
• I-Edema kwisisu, inyawo kunye neenyawo.

I-VSD ngexesha lokuzalwa linokuthi lenzeke ngokungabonakaliyo, ukuba isiphene sincinane, kwaye sibonakaliswe kuphela kwimimiselo kamva (iminyaka emithandathu okanye ngaphezulu). I-symptomatology ngokuthe ngqo kuxhomekeke kubukhulu besiphene (ukukhupha), nangona kunjalo, oogqirha kufuneka baqaphele kwiimvumi ezivakalayo.

I-DMF ye-fetus: izizathu

Nasiphi na isifo senhliziyo esiswini esivela ngenxa yokungaqhelekanga kuphuhliso lombutho kwiinqanaba zokuqala ze-embryogenesis. Inendima ebalulekileyo kule meko yinkalo yangaphandle yemvelo kunye nemfuza.

Nge-VSD, umntwana ufumana ukuvula phakathi kwama-ventricle asekhohlo kunye namanene. Umgca we-muscular layer uqhutywe ngakumbi kunokuba unelungelo elifanelekileyo, ngoko ke igazi elichithwe nge-oksijini ukusuka kwinqanaba le-ventricular elisekhohlo lingene ekunene kwaye lidibanise negazi le-oksijini. Ngenxa yoko, i-oksijini encinci ingene kwizitho kunye nezicubu, ekugqibeleni zikhokelela kwindlala engapheliyo ye-oksijini yomzimba (i-hypoxia). Ngaloo ndlela, ukuba khona kwegazi elongezelelweyo kwi-ventricle elifanelekileyo kubandakanya ukuhluthwa kwayo (ukunyuka), i-myocardial hypertrophy kwaye, ngenxa yoko, ukuvela kwe-cardiac ye-ventricular failure failure kunye nomfutho wexinzelelo lwe-pulmonary.

Imiba yengozi

Izizathu ezibangela ukuba kwenzeke i-VSD ebusweni akungaziwa, kodwa into ebalulekileyo kukuhluthwa okunzima (oko kukuthi, ubukho bentsholongwane enjalo kwiintsapho ezisondeleyo).

Ukongezelela, indima enkulu idlalwe yizinto ezikhoyo ngexesha lokukhulelwa:

• Rubella. Ingumguhlane wegciwane. Ukuba ngexesha lokukhulelwa kwangempela (ngokukodwa kwi-trimester yokuqala) ibhinqa lithatha i-rubella, umngcipheko wezinto ezingafaniyo zamalungu angaphakathi (kuquka i-DMF) kumntwana ophezulu kakhulu.
• Utywala kunye namanye amayeza. Ukuthatha iziyobisi kunye notywala (ngokukodwa kwiiveki zokuqala zokukhulelwa) kwandisa kakhulu umngcipheko wokuphuhlisa imiphumo eyahlukileyo kwi-fetus.
• Ukunganyananga unyango lwesifo sikashukela. I-glucose engaqinisekanga kwindoda ekhulelwe iholele ekuzaliseni i-fetal hyperglycemia, ekugqibeleni ekukhokelela kwiimeko ezahlukeneyo zokuzalwa ezingabantwana.

Ukwahlula

Kukho iinketho ezininzi kwiindawo ze-VAW:

• I-Conoventricular, membranous, i-VSD ene-strown in the fetus. Kukho indawo eqhelekileyo yesiqhelo kunye neengxelo malunga neepesenti ezisibhozo zazo zonke iziphoso ezinjalo. Isiphako sifumaneka kwi-membranous part of the septum phakathi kwama-ventricle anokusasazeka ngokubanzi kwipropati, i-septal kunye namagumbi okungena; Ngaphantsi kwesava ye-aortic kunye ne-valve ye-tricuspid (i-septal flap yayo). I-Aneurysms idla ngokuphindaphindiweyo kwingxenye ye-septum, elandelwa kukuvalwa okulandelayo (okupheleleyo okanye okuyingxenye) yesiphene.
• I-Dbec, i-muscular DMF kwi-fetus. Itholakala kwi-15-20% yazo zonke iimeko. Isiphako sijikelezwe zizihlunu ngokupheleleyo kwaye sinokufumaneka kuyo nayiphi na inxalenye ye-muscular inxenye ye-septum phakathi kwama-ventricles. Kukho ininzi imingxuma yezilwanyana. Ngokuqhelekileyo, i-JMF enjalo kumntwana uvala ngokukhawuleza.
• I-Podlugochnye, i-podaternialnye, infundibular, i-vyrobnevye i-vestibular tract account malunga ne-5% yazo zonke iimeko. Isiphako phantsi kweemigodi (semilunar) yokuphuma okanye isahlulo sesahlulo se-septum sendawo. Ngokuqhelekileyo le VSD ngenxa yokunyuka kwesigufa sokunene se-aorta idibene ne-asor insufficiency;
• Iimpazamo kummandla wendlela. Ivulo lisekwindawo yesango lokungena kweseva, ngaphantsi kwendawo yokuqhotyosheliswa kwiplagi ye-ventricular-valves. Uninzi lwentsholongwane luhamba ne-Down's syndrome.

Ezizona ziqhelekileyo ziyiziphene, kodwa kukho iziphene ezininzi kwi-septum. I-VSD inokuthatha inxaxheba kwiimpembelelo zengqondo ezidibeneyo, ezifana ne-tetralogy ye-Fallot, ukudluliselwa kwemithambo yegazi nabanye.

Ngokuhambelana nobukhulu, iziphene ezilandelayo ziyaziwa:

• Incinci (impawu ezingabonakaliyo);
• Umyinge (iklinikhi ivela kwiinyanga zokuqala emva kokubeleka);
• Inkulu (ngokuphindaphindiweyo ihlawulwe, ngeempawu eziqhakazileyo, inkambo enzima kunye neengxaki ezingakhokelela ekufeni).

Iingxaki zeDMF

Ngomlinganiselo omncinci wesiphene, ukubonakaliswa kweklinikhi akunakwenzeka kuyo yonke okanye imingxuma ingavalwa ngokukhawuleza emva kokuzalwa.

Ngenxa yeziphene ezinkulu, ezi nkathazo ezinzima zilandelayo:

• Eisenmenger syndrome. Ibonakala ngokuphuhliswa kweenguqu ezingaphendukiyo kwimiphunga ngenxa yesifo sengozi yomshukela. Ingxaki efana nale ingakhula kubantwana abancinci nabancinci. Kwimeko efanayo, inxalenye yegazi ihamba ukusuka ekunene ukuya kwi-ventricle ekhohlo ngokuvula kwi-septum, ngenxa ye-hypertrophy ye-myocardial ye-ventricle efanelekileyo, inamandla "kunamandla" kunasekhohlo. Ngoko ke, kwiimpawu kunye neengxenyana zegazi ziyawa, ziphelile kwi-oksijeni, kwaye, ngenxa yoko, zenza i-hypoxia engapheliyo, ibonakaliswe njengomthunzi we-cyanotic (i-cyanosis) ye-nail phalanges, imilomo kunye nesikhumba ngokubanzi.
• Ukungaphumeleli kwentliziyo.
• Endocarditis.
• Stroke. Iyakhula kunye neziphene ezinkulu ze-septum, ngenxa yokuhamba kwegazi. Ukwakhiwa kwamanqatha egazi, okungawagubungela imida yegazi yengqondo.
• Ezinye izifo zentliziyo. Kukho i-arrhythmias kunye ne pathologies yeepavini.

I-DMF ye-fetus: yintoni oyenzayo?

Ngokuqhelekileyo, iziphoso ezinjalo zentliziyo zifunyenwe kwi-ultrasound yesibini ecwangcisiweyo. Kodwa musani.

• Kubalulekile ukukhokela indlela eqhelekileyo yobomi kwaye ungabi nokwesaba.
• Ugqirha oya kwiinkcukacha kufuneka aqwalasele ngokucophelela umfazi okhulelweyo.
• Ukuba i-defect ifunyenwe ngexesha le-ultrasound elicwangcisiweyo yesibini, ugqirha uya kuncomela ukuba alinde uviwo lwesithathu (kwiiveki ezingama-30-34).
• Ukuba i-defect ifunyenwe kwi-ultrasound yesithathu, elinye lihlelwe ngaphambi kokuhambisa.
• Amancinci (umzekelo, i-VSD 1 mm emntwaneni), iifestile zingavalwa ngokukhawuleza ngaphambi okanye emva kokuzalwa.
• Kufuneka ukuba udibane neonatologist kwaye wenze i-fetal EKHO.

Diagnostics

Kunokwenzeka ukukrokra ubukho besiphene ngokukhupha intliziyo kunye nokuhlolwa komntwana. Nangona kunjalo, kwiimeko ezininzi, abazali bafunda malunga nobukho besiphene phambi kokuzalwa komntwana, xa beqhuba izifundo ezicwangcisiweyo ze-ultrasound. Iziphene ezinkulu (ngokomzekelo, i-VSD 4 mm emntwaneni) ibonakaliswe, njengommiselo, kwisibini okanye kwisithathu sesithathu. Amancinci angaphinda afunyanwe emva kokuzalwa, ngengozi okanye xa kubonakala iimpawu zeklinikhi.

Ukuxilongwa kwe "JMP" usana olutsha okanye umntwana omdala okanye umntu omdala unokusekelwe kwi:

• Izikhalazo zesigulane. Le ntsholongwane ihambelana nokuphefumula, ubuthathaka, intlungu entliziyweni, isikhumba esiluhlaza.
• I-Anamnesis yesi sifo (ixesha lokuqala kweempawu zokuqala kunye nokuxhamla kwabo neengcinezelo).
• U-Anamnesis wobomi (ubunzima bokuzala, izifo zikamama ngexesha lokukhulelwa nokunye).
• Uviwo oluqhelekileyo (ubunzima, ukuphakama, uphuhliso oluhambelana neminyaka, ithoni yesikhumba nabanye).
• Ukuqulunqwa (isandi) kunye nomngcipheko (ukwandisa imida yentliziyo).
• Igazi kunye neemvavanyo zomchamo.
• Idatha ye-ECG (imiqondiso ye-hypertrophic ventricular, ukuqhutyelwa kweempawu kunye nokuphazamiseka kwesigqi).
• Uphando lweRengenologichesky (utshintshile uhlobo lwenhliziyo).
• Vetriculography kunye nengcali.
• I-Echocardiography (i.e., i-ultrasound of heart). Olu phofu lukuvumela ukuba ufumane indawo kunye nobukhulu besiphene, kunye ne-doplerometry (enokuthi yenziwe nakwixesha lokubeleka) - umthamo kunye nokuqondisa kwegazi ngomgodi (nangona i-APS-VSD e-fetus 2 mm ububanzi).
• Catheterization ye-cardiac. Oko kukuthi, ukuqaliswa kwekathetha kunye nokuzimisela ngoncedo lwayo uxinzelelo kwiinqanawa kunye nemithwalo yentliziyo. Ngaloo ndlela, isigqibo sithathwa kwiindlela eziqhubekayo zolawulo lwegulane.
• MRI. Nika kwiimeko xa i-Echo KG ingabalulekanga.

Unyango

Xa ibhinqa ine-VSD, umntwana usalindela-mbono, kuba isiphako singasondela ngaphandle kokuzalwa okanye emva kokubeleka. Emva koko, ukuba ukuxilongwa kugcinwe, ulawulo lolo gulane luyenziwa ngabadokotela be-cardiologists.

Ukuba isiphene asiphazamisi ukujikeleza kwegazi kunye nemeko jikelele yesigulane, kubonakala nje. Kwiimingxuma ezinkulu eziphula umgangatho wobomi, zigqiba ukuqhuba ukusebenza.

Amanyathelo angenelelo ophathelene neVSD angaba neentlobo ezimbini: i-paliative (ukukhawuleka kwegazi lompompo ehambayo phambi kobubi obunobungozi) kunye nokugqithisa (ukuvalwa okupheleleyo komngxuma).

Izindlela zokuqhuba imisebenzi:

• Intliziyo evulekileyo (umzekelo, u-tetralogy of Fallot).
• I-catheterization ye-cardiac kunye nokulawulwa okulawulwayo kwikhankaso kwisiphene.

Ukuthintela i-defalular septal defect

Amanyathelo athile okukhusela i-VSD emntwaneni awayiyo, nangona kunjalo ukwenzela ukukhusela i-CHD, kuyimfuneko:

• Faka isicelo kwiklinikhi yangaphambi kokubeletha ukuya kwiiveki ezilishumi elinambini zokukhulelwa.
• Ukutyelela rhoqo i-LCD: kanye ngenyanga ngeenyanga ezintathu zokuqala, kanye emva kweeveki ezintathu kwi-trimester yesibili, kwaye emva kweentsuku ezilishumi kwisithathu.
• Gcina ulawulo kwaye uhambelane nesondlo esifanelekileyo.
• Ukunciphisa impembelelo yezinto ezinobungozi.
• Gwema ukutshaya notywala.
• Thatha amachiza kuphela njengoko ugqirha ugqirha wakho.
• Ukubeka i-inoculation malunga ne-rubella ubuncinane ubuncinane kweenyanga ezintandathu phambi kokuqala kokucwangciswa kokukhulelwa.
• Ngobunzima obunzima, qaphelisisa umntwana ukuba ufumane ukuqala kwePU.

Forecast

Ukufumana umntwana omncinci (2 mm okanye ngaphantsi), ukuxeliswa komzimba kukuthandeka, kuba izibhengezo ezinjalo zivame ukuvala ngokukhawuleza. Ekubeni ubukhulu beziphene, ukuxela kuxhomekeke kwindawo yabo kunye nobukho bokudibanisa nezinye iziphoso.