Defect of an interatrial partition
Defect of an interatrial partition is called existence of through service between the right and left auricle. Morphologically distinguish primary and secondary defects.
Less often primary defect which is in the lower part of a partition in places of an attachment of three-leaved and mitral valves meets. The bottom edge of defect is formed in this case by a partition between atrioventricular openings.
Much more often (at adult 85-90%) secondary defect at which the bottom edge of defect is separated from the place of an attachment of three-leaved and mitral valves by a site of an interatrial partition is found. Defect localization in this case varies. Sometimes defect has multiple character, windowing is observed.
Clinical picture of defect of an interatrial partition
Small defects of an interatrial partition are shown aged from 16 till 30 flyings and are more senior. Complaints are, as a rule, not specific, such patients are disturbed by increased fatigue, an asthma at exercise stresses. Quite often defect bessimptomen, though at these patients is noted tendency to upper respiratory tract infections, pneumonia, cases paradoxical embolisms are described.
At emergence of disturbances of a rhythm (most often a ciliary arrhythmia) feelings of interruptions, heartbeat are possible. In process of a decompensation of defect the complaints connected with progressing of right ventricular insufficiency — increase in stomach sizes, hypostases join; in rare instances — the pains of anginous character which are a consequence of subendocardial ischemia of a dilatirovanny right ventricle.
At survey pallor of integuments comes to light. The cordial hump is sometimes noticeable, the delay of sexual development is possible. Perkutorno is defined expansion of borders of heart to the right and up. In hard cases the pulsation of a pulmonary artery in the second mezhreberye to the left of a breast is expressed.
Due to the expressed pulmonary hypertensia the II tone on a pulmonary artery is accented, quite often split. The relative stenosis of the valve of a pulmonary artery causes short systolic noise with epicenter in the second — the third mezhreberye to the left of a breast. Noise, as a rule, follows the I tone with amplitude maximum in the first half closer to the middle of a systole at once, on FKG has the rhomboid or spindle-shaped form. Intensity of noise depends on expressiveness of pulmonary hypertensia — than it is higher, that noise is weaker.
Owing to a relative stenosis of the three-leaved valve often there is a diastolic noise at the fourth mezhreberye to the right of a breast.
Treatment of patients with defect of an interatrial partition
Patients with an asymptomatic current and with existence of complaints only to fatigue and an asthma at exercise stresses without signs of their progressing are conducted conservatively. In most cases maintaining is reduced to active supervision without prescription of medicines. The indication to surgical correction of defect is strengthening of symptoms and emergence of disturbances of a rhythm, increase of pulmonary hypertensia, a ratio of a pulmonary blood-groove to system 2,5:1 and more, blood dumping size — 40% of the minute volume of blood circulation and more. Contraindication to operation is the IV stage of pulmonary hypertensia.
At impossibility of operational treatment of defect of an interatrial partition and in the postoperative period the symptomatic treatment, mainly heart failure and disturbances of a rhythm is carried out.