Defect of an interventricular partition
Defect of an interventricular partition is called existence of through service between the right and left ventricle. Morphologically distinguish defects of hymenoid and muscular part of a partition which can be localized in the bringing, trabecular and taking out part. In muscular part multiple and fenestrirovanny defects meet.
Clinical picture of defect of an interventricular partition
Defect of an interventricular partition up to emergence of symptoms of heart failure malosimptomen. Small defect is often shown already at youthful age by the increasing weakness, an asthma at an exercise stress and at rest.
Further there are interruptions in cardiac performance, hypostases of the lower extremities. At Eyzenmenger's syndrome can arise a pneumorrhagia, dizziness, unconscious states, thorax pains, thromboembolisms on a big circle of blood circulation. The risk of an infectious endocarditis is increased, respiratory infections, pneumonia are frequent.
At survey pallor, lag in growth and physical development up to a cachexia is quite often observed. On a front chest wall the cross impressions arising because of a chronic asthma — Harrison's furrow often are found, the cordial hump is swept up. At Eyzenmenger's syndrome note diffusion cyanosis and a symptom of drum sticks.
At a palpation strengthening of an apical beat, systolic trembling below at the left edge of a breast, an epigastric pulsation is defined. At percussion — expansion of borders of heart to the right and to the left.
At auscultation the emphasis of the II tone on a pulmonary artery and its splitting owing to pulmonary hypertensia is defined. Over all surface of heart rough pansystolic noise of a rhomboid form with epicenter in the third or fourth mezhreberye to the left of a breast — a consequence of pathological dumping of blood from a left ventricle in right is listened.
In process of increase of pulmonary pressure intensity of systolic noise weakens. At emergence of dumping of blood emergence of diastolic noise is from right to left possible.
Treatment of patients with defect of an interventricular partition
The main approach in treatment of adults conservative. In the absence of symptomatology — clinical supervision, at its existence — a symptomatic treatment, mainly heart failure, prevention of an infectious endocarditis.
Indications to surgical treatment are considerable decrease in tolerance to exercise stresses, increase of symptoms of heart failure, resistant to conservative therapy, the size of pathological dumping of blood more than 40% of the minute volume of blood circulation from left to right. Contraindication — existence of the created Eyzenmenger's syndrome.