I. Definition of ventricular septal defect.
A ventricular septal defect is a hole or multiple holes in the septum of the right and left ventricles, with the diameter of the hole varying from large to small, and can occur in any anatomical part of the septum. Ventricular septal defects may also be acquired, due to penetrating cardiac injury to the septum, or acute myocardial infarction causing perforation of the septum. However, congenital ventricular septal defects are the most common in clinical practice. It can exist alone or be a component of other complex congenital diseases.
II. Morbidity.
Ventricular septal defect is the most common congenital heart disease, and according to statistics, the incidence is 15.5% in precordial heart.
Third, the pathological anatomy and typing.
According to different parts, it is divided into: sub-stem ventricular defect, crestal ventricular defect, membranous ventricular defect and muscular ventricular defect.
Pathophysiology.
The pathophysiology of ventricular septal defect produces hemodynamics based on intracardiac left-to-right shunt and the amount of shunt flow, which increases cardiac load after shunt and leads to myocardial hypertrophy, causing pulmonary vascular lesions, which severely leads to pulmonary hypertension and reverse shunt, resulting in cyanosis and even Eisenmenger syndrome.
V. Clinical manifestations.
The defect is less than 0.5cm, the shunt flow is small, and there are usually no obvious symptoms, while those with large shunt flow have panic, chest tightness, and even dyspnea after activity, and sometimes need emergency surgery.
In large defects, pneumonia and heart failure often appear, both of which are causal, and serious symptoms of hemoptysis are present.
Signs are mainly a heart murmur that can be heard at the left border of the sternum. Later on, Eisenmenger syndrome appears with central cyanosis and also pestle finger.
VI. Diagnosis.
The diagnosis is clear mainly by cardiac ultrasound, which finds a ventricular septal defect.
Surgical indications.
According to the size of the defect, the severity of symptoms, the presence of pulmonary hypertension, choose surgery, generally 1 to 2 years old is the best time for surgery. Ventricular defects with small defects have the possibility of self-healing, but those that have not closed by the age of 2 should be treated surgically.
If the large ventricular defect with high fractional flow is life-threatening, it should be treated by emergency surgery.
VIII. Surgical methods.
Depending on the size and location of the defect, suture closure and patch closure are selected.
1.Expose the heart and establish extracorporeal circulation.
2.Heart incision.