Left Ventricular Dual Outlet
Introduction
Introduction to the left ventricle double exit The left ventricle double outlet means that both aorta originate from the left ventricle. The two arterial openings are located in the same plane. The bilateral cone and conus muscle are insufficiency. The aortic valve and pulmonary valve, the semilunar valve and the mitral valve are continuous. For a very rare congenital cardiovascular malformation. Often accompanied by ventricular septal defect, pulmonary stenosis, tricuspid valvular deformity, right ventricular dysplasia, inconsistent atrioventricular, atrial and visceral orthodontic or deformed. Hemodynamic changes in the left ventricle double outlet, similar to severe tetralogy of Fallot or complete aortic dislocation with ventricular septal defect. basic knowledge Sickness ratio: 0.0004% Susceptible people: no special people Mode of infection: non-infectious Complications: ventricular septal defect pulmonary stenosis tricuspid valvular deformity
Cause
Left ventricular double exit cause
As a rare congenital cardiovascular malformation, the two arterial openings are in the same plane, the bilateral cone and conus muscle are insufficiency, the aortic valve and the pulmonary valve, the semilunar valve and the mitral valve are continuous, resulting in The patient developed a series of clinical symptoms.
Prevention
Left ventricle double exit prevention
The disease is congenital cardiovascular malformation, the prognosis is extremely poor, and there is no effective preventive measure. Therefore, it is advisable to perform early surgery for the confirmed baby, and at the same time pay attention to the contraindications for surgery, such as for patients with severe pulmonary vascular obstructive disease. It is not suitable for surgery.
Complication
Left ventricular double outlet complications Complications, ventricular septal defect, pulmonary stenosis, tricuspid valvular deformity
Often accompanied by ventricular septal defect, pulmonary stenosis, tricuspid valvular deformity, right ventricular dysplasia, inconsistent atrioventricular, atrial and visceral orthodontic or deformed, left ventricular double outlet hemodynamic changes, similar to severe Tetralogy of Fallot or complete aortic dislocation with ventricular septal defect.
1, ventricular septal defect
Ventricular septal defect is an abnormal interventricular communication caused by ventricular septal dysplasia in fetal period, causing blood to be diverted from left to right, resulting in abnormal hemodynamics, small ventricular septal defect, small sub-flow, generally no obvious symptoms, and partial flow Larger, symptoms appear after birth, manifested as repeated respiratory infections, congestive heart failure, feeding difficulties and developmental delay, can overcome the larger ventricular septal defect in infants and young children, it shows that the activity endurance is worse than that of the same age, tired After the shortness of breath, palpitations, and even gradually appear cyanosis and right heart failure.
2, pulmonary stenosis
There are three types of pulmonary stenosis: right ventricular funnel stenosis, pulmonary valve stenosis and pulmonary trunk stenosis, while valve stenosis is the most common, valvular stenosis, three leaflets merge into a conical shape, the valve hole narrows, the smallest is only 2mm The stenosis of the pulmonary artery wall is thinned and expanded due to the blood jet vortex, and the funnel stenosis type, also known as the double right ventricle, is a fibromuscular or diaphragm ring stenosis in the right ventricular outflow tract, and the pulmonary stenosis type is very rare, various Types can be secondary to right ventricular hypertrophy and right heart enlargement. Patients with mild and moderate stenosis are asymptomatic. Severe stenosis can cause palpitations, shortness of breath, chest tightness, chest pain or syncope. In severe cases, there may be jugular vein engorgement. Signs of right heart failure such as hepatomegaly.
3, tricuspid valvular deformity
Refers to the tricuspid valve malformation, the position of the posterior flap and the septum is lower than normal, not at the level of the atrioventricular ring and down to the right ventricular wall near the apex, the position of the anterior flap is normal, resulting in a right atrium larger than normal, and the right ventricle Less normal than normal, there may be tricuspid regurgitation, mild cases without cyanosis, moderate and severe cases with cyanosis, prone to supraventricular tachycardia, often with congestive right heart failure, physical examination in the tricuspid region has contraction The reflux murmur may have a third heart sound or a fourth heart rhythm.
Symptom
Left ventricular double exit symptoms Common symptoms Ventricular hypertrophy sputum systolic murmur
Commonly appear purpura with pulmonary congestion or ischemia, cardiac auscultation has jet or systolic murmur, ECG: common left ventricular hypertrophy, right heart catheterization and selective left ventricular angiography and facet echocardiography as the main diagnostic method, The oxygen saturation in the aorta and pulmonary arteries is almost equal, and the two large arteries are simultaneously developed in the left ventriculography.
Examine
Left ventricular double exit check
1, ECG examination: common heart shadow enlargement, left ventricular hypertrophy and so on.
2, selective left ventricular angiography: visible two large arteries simultaneously developed.
3, the examination of this disease also has right heart catheterization and facet echocardiography, are the main diagnostic methods of this disease.
4, blood gas analysis: can be found in the aorta and pulmonary artery oxygen saturation is almost equal.
Diagnosis
Diagnosis of left ventricle double exit diagnosis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1, right ventricle double exit
Unlike the left ventricle double outlet, the right ventricle double outlet originates from the right ventricle in both the aorta and pulmonary arteries, or the majority of one large artery and the other large artery originate in the right ventricle, and the ventricular septal defect is the only outlet of the left ventricle. The ventricular septal defect is usually larger than the aortic diameter. In only 10% of cases, the ventricular septal defect is smaller than the aortic opening. About 60% of the ventricular septal defect is located under the aortic valve, 30% is below the pulmonary valve, and a few cases have ventricular septal. The location of the defect is in the middle of the aorta and the pulmonary artery opening. In a few cases, the ventricular septal defect is located in the middle and lower part of the ventricular septum and is far from the aortic opening.
2, complete transposition of the great arteries
The anatomical feature is that the atrial and ventricle connections are in the same order, and the order of connection between the ventricle and the aorta is inconsistent, that is, the aorta starts from the right ventricle, and the pulmonary artery starts from the left ventricle. If there are no other malformations of the heart and large blood vessels, the body-lung two The circulation is not connected to each other, the child can not survive after birth, cardiac catheterization and cardiovascular angiography can be identified.
3, corrective transposition of the great arteries
The pathological anatomical feature of the correction of the transposition of the great arteries is that the normal anatomical atrial and ventricular connections are inconsistent, that is, the right atrium is connected to the left ventricle through the mitral valve and connected to the pulmonary artery; and the left atrium is passed through the tricuspid valve and dissecting the right ventricle. Connected, connected to the aorta, if not combined with other cardiac malformations, hemodynamics is naturally corrected, patients without clinical symptoms and pathological signs, no surgical treatment, but the correction of large arterial dislocation often has a combined deformity:
1 ventricular septal defect (VSD), accounting for about 4/5, mostly for pulmonary artery type VSD, followed by membrane VSD;
2 pulmonary artery stenosis (PS), accounting for about 50%, PS is mostly pulmonary valve thickening fusion, annulus stenosis and subvalvular stenosis are also more common;
3 atrial septal defect (ASD), accounting for about 20%, mostly secondary hole type ASD, sometimes for patent foramen ovale;
4 other: patent ductus arteriosus (PDA), left atrioventricular valve insufficiency, aortic coarctation and so on.
Another pathological anatomical feature of the corrective type of large artery dislocation is conduction tissue abnormality. The posterior atrioventricular node fibers in the normal position cannot be placed in the ventricular septum. The anterior chamber node is located at the right atrial junction of the right atrial appendage and the right atrioventricular ring. The bundle passes through the fiber triangle, and the conduction tissue descends from the upper edge in front of the pulmonary valve mouth. If the VSD is combined, it descends on the left ventricular surface of the leading edge, and is divided into left and right bundles between the membrane portion and the muscle portion of the interventricular septum. Branch, repair VSD is easy to damage the conduction tissue, cardiac catheterization and cardiovascular angiography can help identify the left ventricle double outlet.
