atrial septal defect
Introduction
Introduction to the septal defect Atrial septal defect (ASD) is a clinically common congenital heart malformation. It is an abnormality in the original atrial septum during embryonic development, resulting in residual pores between the left and right atrium. Atrial septal defect can occur alone or in combination with other types of cardiovascular malformations. Women are more common, and the ratio of male to female is about 1:3. Due to the presence of shunt at the atrial level, corresponding hemodynamic abnormalities can be caused. From the occurrence of atrial septal defect, it can be divided into two categories: primary atrial septal defect and secondary atrial septal defect. Because the primary atrial septal defect is often accompanied by malformations of the mitral and tricuspid valves. Secondary atrial septal defect is divided into four types: central type defect (oval fossa defect), superior cavity type defect (sinus sinus defect), inferior cavity type defect and mixed type defect according to the defect. basic knowledge The proportion of illness: 0.003% Susceptible people: more common adults Mode of infection: non-infectious Complications: bronchial pneumonia Congestive heart failure Pulmonary edema
Cause
Room septal defect
Septal defect is the most common congenital heart disease, accounting for 10 to 15% of congenital heart disease, and the ratio of male to female is 1:2.
Secondary atrial septal defect due to the pressure difference between the normal left and right atrium, the left atrial oxygenation blood is diverted to the right atrium through the defect, and the blood circulation of the systemic circulation is reduced, which may cause the child to develop retarded and the physical activity is limited. Restriction, some patients can also have no obvious symptoms, oxygenation of blood into the pulmonary circulation can cause small intimal hyperplasia of the pulmonary blood vessels and middle-thickness and other diseases, leading to increased pulmonary artery pressure and pulmonary vascular resistance, but the process is slow, mostly in adults patient.
Primary atrial septal defect, also known as partial endocardial pad defect or atrioventricular tube malformation, is caused by defects in the development of the intima pad in the embryonic development process, forming a semilunar large atrial septal defect, located in the coronary sinus Below the anterior, the lower edge of the defect is adjacent to the mitral annulus, often accompanied by a mitral valve.
Prevention
Room septal defect prevention
1. Abstain bad habits including pregnant women and their spouses, such as smoking, alcohol, etc.;
2. Actively treat diseases affecting fetal development such as diabetes, lupus erythematosus, anemia, etc. before pregnancy.
Complication
Room septal defect Complications, bronchopneumonia, congestive heart failure, pulmonary edema
Often complicated by bronchial pneumonia, congestive heart failure, pulmonary edema and subacute bacterial endocarditis.
Symptom
Room septal defect symptoms Common symptoms Ziqiqi short heart fatigue heart failure cardiovascular angiography see double ball sign pulmonary valve area audible...
Secondary atrial septal defect: palpitations after activity, shortness of breath, fatigue is the most common symptom, but some children may have no obvious symptoms, atrial rhythm disorder is more common in adult patients, if there is severe pulmonary hypertension caused by right to left shunt, Purple eyes appear.
Primary atrial septal defect: palpitations after exercise, shortness of breath, prone to respiratory infection, accompanied by severe mitral regurgitation, early symptoms of heart failure and pulmonary hypertension, developmental delay, heart enlargement, heart The front area is uplifted.
Examine
Room septal defect inspection
1. Electrocardiogram.
2. Chest X-ray: secondary atrial septal defect: increased lung pattern, right atrium, right ventricular enlargement, pulmonary artery bulge, aortic node smaller; primary atrial septal defect: increased lung pattern, right The ventricle is enlarged, the pulmonary artery segment is prominent, and the left ventricle is also enlarged in the mitral regurgitation.
3. Echocardiography.
4. Right heart catheterization: secondary atrial septal defect: the average blood oxygen content of the right atrium is higher, the average blood oxygen content of the inferior vena cava is 1.9 vol%, and the pulmonary artery pressure can be increased to different extents; the primary hole type Atrial septal defect: left atrial shunt in the atria level, and pulmonary artery pressure can be measured.
Diagnosis
Diagnosis of room septal defect
According to typical physical signs and laboratory tests, the diagnosis is not difficult, but it needs to be identified.
Differential diagnosis
(1) Patients whose signs are not obvious should be differentiated from normal physiological conditions: if only the second intercostal space on the left sternal border is heard and the second-grade systolic murmur is accompanied by a second heart sound splitting or hyperthyroidism, then It is also common in normal children. At this time, if X-ray, electrocardiogram, and echocardiography are found to have signs of the disease, further diagnosis of right heart catheterization may be considered.
(2) Large ventricular septal defect: due to the large flow rate from left to right, the X-ray and ECG performance can be very similar to the disease. The physical signs can also be the second heart sound of the pulmonary valve area. Caused the difficulty in differential diagnosis.
However, the position of the ventricular septal defect is low, often in the third and fourth intercostal space of the left sternal border, and more with tremor, the left ventricle often increases, etc., but in children, especially with the first hole The identification of the patent is still not easy. At this time, echocardiography and right heart catheterization help to establish a diagnosis.
In addition, left ventricular-right atrial communication (a special type of ventricular septal defect) patients with signs similar to high ventricular septal defect, right heart catheterization results similar to atrial septal defect, also pay attention to identification.
(C) valvular simple pulmonary stenosis: its signs, X-ray and electrocardiogram, there are many similarities with this disease, sometimes can cause difficulty in identification, but when the valve-type pulmonary stenosis is narrow, the noise is louder, often With tremor, the second heart sound in the pulmonary valve area is reduced or inaudible; X-ray film shows clear lung field, rare lung pattern, can be identified, echocardiogram see abnormal pulmonary valve, right heart catheterization found right ventricle and pulmonary artery There is a systolic pressure gradient, and no evidence of diversion can confirm the diagnosis.
(4) Primary pulmonary hypertension: its signs and ECG findings are quite similar to the disease; X-ray examination can also find that the total dry arc of the pulmonary artery is convex, the vascular shadow of the hilar is thickened, and the right ventricle and right atrium are enlarged; However, the lung field is not congested or is clear, but can be identified. Right heart catheterization can be found evidence of a significant increase in pulmonary artery pressure without left-to-right shunt.
