Pulmonary vein drainage
Introduction
Introduction to pulmonary venous drainage Pulmonary venous drainage refers to a congenital cardiovascular ectopic that is not directly connected to the left atrium but is connected to the right atrium or the systemic vein. The incidence rate is 5.8% of congenital heart disease, often associated with atrial septal defect or other cardiovascular ectopic. During embryonic development control, the pulmonary vein is not linked to the pulmonary vein primordium, but is connected to the visceral vein (such as the right anterior, left anterior main vein, umbilical yolk vein), resulting in some or all of the pulmonary vein opening in the right atrium, or through the vena cava system, and then Inject into the right atrium. The disease is also related to heredity. Generally speaking, there is similarity between traits between parents and children, indicating that traits can be passed from parents to offspring. This phenomenon is called heredity. Complete treatment of total anomalous pulmonary venous drainage is mainly performed by surgery to ectopic drainage of the pulmonary veins, so that reflux to the left atrium, surgery should be implemented early in infants and young children. basic knowledge The proportion of illness: 0.003% Susceptible people: infants and young children Mode of infection: non-infectious Complications: pulmonary edema pulmonary hypertension arrhythmia
Cause
Pulmonary venous drainage
Environmental factors (35%):
Environmental factors are elements of an organization's activities, products, or services that interact with the environment. Environmental factors can cause lesions.
Genetic factors (20%):
The disease is also related to heredity. Generally speaking, there is similarity between traits between parents and children, indicating that traits can be passed from parents to offspring. This phenomenon is called heredity.
Other (15%):
The onset of the disease may also be caused by other pathogenic factors.
Prevention
Pulmonary vein ectopic drainage prevention
1 Eat more vegetables and fruits, and drink less sugary drinks.
2 pay attention to supplement potassium and calcium: daily foods containing more potassium and calcium are green leafy vegetables, fresh milk, bean products, peanuts, walnuts.
3 reduce dietary fat, supplement the right amount of high-quality protein: eat less or not eat fat, can eat lean meat, poultry, fish, eat less animal internal organs (liver, kidney, brain, etc.), dairy products are not limited, eggs 1 day 1 No problem, if you have hypercholesterolemia, it is best to eat less egg yolk. "Limited fat" is required to total fat <30% of total calories, saturated fat <10%.
Complication
Pulmonary venous drainage complications Complications pulmonary edema pulmonary hypertension arrhythmia
Pulmonary edema, pulmonary hypertension, arrhythmia, low cardiac output (low cardiac output syndrome), pulmonary infection.
Symptom
Pulmonary vein ectopic drainage symptoms common symptoms dyspnea right heart failure palpitations ventricular hypertrophy purpura pulmonary artery murmur hemoptysis right bundle branch block air impatience
Partial pulmonary venous drainage
Clinical manifestations can be palpitations, shortness of breath, fatigue, cough, hemoptysis, etc.
Complete anomalous pulmonary venous drainage
The clinical symptoms of children with complete pulmonary venous drainage are mild purpura (very high in patients with pulmonary hypertension), progressive dyspnea, fatigue, dysplasia, and right heart failure.
Examine
Pulmonary venous drainage
Partial pulmonary venous drainage
1, signs often in the left sternal border of the 2-3 intercostal and systolic murmur, the second sound of the pulmonary artery hyperthyroidism or division.
2, ECG showed a change in right heart, which can be expressed as right axis deviation, right bundle branch stagnation, right atrial hypertrophy, right ventricular hypertrophy and so on.
3. Echocardiography is basically the same as secondary atrial septal defect, but sometimes it can detect ectopically connected pulmonary veins.
4, right heart catheterization and right heart angiography.
Complete anomalous pulmonary venous drainage
The examination may have no specific murmur or a systolic jet-like murmur in the second intercostal space of the left sternal border, and the second heart sound in the pulmonary valve region is split and hyperthyroidized, and a vascular murmur can be heard in the chest corresponding to the drainage site. The heart sounds are enlarged, and the anterior region of the heart may have a lifting pulsation, and the clubbing (toe) may be seen.
Auxiliary examination, X-ray, nuclear magnetic resonance can be found in pulmonary vascular enlargement, pulmonary artery segment protruding, right ventricle, right atrium increased, ectopic drainage into the left superior vena cava, the upper mediastinum shadow widened, the entire heart shadow is "8" Glyph. Electrocardiogram and echocardiography mainly suggest right ventricular and right atrial hypertrophy. Cardiac catheterization revealed a high right atrial pressure, increased pulmonary blood flow and pulmonary artery pressure, and low blood oxygen levels in the peripheral arteries.
Diagnosis
Diagnosis and diagnosis of pulmonary venous drainage
The diagnosis of this disease is clear, and it needs to be differentiated from other congenital heart diseases if necessary. The most clinically, the differential diagnosis is made with atrial septal defect. The reason why the disease is easily misdiagnosed as atrial septal defect is as follows:
1. Complete anomalous pulmonary venous return is very rare, which is easy for clinicians to consider. It is reported that this is not enough for heart surgeons to know about some abnormal signs (such as cyanosis after activity, widening of heart shadow in upper mediastinum, etc.). It is also related to the lack of experience of physicians.
2. There are similarities between the two diseases in the symptoms and signs, especially in the case of atrial septal defect with small opening and obvious cyanosis. X-ray examination has no typical "8" shaped heart shadow, and the inexperienced clinician is easy. Misdiagnosis, ultrasound should be reviewed at this time to prevent misdiagnosis.
