Ocena kliniczna i hemodynamiczna niemowląt z ubytkiem przegrody międzykomorowej

Abstract Introduction Ventricular septal defect (VSD) is one of the most common congenital heart diseases in children. Left-to-right shunt through the defect can cause symptoms and signs of heart failure (HF). Aim The assessment of the stage of HF and hemodynamic disturbances in infants with VSD. Patients and methods The study group consisted of 34 infants with VSD aged 38–338 days (mean 130 ± 81 days). HF was diagnosed upon the anamnesis and physical examination. The stage of HF was evaluated based on modified NYHA classification. The hemodynamic disturbances were estimated using ECG, chest X-ray, and echocardiography. Results At least one of the following signs was found: dyspnoea in 22 (65%), tachypnoea in 18 (53%), malnutrition in 18 (53%), and decreased weight gain in 11 (32%). HF was found in 19 (56%) children. The increased vascular markings in chest X-ray was observed in 20 patients. The following parameters estimated by echo exceeded upper normal limits: left atrial diameter in 22 (65%), left ventricular internal diastolic diameter in 18 (53%), pulmonary trunk in 15 (44%), and pulmonary to systemic flow ratio in 27 (79.5%). Conclusions The anamnesis and physical examination are key issues in diagnosing HF in infants with VSD. The tachypnoea, dyspnoea and poor weight gain are the most common clinical consequences in infants with HF due to VSD. HF in infants with VSD is usually classified as II–III degree in modified NYHA scale. In about 2/3 of infants with VSD ECG, chest X-ray and echo reveal hemodynamically significant left-to-right shunt.