Inter-ventricular communication

Mechanism

Pulmonary circulations (blood low in oxygen) and sytemic (blood rich in oxygen) are normally separate. Certain malformations allow the mixture of two circulations. Most frequent are:

the communications inter-auricular S;
inter-ventricular communications;
the Persistence of the arterial channel;

The birth, the communication inter ventricular allows the passage of blood of the system the more high pressure (left ventricle) towards the system of lower pressure (ventricle right). This oxygenated blood which was intended for general circulation finds again in the pulmonary system. This overload of blood in the pulmonary capillaries created of the vascular lesions, which tends to increase the pressures in the pulmonary system. After several months or years (according to its importance) of evolution, it settles a pulmonary arterial Hypertension, initially reversible then irreversible, thus limiting the passage of the blood of the right heart towards the pulmonary Artère. The shunt inter ventricular is reversed and to let appear a Cyanose since badly oxygenated blood passes then in systemic circulation.

When this pulmonary hypertension important and is fixed and forms the essence of the table, one speaks then about a Syndrome of Eisenmenger.

In the case of a Tetralogy of Hand lantern, the pressure of the ventricle right is from the start higher than the pressure of the left ventricle because of association with a sténose of the pulmonary valve. The shunt is thus from the start right-left (pulmonary circulation towards systemic circulation).

Various types

One distinguishes several localizations from inter-ventricular communication:

the CIV muscular one, (4-5-6)
the CIV perish-membranous one, (1-2-3)
the CIV infundibulaire, (8)
the CIV of the room of admission (7).

Diagnosis

Anténatal

Echographic aspects before the birth

Management of the pregnancy

Assumption of responsibility of the newborn

Postnatal

Private clinic

The private clinic is variable in the intensity of these symptoms and this according to the size and of the position of the CIV.

The cardiac Sounding note generally a diffuse systolic breath (" in rays of roue") whose intensity is inversely proportional to the size of the communication.

The infant presents sometimes a Cardiac failure with sweats and fast breathing (polypnée) at the time of efforts in particular the catch of the feeding-bottle or the tears. After several weeks, disorders of the growth settle

Cyanosite is rare: it exists only if the shunt is reversed i.e. when the pressure in the pulmonary circulatory system becomes important. That is noticed then especially at the time of the cries of a child who cyanosite. If the CIV are important, a few months of evolution suffice for an authentic pulmonary arterial hypertension to settle and characterize a Syndrome of Eisenmenger.

Complementary examinations

The diagnosis is generally made by echocardiography Doppler in front of the described clinical signs. The image shows us a blood turbulance (in green) crossing the walls inter ventricular (vertical line in gray), and energy from one ventricle to another (ventricular cavities in black). Doppler makes it possible to quantify the shunt (calculation of the report/ratio of the systemic flow on pulmonary flow). This examination also makes it possible to detect associated cardiac anomalies, to evaluate the repercussion on the ventricle right and to estimate the pressures of the right cardiac cavities.

The Radiographie of the thorax shows an overload of the pulmonary hiles and vascular screen of the lungs.

Treatment

The treatment aims at closing the opening between the two ventricles, either in manner chirugicale, or by the establishment by cardiac Cathétérisme of a sunshade blocking the communication. It is proposed only if the communication is of sufficiently large size, involving a shunt significant left-right. A communication of small size (called disease of Roger generally does not involve any consequence for the child and the adult, and can be sometimes closed spontaneously. The CIV muscular ones can be closed during the muscular development of the heart. One then proposes in certain situations the hooping of the pulmonary artery during one year before considering a radical surgical cure of the CIV. The additional muscular effort of the ventricle right that this obstacle éjectionnel represents, thus increases its work and with long its volume. It is this volume which helps also sometimes with the spontaneous closing of the CIV.

In all case (and even if the communication is small), there is a risk of bacterial infection of the latter within the framework of a infectious Endocardite. A prevention of the latter remains essential ( disease prevention of bacterial endocarditis ) containing Antibiotique S at the time of certain well defined circumstances (dental care in particular).

In the more advanced forms (sights more tardily) and more severe, occurred of a pulmonary arterial Hypertension with inversion of the shunt which becomes right-left complicates the assumption of responsibility. A closing of the communication is imperative if one can prove that the increase in the pulmonary pressure remains reversible (evolution of the pressure of the pulmonary Artère under certain drugs). In the contrary case (arterial hypertension known as fixed), this closing is not enough any more and the treatment of pulmonary arterial hypertension passes in the foreground. In the very important forms, one can sometimes propose a transplantation artificial heart-lung.

To become children

Syndrome of Eisenmenger
Disease of Osler

The genetic Council

Sources

References

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