Possible non-spending diagnosis of a rare form of congenital heart disease - of total anomalous pulmonary venous drainage

Total anormal drainage of pulmonary veins (TADPV) is insufficiently known and rarely occurring congenital heart defect, combining with other heart defect of the heart.The object is to diagnose TADPV in condition of policlinic level of studies. The children were examined by raentgenography, electrocardiogram which together with clinical manifestations allowed to diagnose this defect and to determine its type. All these investigations were perfomed in polyclinic conditions.

TAPVD - one of the rare defects at 0.5 - 4% of all CHD in combination with other heart defects. Until our years it is poorly understood. Diagnosis blemish is very difficult for a cardiologist clinic. CDH was created by J.B. Wenslow and J.Y. Wilson in 1739. Darling classification distinguishes 4 types of vice, depending on the level of the confluence of the pulmonary veins into the systemic circulation. EOvercardbl - pulmonary veins empty into a common header into the superior vena cava, left unmarked in the azygos vein.

ECardia- pulmonary veins empty into the right atrium or into the coronary sinus.

EUndercardial- pulmonary veins empty into the portal vein or inferior vena Vienna.

EMixed Various combinations of these types.

Purpose of the work was the optimization of the diagnosis of total anomalous drainage under outpatient - polyclinic level research. Present their observations.

Patient N. 3 months admitted to the intensive care unit of Almaty General Hospital with complaints of cough, anxiety, poor weight gain.

Of history - by 4 months pregnant mother had SARS and worked in a foundry.

Patient's condition was very serious due to cardiovascular disease. RR - 68 per minute, Ps - 162. Limp slowly sucks. 3950 body weight, height - 55 cm. Of peripheral edema net. Tsianoz visible mucous and skin. In the lung against the hard breathing in the lower listened wet finely wheezing. Rhythmic heart sounds, the deaf, the second tone of the pulmonary artery strengthened.

Auscultated systolic murmur, with its epicenter along the left sternal border, which takes place on the cardiac region. Mild stomach, liver 3,5-3,5-3,0, supple texture.

ECG - sinus rhythm, and tachycardia. pulse 169, EAH deviation to the right of right heart.

X-ray - an increase of the right heart, the signs of pulmonary hypertension.

Echocardiography - pattern typical for TAPVD, ventricular septal defect, atrial septal defect.

After these consultations, the child was sent for surgery to Astana. Patient K. 2 months, was admitted to the emergency department with complaints of shortness of breath, anxiety. One week before admission, she was treated in one State Children's Hospital of Almatys diagnosed pneumonia, was discharged without improvement.

Patient's condition was very serious due to cardiovascular disease and respiratory failure. Ps 196, RR - 84. No peripheral edema. Cyanosis of the skin. Very restless, does not suck, shortness of breath with auxiliary muscles. In the lungs very hard breathing. Border of the relative cardiac dullness extended across, dull tones, 2 tone of the pulmonary artery is split, systolic murmur, with its epicenter - along the left sternal border, held for the cardiac region. Deep palpation of the abdomen is available, the liver 2,0-2,52,5.

ECG - sinus rhythm and tachycardia 196, EAH deviation to the right, signs of right ventricular hypertrophy.

X-ray - ADPV, ventricular septal defect, hypertension. Echocardiography - ADPV, ventricular septal defect.

  1. hours after admission with an increase in cardiac and respiratory failure, the child was transferred to the artificial lung vantilyatsiyu.

With symptoms of terminal heart and respiratory failure death occurred.

Pathological-anatomical diagnosis ADPV - all the veins empty into the right atrium.

Thus, in both cases, children prior to entering our clinic were diagnosed colds.

Data Clinic: shortness of breath, tachycardia, expanding the boundaries of the heart, right ventricular overload, data intsrumentalnogo survey, echocardiography, ECG, R-graphy - are not expensive and can be performed at outpatient examinations of children.



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Year: 2014
City: Almaty
Category: Medicine