室间隔缺损(VSD)
What is it?
VSD is an opening or hole (defect) in the wall (septum) separating the two lower chambers of the heart (ventricles).
正常发育时, 两房之间的壁在胎儿出生前就闭合了, 所以出生时, 富氧血液不能与贫氧血液混合. 当洞没有闭合时, 它可能会导致心脏压力升高或身体氧气减少.
有VSD儿童的父母
病因是什么?
大多数儿童的病因尚不清楚. 这是一种很常见的心脏缺陷. 一些儿童除了室间隔缺损还可能有其他心脏缺陷.
它是如何影响心脏的?
Normally, 心脏的左侧只向身体供血, 而心脏右侧只将血液泵入肺部. 在一个患有室间隔缺损的孩子身上, blood can travel across the hole from the left pumping chamber (left ventricle) to the right pumping chamber (right ventricle) and out into the lung arteries. 如果VSD很大, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested.
VSD对我的孩子有什么影响?
如果开口很小, 它不会引起症状，因为心脏和肺不需要更努力地工作. 唯一不正常的发现是巨大的杂音(听诊器听到的噪音)。.
如果开口很大，孩子可能会比正常情况下呼吸更快、更困难. 婴儿可能在喂养和正常生长方面有困难. 症状可能在出生几周后才会出现. High pressure may occur in the blood vessels in the lungs because more blood than normal is being pumped there. 久而久之，这可能对肺血管造成永久性损伤.
对于VSD可以做些什么?
如果开口很小，就不会使心肺工作更辛苦. 可能不需要手术和其他治疗. 小型vsd通常会自行关闭. There isn't any medicine or other treatment that will make the VSD get smaller or close any faster than it might do naturally.
按补丁闭合
如果婴儿病得很重, 或有一个以上的室隙隙，或室隙隙位于不寻常的位置, 可能需要临时手术来缓解症状和肺部高压. This procedure (pulmonary artery banding) narrows the pulmonary artery to reduce the blood flow to the lungs. 当孩子长大了, 通过开胸手术移除带子并固定室间隔缺损. If the opening is large, open-heart surgery may be needed to close it and prevent serious problems. 患有室间隔缺损的婴儿可能会出现严重症状，需要早期修复, 在最初的几个月, 通常是必要的. 其他婴儿的修复可能会延迟. 可以暂时使用药物来缓解症状, 但它们不能治愈室间隔缺损，也不能防止肺动脉的永久性损伤. Closing a large VSD by open-heart surgery usually is done in infancy or childhood even in patients with few symptoms, 为了预防以后的并发症. Usually a patch of fabric or pericardium (the normal lining around the outside of the heart) is sewn over the VSD to close it completely. Later this patch is covered by the normal heart lining tissue and becomes a permanent part of the heart. 有些缺陷不需要补片就可以缝合. 也许可以关闭导管室中的一些VSDs.
我的孩子可以做什么活动?
如果VSD很小, 或者是否通过手术封闭了室间隔缺损, your child may not need any special precautions regarding physical activity and can participate in normal activities without increased risk.
我的孩子将来需要什么?
这取决于VSD的位置, your child's pediatric cardiologist will examine your child periodically to look for uncommon problems, 比如主动脉瓣泄漏. Rarely, older children with small VSDs may require surgery if they develop a leak in this heart valve. 手术结束后，儿科心脏病专家会定期检查你的孩子. 心脏病专家会确保心脏工作正常. 长期前景良好，通常不需要药物或额外的手术.
那么预防心内膜炎呢?
询问孩子患心内膜炎的风险. Your child's cardiologist may recommend that your child receive antibiotics before certain dental procedures for a period of time after VSD repair. 更多信息请参见心内膜炎部分.
患有室间隔缺损的成年人
病因是什么?
对大多数人来说，病因尚不清楚，但遗传因素可能起着作用. 这是一种很常见的心脏缺陷. 有些人除了室间隔缺损还会有其他心脏缺陷.
它是如何影响心脏的?
Normally, 心脏的左侧只向身体供血, 而心脏右侧只将血液泵入肺部. 当心室之间有一个大开口时, a large amount of oxygen-rich (red) blood from the heart's left side is forced through the defect into the right side. This blood is pumped back to the lungs, even though it has already been refreshed with oxygen. 不幸的是，这会导致心脏泵出更多的血液. The heart, especially the left atrium and left ventricle, will begin to enlarge from the added work. 高血压可能发生在肺部血管，因为那里有更多的血液. Over time, this increased 肺动脉高压 may permanently damage the blood vessel walls. 当缺陷很小时, not much blood crosses the defect from the left to the right and there's little effect on the heart and lungs.
VSD对我有什么影响?
在儿童时期，大开口可能会导致呼吸困难，因此, 这些孩子中的大多数都做了手术来弥补缺陷. Therefore, 在成人中大的VSDs并不常见, 但是当他们出现的时候, 会引起呼吸短促吗.
Most adults have small VSDs that don't usually cause symptoms because the heart and lungs don't have to work harder. 在体检时，小的VSDs会产生很大的杂音. 即使很小的VSDs偶尔也会成为感染源，称为心内膜炎.
如果我的VSD很小或自己关闭了怎么办?
许多患有室间隔缺损的儿童不需要手术或其他治疗, 很多缺陷都是自己闭合的. Adults who were told they "had a hole in their heart" that closed on its own usually have no murmur and a normal EKG. 如果进行超声心动图检查, it may show an outpouching called a ventricular septal aneurysm in the area where the VSD was located. 如果在VSD关闭后动脉瘤没有被发现, 这会导致不必要的担忧和测试.
如果我的VSD在童年时就关闭了，我还能期待什么?
如果开口很大，很可能做了开胸手术.
VSD closure is usually performed by sewing a patch of fabric or pericardium (the normal lining around the outside of the heart) over the VSD to close it completely. The normal heart lining tissue eventually grows to cover this patch and it becomes a permanent part of the heart. 有些缺陷不需要补片就可以缝合. It's now possible to close some types of VSDs in the catheterization laboratory using a special device that can "plug" the hole and some younger adults may have had this procedure.
VSDs修复且肺动脉压力正常的患者寿命正常. 晚期问题并不常见, but a small number of patients may have problems with the heart valves (aortic or tricuspid) or extra muscle inside the right side of the heart. Anyone who had surgery for a VSD requires a regular check up with a cardiologist who is experienced with adults with congenital heart defects. 很少需要药物治疗. 对于大面积未修复的室间隔缺损患者，可发生肺动脉高压.
如果缺陷仍然存在怎么办? 成年后需要修复吗?
Usually closure is recommended for small VSDs only if there's been an episode of 心内膜炎 which is a heart infection that may be due to the VSD, 或者室间隔缺损的位置是否影响了心脏瓣膜的功能. 如果VSD很大, 对于一个成年病人来说，肺部的压力决定了它是否能被闭合. Those with low lung pressures will benefit from surgery; those with high pressures may or may not.
你可能遇到的问题
Patients with small VSDs that stay open have a small risk of a heart infection called 心内膜炎. 主动脉瓣可能发生渗漏，应进行监测.
Patients whose VSD has been repaired early in life are unlikely to have any significant long-term problems. 如果室间隔缺损完全闭合，补片无漏, 晚期感染的风险, 心内膜炎, is minimal. 不正常的心律很少会发生. 对一些人来说，在室间隔缺损修复后，心肌的收缩能力可能会降低. 如果心脏肌肉无力导致心力衰竭, 利尿剂控制积液, 帮助心脏更好地泵血的药物和控制血压的药物经常被给予.
在罕见的室间隔缺损患者中 肺动脉高压，可能需要药物治疗.
Ongoing Care
医学随访
心脏病专家应该定期给你做检查. 如果你的室间隔缺损很小，或者小时候就封闭过，没有发现其他问题, 每3-5年一次可能就足够了.
我将来需要什么?
Medications may be required only if you have heart failure (which is very uncommon) or if you have 肺动脉高压. 如果需要的话，你的心脏病专家可以用非侵入性检查来监测你. These include electrocardiograms, Holter monitors, exercise stress tests and echocardiograms. 它们将有助于显示是否需要更多的手术，如心导管插入术.
活动的限制
大多数患者不需要限制他们的活动. However, 如果你有肺动脉高压或者你的心脏不像以前那么跳动, 你可能需要根据你的耐力来限制你的活动. 你的心脏病专家会帮助你决定是否需要限制你的活动.
心内膜炎的预防
未修复的室间隔缺损不需要预防心内膜炎, 根据美国心脏协会的最新建议. 在VSD成功关闭后, 预防性治疗只需要在六个月的恢复期. 请参阅有关 心内膜炎 欲了解更多信息.
Pregnancy
一旦VSD关闭，就没有剩下的肺动脉高压了, 怀孕的风险很低. 如果VSD仍然打开，就有必要和你的心脏病专家谈谈. 除非有肺动脉高压, 怀孕可能是耐受良好的, but before you decide to get pregnant you need to find out the exact risks to you and your child. 请参阅有关 Pregnancy and 遗传咨询 欲了解更多信息.
你还需要更多的手术吗?
People whose ventricular septal defects are repaired rarely need more surgery unless the patch leaks or other holes are discovered later. 如果发生这种情况，是否需要手术取决于残留缺陷的大小.
