Chapter 2581 Another Way [2581]
Normally, the secundum closes after the child is born. After the baby is born, the pressure of the left atrium is greater than that of the right atrium, and the patch is directly pressed on the hole to erase the hole.
Fear is where it is. For some people, the defect grows too large, and the patch is not big enough, so it cannot be covered and closed completely. This kind of people occupies a certain proportion in the crowd, and it is not low, it can account for 20 to 30 percent. Another large type of atrial septal defect occurs here, called atrial septal defect with secundum foramen.
Hearing this, some people couldn't believe that there were so many people suffering from this disease, because it was rare to hear of such patients around.
This is because the pores of most of these defects are very small, which basically does not affect the hemodynamics of the heart. The patients are asymptomatic and have not been found without seeking medical treatment, and the discovery does not affect human health. Medically, it is considered that there is no need for intervention. Why take a knife if there is nothing to do?
People who need surgery are symptomatic. This symptom is based on the large defect area, too much blood infused from the left atrium into the right atrium, resulting in pulmonary hypertension, continuous pulmonary hypertension will evolve into pulmonary artery organic disease, and the blood from the right atrium will be re-pressed into the left atrium. The ventricles cause symptoms such as left heart failure and cyanosis. This evolution is called Eisenmenger syndrome. At this point, we know from previous cases that it is very troublesome, and the only option is lung transplantation.
If an operation is to be performed, it must be detected and resolved in time. The problem is that the electrocardiogram or chest X-ray of this kind of disease can't be found until there is pulmonary hypertension or arrhythmia.
Even if the defect area is large, such patients will at most show symptoms of being prone to colds in childhood, without any other obvious symptoms, which cannot be detected by ordinary physical examination items.
When I was a teenager, some symptoms appeared, which showed that I was more prone to shortness of breath than ordinary people.
Our countrymen like to classify such patients as weak constitutions, and never thought that there would be organic diseases in them. The main reason is still one, the inspection items are too simple and wrong to do the necessary screening.
Such patients can continue to live without severe pulmonary hypertension. After the age of 40, the symptoms will become more and more serious. At that time, the investigation will finally find out and I will have to do a color ultrasound of the heart. If the timing of the operation for pulmonary hypertension is missed, the life expectancy will be reduced by 10 to 20 years.
For treatment, there is the option of interventional closure after interventional surgery. Like other interventional surgeries, there are conditions and thresholds for interventional surgeries. If the location of the defect is not good, and the shape of the defect is strange and complicated, interventional surgery cannot be done, and the only choice is surgery.
The male-to-female ratio of this disease is more than double that of females.
A 12-bed girl, admitted to the hospital, showed echo loss in the central part of the interatrial septum, with a size of about 30mm. The color blood flow showed a left-right shunt at the atrial level. The defect is large and the edges are uneven, so the intervention cannot be performed and transferred to surgery.
Most of the heart surgery was done with two median sternotomies before. Today, I heard the teachers discussing in a low voice, it is possible to take the lateral thorax incision on the right side of the chest.
In the early stage of open heart surgery, lateral incision was actually adopted. Later, it was found that incision of the sternum to expose the surgical field is very convenient for doctors to operate. Some very complicated heart diseases can only be performed by incision of the sternum.
In modern times, the right side incision has returned to the field of heart surgery again. This is because doctors have discovered that it is no problem to continue to use the right side incision for not very complicated heart diseases, and the surgical scars left by the incision on the armpit are easy to hide and are hung down. Covering the arms is in line with the patient's pursuit of beauty.