Interventricular defect: classification, symptoms, diagnosis and treatment
After the bicuspid aortic valve, the interventricular defect is the second best known and most widespread congenital heart disease in the world
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The interventricular defect consists in the presence of a communication ‘hole’ at the level of the interventricular septum, i.e. the wall separating the right ventricle from the left ventricle in the heart; in this way, the two cavities are put in communication and their blood mixes.
The consequence is that oxygenated blood, which the left ventricle should pump into the aorta and thus to the different parts of the body, passes into the right ventricle and from there to the lungs.
The communication can vary in size and location.
Small defects may close by themselves and not be associated with serious complications.
In other cases, the consequences can be quite serious, even in childhood, and surgery is therefore necessary.
Interventricular defects can be classified into:
- muscular DIVs, in which the margins are defined entirely by myocardium;
- Perimembranous DIVs, located in the membranous septum;
- subarterial DIVs, characterised by double connection, located in the infundibular outflow septum, confined by the fibrous continuity of the aortic and pulmonary valves.
Alternatively, they may be classified according to location:
- Perimembranous, or conoventricular, is the most common form and affects the membranous septum near the tricuspid valve.
- Trabecular, less common than the previous one, can affect any part of the trabecular portion of the interventricular septum.
- Subpulmonary, with varying frequency depending on the region, affects the ventricular septum just below the annulus of the aorta. Sometimes this defect can lead to a prolapse of the aortic leaflet or aortic insufficiency.
- Inlet, in which the atrioventricular canal septum is totally or partially absent.
Symptoms of interventricular defect
Symptoms of interventricular defect vary from person to person depending on age, severity of the condition (size and location of the defect) and the presence of other factors.
It is very important to pay attention to certain signs from an early age.
One of the symptoms of the interventricular defect is the heart murmur, the typical noise that can be observed by the doctor during auscultation of the patient’s heart.
The noise can vary greatly in intensity and characteristics depending on the size of the hole.
Other symptoms are:
- tiredness
- breathlessness
- lack of appetite and slow growth
- irritability
- susceptibility to respiratory infections
Complications include the development of lower limb oedema or jugular turgor to pulmonary oedema.
Diagnosis
The difficulty in making a diagnosis depends on the severity of the defect itself.
It is essential to collect a correct medical history from the child’s parents, asking questions regarding symptoms or family history of congenital pathologies.
During routine examinations, data regarding growth is always collected.
The diagnosis is already suspected from the objective test, during which auscultation of the heart may reveal pathological murmurs, supported by subsequent investigations such as:
- chest X-ray, to obtain images of the vascular pattern of the lungs and the size of the heart
- ECG, to obtain information on the heart’s electrical activity but also on aspects such as ventricular hypertrophy or atrial dilatation
- echocardiography, which is often diagnostic as it can provide anatomical and haemodynamic information, including the location, size of the defect and important haemodynamic information.
Treatment of interventricular defect
Treatments also vary depending on a number of factors, such as the severity of the defect, associated symptoms and the clinical picture at the time of diagnosis.
Small ventricular septal defects may close spontaneously and require no treatment.
On the other hand, in the case of significant defects that begin with heart failure, the use of diuretics or ACE inhibitors is essential; diuretics, in particular, reduce fluid overload both peripherally and in the lungs, thus improving dyspnoea.
In the case of significant defects, in order to prevent subsequent complications, the surgical approach is indicated, which is burdened by a low mortality rate.
Among the possible approaches, one consists of applying a patch, i.e. a kind of patch, to correct the defect.
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