Common truncus arteriosus in a newborn. Treatment of the common arterial trunk
Arteriovenous fistulas or arteriovenous fistulas - These are hollow tubes-tubules formed in the body due to injuries or pathological processes.
Arteriovenous fistulas (fistulas) are connections between veins and arteries. As a result of the appearance of fistulas, blood from the veins begins to flow directly into the arteries, while with normal mode functioning human body blood from the heart must go through the arteries to the capillary system and from there, through the veins, return to the heart.
Arteriovenous fistulas and aneurysms are serious vices vascular system. Untimely or unqualified treatment leads the patient to severe complications(such as, for example, decompensation of cardiac activity), disability and often death at a fairly young age!
In "MedicCity" diagnostics of the heart and blood vessels is carried out. Our phlebologists, vascular surgeons are high-class specialists who own modern methods of treatment vascular diseases. Seek help from professionals!
What are dangerous arteriovenous fistulas
The appearance of arteriovenous fistulas or fistulas leads to a deterioration in the blood supply to important areas and organs of the human body. The blood pressure also falls, while the pressure in the veins rises. The load on the heart increases, which at the same time begins to experience insufficient blood flow due to a violation of the circulatory cycle.
All this can lead to the development of various, including severe cardiovascular disease, aneurysm - increased load blood flow to the veins can cause them to stretch and tear - and thrombosis, which can develop in the areas of the veins below the site of the fistula.
Another type of complications caused by arteriovenous fistulas (fistulas) is cosmetic defects: spots on the skin and swelling of tissues.
Types of arteriovenous fistulas, their symptoms
Arteriovenous fistulas (fistulas) are congenital And acquired.
Congenital arteriovenous fistulas can be located in any part of the body and are often associated with localization nevi- birthmarks, melanoma, etc.
Forming at the stage prenatal development of the human embryo, congenital arteriovenous fistulas (fistulas) can already in the first weeks and months after birth provoke pathological ischemia(lack of blood supply) to limbs and venous hypertension(syndrome of increased venous pressure). This may be accompanied by skin pigmentation, limb enlargement, hyperhidrosis, swelling of the saphenous veins, and other symptoms.
Appearance acquired arteriovenous fistulas(fistula) can be the result of injuries, wounds, as well as a consequence medical manipulations- for example, shunting. Also during surgical operations for hemodialysis, arteriovenous fistulas (fistulas) can be created specifically to ensure the effectiveness of this treatment. Therefore, it is important to be operated on by experienced qualified doctors with modern technical capabilities.
The appearance of large arteriovenous fistulas (fistulas) is accompanied by swelling and redness of the tissues, however, small fistulas (fistulas) may not manifest themselves in any way until they appear. heart failure.
Diagnosis and treatment of arteriovenous fistulas
The presence of arteriovenous fistulas (fistulas) is diagnosed using modern ultrasound research(dopplerography, ultrasound scanning), computed and magnetic resonance imaging. If the fistulas lie deep, then doctors may resort to contrast x-ray angiography.
Treatment of arteriovenous fistulas (fistulas) is carried out surgically.
Small congenital fistulas can be removed with laser coagulation. Also, congenital and acquired arteriovenous fistulas can be removed by endovascular methods, when under the influence x-rays a certain substance is introduced into the vessel, which blocks the direct communication between the vein and the artery.
In more difficult cases held surgical intervention to remove a fistula (fistula).
In the treatment of vascular diseases, it is of great importance early diagnosis. With any symptoms (swelling, pain, heaviness in the legs, cramps, protruding veins on lower limbs etc.) contact a phlebologist immediately! In "MedicCity" specialists will come to your aid, in whose arsenal the most modern techniques diagnostics and treatment of vascular and vein diseases!
OSA is characterized by the fact that a single main vessel with a common semilunar valve departs from the right and left ventricles, from which the branches of the aortic arch and LA originate. Under the common semilunar valve of this vessel is a large VSD.
Anatomical classification SLA by Van Praagh:
- Type A1- pulmonary arteries start from a short trunk of the LA, extending from the wall of the OSA (common truncus arteriosus).
- Type A2- pulmonary arteries begin as independent mouths from ascending department OAS.
- Type AZ- one of pulmonary arteries, more often the right one, starts from the OSA, the second one is supplied with blood through the PDA or a collateral vessel.
- Type A4- a combination of OSA with a break in the aortic arch (the descending aorta is supplied with blood through the PDA).
In OSA, only one leaves the heart arterial vessel, through which coronary hemodynamics, hemodynamics of the ICC (lesser circulation) and BCC (large circulation) are provided. Since mixed blood enters the OSA, cyanosis is the main and first symptom of the disease. Otherwise, the pathophysiology of the defect will depend on the presence of concomitant anomalies (rupture of the aortic arch, malformations of the coronary arteries) and the type of LA (pulmonary artery) origin from the OSA. Depending on this, both enrichment and depletion of the MCC can be observed (in rare cases), varying degrees severity of heart failure associated with both ventricular volume overload and deficiency coronary blood flow. OSA valve insufficiency progresses continuously.
Most patients die within the first two weeks of life, 85% by the end of the first year of life. OSA in 33% of cases is an integral part of the DiGeorge syndrome. The prognosis for life in patients with OSA is unfavorable.
CLINIC
A. Clinical manifestations of the disease:
Cyanosis of varying severity;
Signs of heart failure (shortness of breath) from the first days after birth.
b. Physical examination:
High pulse pressure;
Pronounced pulsation of the precordial region, the apex beat is significantly shifted to the left;
Rough (2-4/6) systolic murmur associated with the presence of VSD, which is best heard along the left edge of the sternum;
With hypervolemia of the ICC in the projection of the apex, a rough diastolic murmur (“rumble”) is heard, which can be combined with the “gallop rhythm”;
Gentle diastolic murmur of OSA valve insufficiency.
DIAGNOSTICS
- Electrocardiography
ECG signs of biventricular hypertrophy (less often, hypertrophy of one of the ventricles is noted);
Rarely LA hypertrophy.
- echocardiography
Diagnostic criteria:
Detection of one wide vessel extending from both ventricles;
Detection of the pulmonary artery extending from the OSA;
The presence of mitral semilunar fibrous continuation;
The presence of only one semilunar valve.
TREATMENT AND OBSERVATION
- Observation and treatment of patients with uncorrected OSA
A. Before surgery, all patients should have active treatment heart failure (diuretics, digoxin).
b. Since OSA in 33% of cases is a manifestation of DiGeorge syndrome, the following recommendations should be followed:
Continuous monitoring of serum potassium and magnesium levels and, if necessary, its correction,
Treatment and prevention of streptococcal and pneumococcal infections, given the presence of thymus-dependent immunodeficiency;
Avoid immunization with live vaccines.
V. Prevention bacterial endocarditis according to indications.
- Surgery
Indications for surgical treatment:
Diagnosis of OSA absolute reading to surgical treatment.
Contraindications for surgical treatment:
High pulmonary hypertension (OLC > 10 U/m2 at baseline and > 7 U/m2 after vasodilator use);
Availability absolute contraindications on concomitant somatic pathology.
Surgical tactics
Ideally, the diagnosis of OSA should be made within the first hours after birth. In this case, planned surgical treatment is carried out during the first week of life. If the diagnosis is late, it is necessary to evaluate the ALC.
The procedure of choice is the primary radical correction.
LA narrowing, even if anatomically possible, is not clinically effective.
Surgical technique
Artificial circulation. Bicaval cannulation and OSA cannulation. Pulmonary arteries are isolated and taken on tourniquets. During cardioplegia, they are briefly clamped to direct the cardioplegia solution into the coronary arteries. Prolonged clamping of the pulmonary arteries can damage the lungs. To avoid shunting the flow from the aortic cannula into the LA, the aorta clamp should be applied above the LA ostia. When cardioplegia is reset through an incompetent trunk valve, it is necessary to open the lumen of the OSA, and the perfusion of the cardioplegia solution is carried out directly into the orifices of the coronary arteries.
LA are cut off from the OSA wall. The wall defect is sutured or repaired with a xeno/autopericardial patch. VSD plasty is performed through ventriculotomy in the VOP (pulmonary artery). Plastic material - dacron. After VSD plasty, the LA trunk and valve are replaced with a valve-containing conduit. First of all, a distal anastomosis is formed between the conduit and the LA. Perform plastic surgery of the OSA, reducing its diameter, and plastic surgery of the truncal valve to prevent its insufficiency. DoK prosthetics by any known technique leads to unsatisfactory results. The correction is completed by the formation of a proximal anastomosis between the valve-containing conduit and the RVOT through ventriculotomy. In the postoperative period, the development of "pulmonary crises" is characteristic. Despite the wide options for medical treatment, it is advisable to leave an interatrial fistula with a diameter of 3 mm to ensure systemic hemodynamics with an increase in pressure in the LA (especially if surgical treatment was performed at the age of more than 6 months).
Specific complications of surgical treatment:
pancreatic insufficiency (pulmonary crises);
Residual pulmonary hypertension;
Atrioventricular nodal ectopic tachycardia;
Conduit dysfunction.
Postoperative follow-up
- Postoperative monitoring is carried out every 4-6 months for life. The states of the truncal valve, conduit are monitored, the severity of arrhythmias is assessed.
- Prevention of bacterial endocarditis is carried out according to indications throughout life.
- Physical education and sports are not recommended.
When the two main vessels leaving the heart (the aorta and the arteries of the lungs) unite into a single highway, which ensures the flow of blood to all tissues of the body, a common arterial trunk is formed. This congenital pathology baby. The defect needs to be corrected by surgery.
Read in this article
Causes of the development of congenital heart disease common arterial trunk in the fetus
The formation of large vessels occurs in the 3rd - 5th decade of pregnancy. Due to the action at this time of damaging factors or the presence genetic defects the common trunk is not divided into the aorta and pulmonary artery. There is a big message between them. Such a vessel comes from two ventricles at once, the blood in it consists of venous and arterial blood, it feeds the heart, brain and everything. internal organs. In all chambers of the heart and the main vessels, the same pressure is recorded.
In this case, the heart of a newborn may have three or even two chambers, since the development of the cardiac septum is also inhibited. One of typical signs with a four-chambered heart, there is a large area of the defect in the interventricular wall. The valve of this vessel has from one to four leaflets, narrowing or insufficiency of its function is often diagnosed.
The reasons provoking an anomaly of development are:
- maternal diseases - influenza, herpes, rubella, measles, chicken pox, cytomegaly, syphilis, rheumatism, tuberculosis, diabetes mellitus;
- action external environment- polluted water, air, occupational hazards in the mother or father;
- one of the parents or both - alcoholism, drug addiction, age under 16 or over 45;
- taking pregnant hormones, sulfonamides, anticonvulsants and psychotropic drugs, cytostatics, antitumor antibiotics;
- cases of malformations in the family;
- toxicosis, the threat of abortion.
Symptoms in a newborn
If the pulmonary artery has a wide lumen, then the child from the first minutes after birth is in an extremely difficult condition due to the fact that a blood flow enters the lungs under great pressure. This leads to critical circulatory disorders and death of the newborn. If, nevertheless, the baby survives, then he has a severe form. Clinical signs common arterial trunk can be:
- lethargy;
- low physical activity;
- fast fatigue during feeding;
- weak weight gain;
- shortness of breath and cyanosis, even at rest, with an increase in light exertion;
- sweating;
- frequent heartbeat;
- enlarged heart and liver;
- heart hump, fingers in the form drumsticks, nail plates, like the glass of a watch.
However, with narrowing of the pulmonary artery, the symptoms are less severe, as this protects the small circle from excessive overflow, allows such children to live to 16 or even 40 years (it happens extremely rarely). Manifestations of pathology in such a situation are due to the development of circulatory failure according to mixed type(right and left ventricular).
in the nursery and school age the child is often sick, against the background colds or recurrent pneumonia, the condition deteriorates sharply.
Types of pathology
Depending on the variants of the branching of the arteries of the lungs, there are four types of this congenital anomaly of development:
- departs common vessel, and then it splits into 2 branches;
- two branches come from rear wall;
- the right and left vessels depart from the respective sides;
- there are no pulmonary arteries, and blood enters through the bronchial branches of the aorta (a type of Fallot's disease).
General main shaft located above both ventricles or predominantly above one. Anatomical shape of this vessel and the degree of narrowing of the pulmonary artery leads to the appearance of three types of circulatory disorders:
- increased blood flow to the lungs, progressive pulmonary hypertension and cardiac decompensation resistant to therapy;
- pulmonary blood flow slightly exceeds the norm, there is shortness of breath and cyanosis of the skin during exercise, circulatory failure is absent or not higher than 1 degree;
- poor blood flow to the lungs due to a narrowed artery, intense and stable cyanosis, respiratory failure, oxygen starvation organism.
Manifestations on ultrasound and other diagnostic methods
Expert opinion
Alena Ariko
Expert in cardiology
With sufficient qualification of the doctor, the detection of a common trunk occurs even at the stage of antenatal (prenatal) diagnosis. At 25 - 27 weeks of gestation, you can see a large duct in the center or displaced to one of the ventricles. At the same time, concomitant anomalies in the development of the aorta, fusion of the valves, hypoplasia or absence of the ventricles of the heart are often detected. Most often, in such a situation, a woman is recommended to interrupt the gestation artificially.
If the diagnosis is carried out in a newborn, then the following signs are taken into account:
- - more often in systole, enhanced 2nd tone;
- - overload of all parts of the heart and axis deviation to the right side;
- x-ray examination- the configuration of the heart resembles a ball, the ventricles are enlarged, shadows main vessels and branches of the pulmonary artery are dilated;
- Ultrasound of the heart – main method detection of a defect, a ventricular septal defect and a main trunk extending from it are visualized;
- - the catheter easily passes from the right ventricle to the common trunk and aorta, the same pressure in the heart, with narrowing of the lung artery - pressure drop, the degree of blood oxygen saturation is below normal (with high hypertension in the lungs it decreases to extremely low values);
- aortography- helps to determine the level of branching of the pulmonary arteries and valvular narrowing or insufficiency.
Treatment of the common arterial trunk
Medical therapy is ineffective. The newborn is placed in an incubator, where body temperature is maintained, blood circulation and blood composition are adjusted. At critical condition infant, the first stage of the operation consists in narrowing the lumen of the lung artery. A few months later, a radical correction is carried out:
- separation of the pulmonary branches from the common vessel;
- installation of a prosthesis with a valve in the right heart;
- plastic hole in the septum between the ventricles.
The success of treatment is determined by the severity of hypertension in the pulmonary vessels and the presence of other anomalies in the structure of the heart. Without surgery, about 15% of children survive to adolescence. After surgery, ten-year survival reaches 70%, and replacement of the prosthesis may be necessary.
Watch the video about the surgical treatment of the common arterial trunk:
Prevention
It is possible to prevent the development of heart disease when planning pregnancy, when future parents undergo medical genetics in cases of congenital anomalies in the family. During gestation, it is necessary to exclude independent application any medications, drinking alcohol, smoking, contact with toxic compounds at work.
Patients with this congenital heart disease should be under the supervision of a cardiologist all their lives, give rise to preventive courses of therapy. They are advised to take antibiotics even with minor surgical procedures to prevent infectious complications. When compensating for heart failure, it is important that the daily routine includes:
- rest during the day from 1 to 2 hours;
- night sleep for at least 8 hours;
- walk in the fresh air;
- breathing exercises;
- physiotherapy exercises;
- work at a reasonable intensity.
Expert opinion
Alena Ariko
Expert in cardiology
It is necessary to warn the patient that both complete immobility and sharp, fast movements are equally harmful, especially dangerous with high speed climb stairs or natural hills.
As far as possible, contact with infected patients during epidemics, as well as travel with sudden changes in climate, should be avoided. Diet food provides:
- obligatory calculation of caloric content depending on the degree motor activity(for example, with half-bed rest - not more than 30 Kcal per 1 kg of weight);
- fractional meals - 5 times a day in small portions;
- preparation of easily digestible meals;
- sufficient content of lean protein and vitamins;
- in the presence of edema, it is necessary to reduce the amount of salt and water, periodically appoint fasting days on milk, rice, potatoes.
The common arterial (aortopulmonary) trunk is congenital anomaly development, in which one comes from the heart large vessel. It collects blood from two ventricles and then enters the pulmonary vessels and arterial network great circle circulation.
There is always a septal opening in the interventricular part. Newborns are most often in serious condition due to blood overflow pulmonary system. Increasing cardiac decompensation leads to the death of the child without early surgery.
Read also
In modern diagnostic centers heart disease can be determined by ultrasound. In the fetus, it is visible from 10-11 weeks. Congenital signs are also determined using additional methods examinations. Errors in determining the structure are not excluded.
Common arterial trunk - CHD, in which one large vessel departs from the base of the heart through a single semilunar valve and provides coronary, pulmonary and systemic circulation. Other names: common trunk, common aortopulmonary trunk, persistent arterial trunk (persistent truncus arteriosus). The first description of vice belongs to A. Buchanan (1864). This defect accounts for 3.9% of all CHD according to the results of pathoanatomical studies and 0.8-
- 7% - according to clinical data.
- - origin of the right, left or both pulmonary arteries from the side walls of the trunk; IV - the absence of pulmonary arteries, due to which the blood supply to the lungs is carried out through the bronchial arteries extending from the descending aorta. This variant is not currently recognized as a type of true truncus arteriosus, in which at least one branch of the pulmonary artery must originate from the truncus. Thus, we can talk mainly about two types of defects: I and II-III.
cynosis. The leaflets of the valve of the common trunk are fibrously associated with the mitral valve, so it is considered to be mainly aortic.
The location of the truncus above the ventricles is important in the selection of patients for radical correction of the defect. In the observations of F. Butto et al (1986), in 42% it was located in equally over both ventricles, in 42% - mainly over the right and 16% - mainly over the left ventricle. In these cases, the exit from the ventricle, which is not connected to the trunk, is the VSD. According to other observations, the discharge of the trunk from the right ventricle occurs in 80% of cases, while the closure of the VSD during surgery leads to subaortic obstruction.
VSD is always present at the common arterial trunk, it does not have an upper edge, lies directly under the valves and merges with the mouth of the trunk, there is no infundibular septum.
This defect is often combined with anomalies of the aortic arch: interruption, atresia, right arch, vascular ring, coarctation.
Other concomitant UPUs are open general atm.
rioventricular canal, single ventricle, single pulmonary artery, anomalous pulmonary venous drainage. Anomalies occur among extracardiac defects gastrointestinal tract, urogenital and skeletal anomalies.
Hemodynamics. Blood from the right and left ventricles enters a single vessel through the VSD; the pressure in both ventricles, trunk and branches of the pulmonary artery is equal, which explains early development pulmonary hypertension; the exception is cases with stenosis of the mouth of the pulmonary artery and its branches or their small diameter. The right ventricle, with a common arterial trunk, overcomes systemic resistance, which causes hypertrophy of its myocardium, dilatation of the cavity. The hemodynamic features of the defect are largely determined by the state of circulation in the pulmonary circulation. The following options can be distinguished.
- Increased pulmonary blood flow with low resistance in the vessels of the lung, the pressure in the pulmonary arteries is equal to the systemic one, which indicates high pulmonary hypertension. It is more common in young children, accompanied by heart failure resistant to therapy. cyanosis may not be a large number of blood is oxygenated in the lungs and mixed in the ventricles due to big size VSD. A large discharge into the common trunk, especially with a multi-leaf valve, contributes to the appearance of valvular insufficiency over time, which further aggravates the severity of the clinical course of the disease.
- Normal or slightly increased pulmonary blood flow due to new resistance in the vessels of the small circle, preventing a large discharge of blood into the common trunk. There is no heart failure, cyanosis appears during exercise.
- Reduced pulmonary blood flow (hypovolemia) may occur when the mouth of the trunk or branches of the pulmonary artery narrows or with progressive sclerosis of the pulmonary vessels. Severe cyanosis is constantly noted, as a small part of the blood is oxygenated in the lungs.
Clinic, diagnostics. According to clinical manifestations, children with this defect resemble patients with large VSD. The leading sign should be considered shortness of breath by the type of tachypnea up to 50-100 per minute. In cases of reduced pulmonary blood flow, shortness of breath is much less pronounced. Cyanosis in the common arterial trunk is different: it is minimal or absent with increased pulmonary blood flow, expressed with sclerotic changes in the pulmonary vessels (Eisenmenger reaction) or pulmonary artery stenosis. In the latter cases, it
driven by the development of symptoms of "watch glasses" and "drumsticks", iolicythemia. With cardiomegaly, a heart hump appears. The heart sounds are loud, the II tone above the pulmonary artery is accentuated, it can be single and split in the presence of more than three valves. An apical systolic click is often determined. Rough, prolonged VSD murmur is determined in the third and fourth intercostal spaces on the left side of the sternum, at the apex there may be a mesodiastolic murmur of relative stenosis mitral valve- a sign of hypervolemia of the pulmonary circulation. If the leaflet structure causes a stenotic effect in the second and third intercostal spaces, an ejection-type systolic murmur is heard on the left or right. With the development of insufficiency of the trunk valves along the left edge of the sternum, a protodiastolic murmur appears. Heart failure is expressed according to the right and left ventricular type up to the picture pulmonary edema; it is less or absent in hypovolemia of the pulmonary circulation and sclerotic changes in the pulmonary vessels.
There are no specific electrocardiographic characteristics of the defect. Electric axle the heart is located normally or deviated to the right (from - (-60 to 4-120 °). Half of the patients have increased right atrium, right ventricle (in assignment QRS complex type R or qR), less often both ventricles. With pulmonary hypertension, the ECG shows signs of "strain" overload in the right chest leads (decrease in the ST interval by 0.3-0.8 cm, negative T waves in the leads
Vi-h).
On the FCG, the usual amplitude of the tone at the apex is visible, in the second intercostal space aortic clicks are fixed; II tone is often single, but can be wide and consist of several high-amplitude components; a pansystolic murmur is recorded, sometimes high-frequency with a maximum in the third and fourth intercostal spaces on the left, and a protodiastolic murmur is a sign of valvular insufficiency.
On radiographs of organs chest the pulmonary pattern is usually enhanced, with stenosis of the mouth of the pulmonary artery it is depleted on both sides, with stenosis or atresia of one of the branches - on one, with the sclerotic phase of pulmonary hypertension - it is depleted mainly along the periphery and enhanced in the root zone. The heart is often moderately enlarged (cardiothoracic ratio - from 52 to 80%), may become ovoid with a narrow vascular bundle, which resembles the transposition of the great vessels, but with a straighter upper left margin. Both ventricles are usually enlarged. Sometimes the heart is similar in shape to that of Fallot's tetrad, there is a characteristic wide base of the vessel with an S-shaped course. The right-sided location of the aortic arch is found in one-third of patients, which, combined with increased pulmonary blood flow and cyanosis, should raise suspicion of a common arterial trunk.
Nostic value may have a high position of the left pulmonary artery.
A characteristic M-echocardiographic sign of the defect is the absence of a continuous septal-aortic (anterior) continuation, while the wide vessel "sits on top" of the VSD. With a predominant departure of the common trunk from the left ventricle, the posterior (mitral-lunate) continuation is preserved. When the arterial trunk communicates mainly with the right ventricle, a violation of the anterior and posterior continuous continuations is recorded. Other M-echocardiographic signs of defect are: the inability to determine the second semilunar valve; diastolic flutter of the anterior leaflet of the mitral valve due to insufficiency of the semilunar valve of the common arterial trunk; dilatation of the left atrium.
A two-dimensional echocardiographic examination in the projection of the long axis of the left ventricle reveals a wide main vessel that crosses the ("top sitting") septum, a large VSD, the posterior continuation is preserved. In a short projection at the level of the base of the heart, the ventricular outflow tract and the pulmonary valve are not identified. From the suprasternal approach, in some cases it is possible to determine the place of origin of the pulmonary artery or its branches from the trunk.
Cardiac catheterization and angiocardiography have crucial in diagnostics. Venous catheter enters the right ventricle, where the pressure is equal to the systemic one, but in combination with an increase in blood oxygen saturation indicates
about DMZHP. Further, the catheter is freely passed into the truncus, where the pressure is the same as in the ventricles. The saturation of blood with oxygen in the common arterial trunk usually ranges from 90-96% in cases with hypervolemia. The difference in oxygen saturation of the blood of the pulmonary artery and truncus does not exceed 10%. A decrease in blood oxygen saturation to 80% indicates sclerotic changes in the pulmonary vessels and inoperability of patients. With the introduction contrast agent in the right ventricle is visible (preferably in a lateral projection) a common arterial trunk, from which the coronary vessels and the pulmonary artery (or its branches) depart. Aortography allows you to finally confirm the origin of the true pulmonary arteries directly from the trunk, detail the type of defect and determine the degree of truncus valve insufficiency (Fig. 66).
Differential Diagnosis should be carried out in cases without cyanosis with VSD, with cyanosis - with Fallot's tetrad (especially with pulmonary artery atresia), transposition of the great vessels, Eisenmenger's syndrome.
Course, treatment. The course of the defect is severe from the first days of the patient's life due to severe heart failure and
1
pulmonary hypervolemia; in cyanosis, the severity of the patient's condition is determined by the degree of hypoxemia. Most children die in the first months of life and only "/5 of them survive the first year, and 10% survive until the 1-3rd decade)
