Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.


Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.

"Child`s Health" 3 (63) 2015

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Clinical case of the combination of congenital heart disease and reversing the internal organs of a teenager

Authors: Lymarenko M.P., Bordugova O.V., * Smyrnova T.V., Vlasenko A.I.
Donetsk National Medical University named after M. Gorky, Ukraine
*Institute of Urgent and Restoration Surgery, Donetsk

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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The article is devoted rare clinical case of a combination corrected transposition of the great arteries with ventricular septal defect, pulmonary valve stenosis artery, abnormal position of the heart and reversing the internal organs of a teenager 16 years.
To date, the literature has accumulated enough information about the various types of abnormal heart intrathoracic location. The first reports of anomalies related to right-hand drive in reverse heart location of all internal organs. Right-hand drive as heart isolated anomaly has been described much later. The mere existence of the anomalous position of the heart is not accompanied by hemodynamic disorders, and only the presence of concomitant heart disease results in heart surgery patients in the clinic.
In 90-98% of patients with heart pravosformirovannym pravoraspolozhennym encountered congenital heart diseases (CHD), which at 96,7% of them are multiple. Most often combined – corrected transposition of the great arteries (CTGA) with ventricular septal defect (VSD), valve and subvalvular pulmonary artery stenosis, atrial septal defect (ASD), anomalous pulmonary venous connection, hypoplasia of the pulmonary artery, patent ductus arteriosus (PDA). Corrected transposition of great arteries – CHD "pale" type, in which the aorta is abnormally based on the morphology of the right ventricle, but physiologically arterial, pulmonary artery and starts from the left ventricle morphologically, physiologically venous but while maintaining normal blood flow. There are several options CTGA: CTGA without accompanying CHD and normal position of the heart; CTGA associated with CHD and normal position of the heart; CTGA associated with CHD and abnormal location of the heart.
Evaluation of patients with abnormalities in his heart has a number of features. The main objectives in this are to establish the type of abnormal heart, the disclosure of the contents of the accompanying anatomical defect and the nature of hemodynamic disturbances due to defect. Examination of the patient should be carried out consistently, since, without establishing the type of abnormal position of the heart, it is difficult to give a correct interpretation of the manifestations of evil. Anomalies in his heart changed the topography of cardiac chambers, so their proper recognition is based on a study of the features of the anatomical structure of the inner surface. The paper presents the morphological features of the recognition of the atria and ventricles. To the right atrium following are the most important signs – on the barrier surface are determined and oval fossa limbus, flows into the lower hollow Vienna, flows into the coronary sinus. To the left atrium – on the septal surface marked derivative of the primary partitions. The right ventricle is characterized by coarse trabecular inner surface, especially in the septum, there supraventricular crest separating the ventricular cavity pas supply and output units. The left ventricle is characterized by gentle trabecular, especially in the septal surface, there is no supraventricular crest. Diagnosis of these anomalies is based on an electrocardiography, phonocardiography, chest radiography, echocardiography, probing the heart cavities and angiocardiography. The most valuable research methods are echocardiography and angiocardiography. These methods make it possible to determine not only the abnormal location and course of the great vessels, but also the localization of the atrioventricular valves, their structure, and also to identify the ventricles. 
Powered article clinical case demonstrates the natural history of CHD in a patient survey plan, the tactics of the patient and is of interest to pediatricians and pediatric cardiologists.

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