Diaphragmatic pores are narrow

Introduction The time when the symptoms of the three chambers are related to the size of the diaphragm channel. In severe cases with narrow diaphragm channels, severe pulmonary congestion and shortness of breath can occur shortly after birth, followed by severe pneumonia and congestive heart failure. Sanfangxin is a congenital cardiovascular malformation that is divided into two parts by the fibrosis of the left or right atrium due to embryonic developmental disorders. It is a rare congenital heart disease, accounting for about 0.1% of congenital heart disease. Usually referred to as the three-chamber heart refers to the left atrium is divided into the atrium and the true left atrium (connected to the left atrial appendage and through the mitral and left ventricular traffic). The right three-room heart is less common, accounting for only about 8% of the three-room heart case. There are many types of three-room heart classification. According to the position of the auxiliary room, it can be divided into three types: a, b, and c: a type, the auxiliary room is located above the true left atrium; b type, the auxiliary room is located behind the true left atrium; c Type, the auxiliary room rides across the room interval. From the hemodynamics, according to the traffic conditions of the atrium and the true left atrium, and the left and right atrial traffic, it is roughly divided into two types of mitral stenosis and atrial septal defect.

Cause

The cause of the disease is not very clear. It is generally believed that the common venous trunk failed to merge with the left atrium during the embryonic period, and the enlargement of the common pulmonary vein constitutes a part of the left atrium, and the original left atrium is not integrated into the sub-atrial. As well as the abnormal development of the primary septum, the abnormal diaphragm in the left atrium, the left atrium is divided into the auxiliary room and the real left atrium.

an examination

Related inspection

Chest CT chest CT examination

First, clinical manifestations: the time of symptom on the size of the diaphragm channel. In severe cases with narrow pores, severe pulmonary congestion and shortness of breath can occur shortly after birth, followed by severe pneumonia and congestive heart failure. In cases with larger channels, the symptoms appear later, in the case of young children or children. Cases with large tracts are similar to atrial septal defect, clinically asymptomatic, normal life, and only a little shortness of breath after activity. In most cases, jet systolic murmurs and diastolic murmurs can be heard at the bottom of the heart. Sometimes continuous murmurs can be heard. This is due to the high degree of obstruction and the high pressure gradient near the distal end of the hole. P2 hyperthyroidism. But there is no noise.

Second, hemodynamic changes depend on the size of the diaphragm channel in the atrium and the concurrent deformity. The hemodynamics of the left three-chamber heart is similar to the mitral stenosis. The left septum is only a few millimeters in diameter, which can cause pulmonary venous return stasis, pulmonary stagnation, pulmonary edema and pulmonary hypertension, and partial pulmonary vein abnormal reflux or A septal defect between the right atrium and the secondary atrium creates a left-to-right shunt. If the atrial septal defect is close to the intrinsic atrial lumen, it is a right-to-left shunt.

Differential diagnosis

Differential diagnosis of narrow diaphragm channels:

(1) Congenital mitral stenosis: Hemodynamic changes are similar to the three-room heart, so clinical symptoms and signs are difficult to identify. Echocardiography revealed a left atrial enlargement, no septum or intracardiac shunt, only mitral stenosis. Left atrial angiography showed enlargement of the left atrium, delayed emptying, and no presence of the diaphragm and the third atrium.

(2) Complete pulmonary vein abnormal reflux: X-ray chest plain film heart shadow is "8" or "snowman". Pulmonary angiography can show abnormal connections in the pulmonary veins. Echocardiography revealed abnormal pulmonary venous return and atrial septal defect.

(3) Left atrial myxoma: When the myxoma partially blocks the mitral valve, the clinical symptoms are similar to mitral stenosis or three-chamber heart. Echocardiography showed that the abnormal mass in the left atrium moved after the heart contracted.

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