Metody klinicznej oceny zaawansowania niewydolności serca u niemowląt z ubytkiem przegrody międzykomorowej

*Jacek Skiendzielewski

Summary
Introduction. Ventricular septal defect is one of the most common congenital heart defects in children. Hemodynamic disturbances due to these lesion can lead to the deterioration of the general condition and heart failure.
Aim. To assess the symptoms and signs in infants with ventricular septal defect as well as to evaluate the stage of heart failure.
Material and methods. The study group consisted of 34 children (aged 38-338 days, mean 130 ± 81 days) with isolated ventricular septal defect. The diagnosis of the heart failure was established upon clinical signs and symptoms. The stage of heart failure was assessed on the basis of four classifications: adapted NYHA functional class, Ross score modified by Läer, Ross score modified by Reithmann and NYU PHFI.
Results. The episodes of tachypnoea in 14 (41%) children, decreased weight gain per month in 11 (32%), diaphoresis in 9 (26%), prolonged feeding time in 5 (15%) were reported by parents. The most common clinical signs were: systolic murmur (100% of patients), dyspnoea (65%), tachypnoea (53%), malnutrition (53%). The number of children with the heart failure depended on the applied classification: in the Ross score modified by Läer – 17 (50%), in adapted NYHA functional class – 19 (56%), in the Ross score modified by Reithmann – 20 (59%), in NYU PHFI – 24 (71%).
Conclusions. 1. The most common clinical abnormalities in infants with ventricular septal defect are: typical systolic murmur, dyspnoea, tachypnoea and malnutrition. 2. The diagnosis of ventricular septal defect does not reflect the clinical condition of the patient. 3. The precise anamnesis and careful physical examination are crucial for the diagnosis of the heart failure in infants with ventricular septal defect. 4. The classifications of the heart failure are useful in the diagnosis of the heart failure and the evaluation of the stage of the heart failure.

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