Difetti interventricolari isolati nel feto

I Difetti Interventricolari Settali ( DIV ) isolati, diagnosticati nel feto non assumono rilevanza emodinamica, ma hanno un significato rilevante nel counseling prenatale dei genitori.
Tecnicamente sono, specialmente se di piccole dimensioni, di difficile rilievo perche’ non sono visibili sull’immagine 2D e possono essere visualizzati con il Color Doppler se adeguatamente regolato, dal momento che nel feto lo stato circolatorio intracardiaco e’ isobarico ( non si hanno gradienti di pressioni fra le cavita’ ) per cui si possono verificare shunt a basse velocita’ di difficile rilievo Doppler.
Dagli studi riferiti in letteratuta risulta che i DIV sia muscolari che perimembranosi isolati comportano :

1. alta incidenza di anomalie cromosomiche ( trisomie 21,13 e 18 )
2. possibile coesistenza di anomalie extracardiache
3. che i DIV con cromosomi normali, oltre un terzo nel feto e oltre un’altro terzo nell’infanzia chiudono spontraneamente

Ogniqualvolta l’ecocardiografia fetale rilevi un DIV sara’ opportuno un esame cardiaco e morfologico generale
completo ed attento ad escludere anomalie associate, e indica l’esecuzione di in cariotipo fetale.

Isolated ventricular septal defects detected by color Doppler
imaging: evolution during fetal and first year of postnatal life
R. AXT-FLIEDNER*, A. SCHWARZE*, J. SMRCEK*, U. GERMER†, M. KRAPP* and
U. GEMBRUCH‡
Ultrasound Obstet Gynecol 2006; 27: 266–273
Published online in Wiley InterScience ()

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