CLINICAL AND RADIOLOGICAL FEATURES OF THE COURSE OF COMMUNITY-ACQUIRED PNEUMONIA IN YOUNG CHILDREN AFTER SURGICAL TREATMENT OF VENTRICULAR SEPTAL DEFECT

Introduction. Community-acquired pneumonia remains a leading pathology in young children. The diagnosis and treatment of pneumonia in the presence of concomitant congenital heart defects present particular difficulties. An isolated ventricular septal defect (VSD), even after surgical correction, is often accompanied by residual hemody­namic and conduction disorders. This leads to an atypical and more severe course of pulmonary inflammation, which dictates the need to improve diagnostic approaches at early clinical stages.

Objective of the study: To analyze the clinical and radiological features of the course of severe community-acquired pneumonia in young children after surgical treatment of a ventricular septal defect.

Material and methods. The study included 62 children aged 1 to 3 years diagnosed with pneumonia. The main group consisted of 32 patients with VSD after surgical correction of the defect, and the comparison group included 30 children with bacterial pneumonia without congenital heart defects. The control group consisted of 22 healthy children of a similar age. Clinical, laboratory, radiological, and instrumental (ECG, Echocardiography) examination methods were used. Statistical data processing was performed using Statistica 6.0 software, with significance evalu­ated by Student's t-test.

Results. The disease in children with VSD proceeded with a predominance of febrile temperatures (60%) and the frequent development of broncho-obstructive syndrome. According to ECG and Echocardiography data, patients retained abnormalities in the postoperative period: sinus tachycardia (71.8%), signs of right ventricular hypertrophy (in 2/3 of the children), and conduction disorders (complete and incomplete right bundle branch block). Radiologi­cally, children with VSD significantly more often presented with a bilateral focal character of pneumonia (80% of cases versus 68.8% in the comparison group), as well as an adaptive enlargement of the thymus (50%). Complete blood counts showed a decrease in hemoglobin (down to 97.1±2.42 g/L), pronounced lymphocytosis (in 90% of children), and leukocytosis.

Conclusion. Community-acquired pneumonia in children who have undergone surgical correction of VSD is characterized by a persistent and severe course. Aggravating factors include persistent postoperative hemodynamic disorders, residual shunts, and cardiac arrhythmias. The pronounced predominance of bilateral focal lung damage requires targeted radiological monitoring and serves as the basis for developing improved management and therapy algorithms for this category of patients.