Heart defect at 5 years of age. Threshold of a child's heart. Open duct of Botall
Today, children suffer from various diseases no less than adults. Among them there are minor ones, but there are also those that threaten their lives. One of these is heart disease in children. In pediatrics, serious attention is paid to this pathology, but much depends on the parents.
Congenital heart disease is a common pathology in children and adolescents, which leads to social failure and disability. This does not mean that treatment will not bring results. Carefully following medical instructions and loving your child will help alleviate his condition, despite his disability. Among heart defects there are more and less serious ones. It depends on various factors. The topic should be considered based on the fact that there are two main groups of such pathologies:
- congenital;
- acquired.
Causes
The heart of a newly born child is large and has significant reserve capacity. The heart rate in babies is 100-170 beats per minute in the first week of life, and 115-190 in the second week. In the first month of life, a child’s heart rate can slow down and reach one hundred beats per minute when he sleeps and strains, but during the process of crying, swaddling and feeding, it reaches 180-200 beats.
Congenital heart defects develop mainly in the second to eighth weeks of pregnancy. Particular reasons why this happens are the following factors:
- maternal viral diseases;
- her taking certain medications;
- harmful production conditions under which it works;
- maternal alcoholism, drug addiction;
- exposure to radiation.
Heredity may also play a role. There are risk factors for having a child with congenital heart disease: the age of the mother, the threat of miscarriage in the first trimester, endocrine disorders of the spouses, stillbirth in the woman’s medical history, the presence of heart pathologies in close relatives.
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In pediatrics, more than one hundred congenital heart defects are identified. Some of them give you a disability, which, of course, cannot be refused. Children and adolescents with similar disabilities are shown a special way of life.
CHD is a defect of the cardiovascular system that occurs most often. In this case, normal blood flow through the vessels or inside the heart muscle is impossible. CHD can be divided into several groups based on external signs and internal location of the pathology.
- White UPS. When pallor of the skin is noted with a heart defect, this means that the tissues do not receive enough arterial blood. This is explained by the left-right shunting of blood. White congenital heart defects in children can be: with enrichment or depletion of the pulmonary circulation (in the first case, it is an open ductus arteriosus, ventricular or atrial septal defect, in the second case, it is isolated pulmonary stenosis, and so on), with depletion of the systemic circulation (narrowing aortic valve, coarctation of the aorta and so on). If this defect is not corrected in time, the child’s development of the lower half of the body is disrupted, heart pain, a fighting sensation in the lower part of the body, dizziness, and so on appear. This will affect the life of a teenager and then an adult. The most common pathology in the group of “white” defects is ventricular septal defect.
- Blue UPS. In this case, the skin turns blue because venous and arterial blood mixes, which does not contain enough oxygen. When such blood enters the tissues, the skin begins to turn blue, that is, cyanosis develops. This group also contains pathologies with an enriched pulmonary circulation, for example, complete transposition of the great vessels. Another group is pathologies with a depleted pulmonary circulation, for example, pulmonary atresia. The most common defect is tetralogy of Fallot, which is detected in 15% of children with congenital heart disease.
- Heart defects in which hemodynamics are not impaired. When they occur, the position of the heart is disturbed. Doctors cannot say with certainty why a congenital heart defect develops, which often forms in the second week of pregnancy. It is the leading cause of infant mortality due to congenital disorders. Nevertheless, the reasons that were listed above can provoke the appearance of pathology.
All this suggests that every woman needs to carefully monitor the conditions in which she carries her baby. The child's health largely depends on the mother's care, which begins even before pregnancy, but the father's health also plays a significant role. If you want your children not to have disabilities and to become full-fledged teenagers and adults, future parents should reconsider their lifestyle.
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However, in pediatrics there are also acquired heart defects. They are characterized as persistent changes in the structure of the heart, which develop after birth and lead to impaired cardiac function. Because of them, general and intracardiac hemodynamics are disrupted. The cause of the development of acquired pathologies is often rheumatic endocarditis. Other factors:
- diffuse connective tissue diseases;
- infective endocarditis, which affects the valves, chordae and papillary muscles;
- chest injury.
Heart valves can be damaged as a result of septic complications of Seldinger vascular catheterization. Sometimes a child may develop mitral regurgitation due to improperly performed valvotomy. According to some data, heart defects are detected in approximately 18% of children who have been diagnosed with primary rheumatic carditis. Most often, left atrioventricular valve insufficiency develops, sometimes combined mitral valve disease, isolated aortic valve insufficiency. In some cases, combined lesions of two valves are determined. Mitral insufficiency develops when the valves do not close completely during ventricular systole and the left atrioventricular orifice does not close.
Symptoms
Parents need to pay special attention to the condition of their baby after birth and during development. This will help to identify the pathology in time and begin treatment, if necessary, register for disability and take all necessary measures to prolong the life of your child.
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It is important to understand that not all congenital heart defects present with obvious symptoms. However, a pediatrician may reveal some signs during examination. When the doctor listens to the baby, he evaluates the sound of heart tones. Sometimes noise can be heard in the background of the sound. Often, especially if there are no other symptoms, heart murmurs are a harmless finding that goes away with age, but sometimes they indicate that the child’s organ is not developing properly. Suspecting such negative symptoms, the pediatrician refers the parents and baby to a cardiologist, who prescribes additional examinations and makes a diagnosis. Pediatrics has the necessary information to make an accurate diagnosis based on symptoms and prescribe effective treatment.
Still, a lot depends on the parents. They should pay attention to the following symptoms that indicate they need to go to the hospital urgently:
- the color of the skin has changed (especially in the area of the face, fingers, feet), it has become pale or bluish;
- the limbs look swollen, bulging is observed in the area of the heart;
- the child cries for no reason, which may be accompanied by blue or pale skin, cold sweat appears on the forehead;
- the child eats sluggishly, often spits up, does not gain weight well, and experiences anxiety when latching on;
- there are attacks of shortness of breath;
- For no reason, the heartbeat becomes rare or frequent.
If the child has grown up, he can tell about some of the signs himself. For example, he may complain of pain in the chest and heart, rapid breathing during physical activity or at rest, and an unreasonable change in heartbeat. These signs cannot be ignored.
If any symptom occurs, you should immediately contact your pediatrician. This will allow you to quickly make a diagnosis and receive further recommendations. Parents must follow them exactly, because we are talking about the baby’s life.
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Acquired heart defects in children can also be identified, but this is not always easy. Symptoms of such pathologies depend on the affected valve. Common symptoms include shortness of breath, frequent heartbeat, and noise, by the nature of which a specialist determines a child’s defect. A patient with left atrioventricular valve insufficiency of the first and second degrees usually does not complain of anything for a long time. If the defect is more serious, shortness of breath is observed during normal physical activity. The child's appearance has no peculiarities. If the defect is pronounced, a cardiac hump is noted.
Treatment
The treatment process is determined by the type of pathology. Unfortunately, more than 50% of patients with this pathology die in the first year of life if surgery is not performed. Therefore, parents do not need to neglect this appointment. If surgical treatment is not required, long-term use of various heart medications is prescribed. They should be given only as prescribed by the doctor, monitoring the volume and time.
For a child with congenital heart disease, it is important to create a regime in which he will spend a long time in the fresh air. He should do light physical exercise. They need to be fed two or three times more, but the volume decreases.
Parents can be of great help. If they notice even slight changes in their child’s condition, they should immediately consult a doctor. Physical activity is contraindicated in children if there are symptoms of respiratory or heart failure. If they are not there, exercise therapy is prescribed in a special group under medical supervision. In hot weather, children should not stay in the sun for a long time, and in winter, in the cold.
If there are indications, there is no need to delay registering disability. This helps you receive useful benefits and financial assistance, which comes in handy during the treatment process. Disability is not for everyone. It is defined as a limitation of life activity due to a health disorder that leads to the need for social protection. The basis for disability is a combination of several factors. Disability with congenital heart disease is not a death sentence, but an opportunity to create more suitable conditions for the child.
Heart defects in children, which are acquired, are not treated for a long time, as they are compensated. If decompensation occurs, treatment is required. If the rheumatic process is inactive and full compensation is observed, the child should lead an active lifestyle, but heavy physical activity is contraindicated, as well as mental activity. With heart defects in children, a lot depends on the parents!
The leading private clinic in Israel, Herzliya Medical Center, specializes in the diagnosis and treatment of all types of heart defects in children. The hospital's doctors have accumulated vast experience in conservative and surgical treatment with the goal of completely restoring cardiac function in children and adolescents.
What is a heart defect?
Heart disease is a violation of the structure of the heart chambers, its valves and areas of exit into the great vessels (aorta and pulmonary artery). As a rule, these anatomical defects entail functional disorders, expressed to varying degrees, which lead to overload of the heart muscle, as well as to a decrease in the compensatory abilities of the heart. Hemodynamic disturbances manifest themselves as symptoms of heart failure, which often endangers the lives of patients. Heart defects are usually divided into two large groups:
- Congenital heart defects;
- Acquired heart defects.
Congenital heart defects in children
Congenital heart defects in children develop during fetal development. Possible causes of birth defects include:
- genetic mutations;
- exposure to teratogenic substances (including drugs);
- radiation;
- severe maternal metabolic diseases;
- infectious diseases suffered during pregnancy.
The peculiarities of the placental blood circulation of the fetus in most cases allow continued growth and development even in the presence of serious structural damage to the heart. Severe hemodynamic disturbances can occur immediately after childbirth or appear during the period of intensive growth of the child. Congenital heart defects in children are divided into defects with preserved pulmonary circulation volume (white defects) and defects with reduced pulmonary circulation volume (blue defects).
The most common congenital heart defects in children are:
- Ventricular septal defect;
- Atrial septal defect;
- Open aortic duct;
- Coarctation of the aorta;
- Congenital stenosis and atresia of the pulmonary artery;
- Combined congenital defects in which there is a complex of structural disorders (Fallot's triad, tetralogy of Fallot, transposition of the great arteries).
Acquired heart defects in children
Acquired heart defects in children are a complication of various diseases and develop throughout the child’s life. The main cause of acquired heart valve damage in children is streptococcal infection (rheumatic disease). Functional and anatomical changes in the valve mechanism can also be caused by severe hypertension, cardiomyopathy, non-rheumatic (including toxic) lesions of the endocardium and myocardium, pericarditis, Kawasaki disease and dysfunction of the cardiac conduction system. Lesions caused by trauma and tumors are much less common.
The most common acquired heart defects in children are:
- Stenosis and insufficiency of the bicuspid (mitral) valve;
- Stenosis and insufficiency of the tricuspid (tricuspid) valve;
- Aortic valve stenosis and insufficiency;
- Pulmonary valve stenosis and insufficiency.
Common symptoms of heart defects in children
Despite the different etiology and pathogenesis, the symptoms of heart defects in children are mostly similar, since the disease leads to a decrease in the volume of blood ejection and the development of one of the types of heart failure. Impaired perfusion of organs and tissues, as well as congestion in the pulmonary and systemic circulation lead to severe dysfunction of almost all systems of the growing body.
Symptoms of heart defects in children include:
- Low endurance of physical activity. Increased fatigue and weakness do not allow you to lead an active lifestyle;
- Slowing of physical development, malnutrition;
- Shortness of breath during physical exertion, and in severe cases, at rest;
- Change in skin color - pallor or cyanosis;
- Signs of chronic hypoxia (oxygen deficiency) of the brain such as irritability, insomnia or excessive sleepiness, memory impairment, learning disabilities, psychological disorders;
- Signs of tissue hypoxia, such as dysfunction of internal organs, changes in the structure of the terminal phalanges of the fingers of the upper extremities;
- Edema resulting from severe congestion;
- Early manifestations of coronary heart disease (as a result of severe hypertrophy and relative insufficiency of coronary circulation.
Diagnosis of congenital and acquired heart defects in children
The Herzliya Medical Center clinic carries out all types of functional and invasive diagnostics of diseases of the cardiovascular system in children. If there is a clinical suspicion of heart disease, the hospital's experienced cardiologists will prescribe an individual examination program to determine the exact diagnosis and the degree of functional impairment. Among the main methods of instrumental diagnosis of heart defects in children, it is important to note:
- Electrocardiography and long-term (including remote) heart rate monitoring;
- Echocardiography (ultrasound) at rest and under load;
- Tomographic examination of the heart - cardio-CT and MRI;
- Isotope scanning of the heart.
Treatment of congenital and acquired heart defects in children
Establishing an accurate diagnosis helps cardiologists at the Herzliya Clinic develop the most effective treatment program for congenital and acquired heart defects in children. The main methods of therapy are:
- Conservative treatment of heart defects, aimed at compensating the symptoms of heart failure and stabilizing the patient’s general condition. Drug treatment of most heart defects in children is a temporary measure necessary to prepare for a surgical procedure that restores normal anatomy;
- Open heart surgery. These complex surgical procedures require a high level of professionalism, experience and technological capabilities to safely transfer the patient to extracoronary circulation during the procedure. At the Herzliya Medical Center hospital, operations of any degree of complexity are successfully performed;
- Minimally invasive procedures to eliminate congenital and acquired heart defects using catheterization. Innovative endoscopic surgery techniques allow for effective and safe intervention on the beating heart.
Cardiologists at the Herzliya Medical Center hospital explain in detail the tasks and importance of the upcoming procedures, accompanying patients and their parents at all stages of diagnosis and treatment of heart defects.
Congenital heart defects in children are rare and may not appear outwardly at first. Therefore, pediatricians and parents sometimes do not pay due attention to this pathology, which, meanwhile, often requires immediate assistance. You need to know about congenital heart defects in order to help your baby in time.
Congenital heart defects are anatomical defects of the heart, its valve apparatus or blood vessels that occurred in utero, before the birth of a child. They occur with a frequency of 6-8 cases per thousand births and occupy first place in mortality of newborns and children of the first year of life.
It's sad but true that even with careful monitoring of a pregnancy, doctors often miss congenital heart defects. This is due not only to the lack of sufficient qualifications of specialists in this field (the pathology is rare - there is little experience) and imperfect equipment, but also to the peculiarity of the fetal blood flow.
Therefore, even if the pregnancy progressed favorably and all necessary examinations were completed, the baby’s heart needs to be checked after birth. Unfortunately, as part of the medical examination, the range of mandatory screening methods of examination at 1 month includes only electrocardiography. However, there may be no changes in the electrocardiogram at this age even with complex congenital heart defects. In addition, not all clinics have personnel who are trained to remove ECG film from infants. The presence of a congenital heart defect can be 100% excluded by resorting to a study such as echocardiography or ultrasound examination of the heart. But on one condition: if it is performed by an experienced doctor. Not all clinics have such a device and a highly qualified specialist. If a congenital heart defect is suspected, the pediatrician will refer the child to another clinic or cardiac surgery center for this test. However, some congenital heart defects are asymptomatic in the first months of life, i.e. have no manifestations, or they are very insignificant. To be sure of the baby’s health, parents can do this test without a referral, for a fee, at a medical center.
What may alert the doctor and parents?
- Heart murmur. It is detected by the doctor by listening to the baby’s heart. Echocardiography is mandatory in this case. Murmurs can be organic, which are associated with heart disease, and inorganic, or functional.
Functional murmurs in children are normal. As a rule, they are associated with the growth of the chambers and vessels of the heart, as well as the presence of an additional chord or trabecula in the cavity of the left ventricle (heart chamber). The notochord or trabecula is a cord that stretches from one wall of the ventricle to the other; a turbulent blood flow is created around it, resulting in the hearing of a characteristic noise. In this case, we can say: “Much ado about nothing,” since this feature is not a congenital heart defect and does not lead to heart disease. - Poor weight gain. If in the first months of life the baby gains less than 400 g, this is a reason to contact a pediatric cardiologist for a thorough examination, since many heart defects manifest themselves precisely as a delay in physical function.
- Dyspnea (impaired frequency and depth of breathing) and increased fatigue. It is the prerogative of the doctor to see moderate shortness of breath, since this requires sufficient experience. The mother may notice that the baby is tired while sucking; the baby eats little by little and often; he needs a break to gather his strength.
- Tachycardia(cardiopalmus).
- Cyanosis(blueness of the skin). Characteristic of complex, so-called “blue” heart defects. In most cases, it is due to the fact that arterial blood, rich in oxygen (bright red), which runs through the vessels to the skin and other organs, is mixed due to a defect with venous blood, poor in oxygen (dark, closer to purple), which should enter into the lungs for oxygen enrichment. Cyanosis can be mildly expressed, then it is difficult to notice even for a doctor, or it can be intense. With moderate cyanosis, the lips acquire a purple tint, the skin under the child’s nails turns blue, and the heels turn blue.
Who is forewarned is forearmed
It is very important to identify problems in time. And this can be done in utero using an ultrasound examination of the fetus. In the early stages () it is easier for a specialist to identify a congenital heart defect with a transvaginal (transvaginal) ultrasound. However, some pathologies of the heart and blood vessels are detected at a later date, therefore, if they are suspected, it is necessary to do a transabdominal (through the anterior abdominal wall) ultrasound of the fetal heart. First of all, it is necessary to think about this for those women who have had spontaneous abortions and stillbirths, have children with congenital malformations, including congenital ones, as well as arrhythmias (heart rhythm disturbances). In addition, the risk group includes:
- women who have had a viral infection in the early stages of pregnancy, especially in the first two months, when the main structures of the heart are formed;
- families in which future parents or close relatives were also diagnosed with congenital heart disease;
- women with diabetes and other chronic diseases who took medications during pregnancy;
- expectant mothers over 37 years old;
- women who used drugs during pregnancy;
- women living in environmentally unfavorable areas.
I would like to add that in the presence of a heart defect, there may be none of these signs or they will be expressed very slightly in the first months of the child’s life, therefore it is advisable to perform echocardiography on all children. It is impossible to talk about all congenital heart defects in one article; there are about 100 of them. Let’s focus on the most common ones. These include patent ductus arteriosus and ventricular septal defect.
Patent ductus arteriosus
It is a vessel connecting the aorta (a large vessel that arises from the heart and carries arterial blood) and the pulmonary artery (a vessel that arises from the right ventricle and carries venous blood to the lungs).
Normally, a patent ductus arteriosus exists in utero and should close within the first two weeks of life. If this does not happen, they say there is a heart defect. The presence or absence of external manifestations (shortness of breath, tachycardia, etc.) depends on the size of the defect and its shape. External manifestations noticeable to the mother may not be present in a one-year-old baby, even with large ducts (6-7 mm).
Respiratory and heart rates are normal in children
Patent ductus arteriosus has sound symptoms, and the doctor, as a rule, can easily listen to a heart murmur. The degree of its intensity depends on the diameter of the duct (the larger the duct, the louder the noise), as well as on the age of the child. In the first days of life, even large ducts are difficult to hear, since during this period the pressure in the pulmonary artery is normally high in children and, therefore, there is no large discharge of blood from the aorta into the pulmonary artery (which determines the noise), since the difference in blood pressure between vessels are small. Subsequently, the pressure in the pulmonary artery decreases and becomes 4-5 times less than in the aorta, the discharge of blood increases, and the noise intensifies. Consequently, doctors in the maternity hospital may not hear the noise; it will appear later.
So, as a result of the functioning of the patent ductus arteriosus, more blood enters the vessels of the lungs than normal; due to the increased load, over time, their walls irreversibly change, become less pliable, more dense, their lumen narrows, which leads to the formation of pulmonary hypertension (a condition when which increases the pressure in the blood vessels of the lungs). In the initial stages of this disease, when changes in the blood vessels of the lungs are still reversible, you can help the patient by performing surgery. People with the last stages of pulmonary hypertension have a short life expectancy and poor quality of life (shortness of breath, increased fatigue, severe limitation of physical activity, frequent inflammatory bronchopulmonary diseases, fainting, etc.). Pulmonary hypertension develops only with large ducts (more than 4 mm), and its irreversible stages usually occur in adolescence. With a small size of the duct, pulmonary hypertension does not form, but there is a risk of bacterial endocarditis - mainly due to the fact that a stream of blood under high pressure “beats” into the wall of the pulmonary artery, which changes over time under this influence and is more susceptible to inflammation than healthy tissue. Bacterial endocarditis is a special type of blood infection that affects the endocardium (the inner layer of the heart and blood vessels) and valves. Prevention of this disease consists of combating chronic foci of infection, which include: carious teeth, chronic tonsillitis (inflammation of the tonsils), chronic adenoiditis (inflammation of the nasopharyngeal tonsil), inflammatory kidney diseases, furunculosis, etc. Even with such interventions as, for example, tooth extraction, it is necessary to “cover” with antibiotics (these drugs are prescribed by the doctor).
In the first year of life, a decrease in large ducts and spontaneous closure of small ducts is possible. When it comes to surgery, parents are faced with a choice. Surgery can be of two types. In one case, the duct is ligated by opening the chest using artificial ventilation (that is, the machine “breathes” for the child). In the second case, the duct is closed endovascularly. What does it mean? A conductor is inserted through the femoral vessel into the open ductus arteriosus, at the end of which there is a closing device, and it is fixed in the duct. For small ducts (up to 3 mm), spirals are usually used, for large ducts - occluders (they resemble a mushroom or a coil in shape, depending on the modification). This operation is usually carried out without artificial ventilation, children are discharged home 2-3 days after the operation, there is not even a stitch left. And in the first case, discharge is usually made on the 6-8th day and a suture remains on the posterolateral surface of the back. With all the visible advantages, endovascular intervention also has disadvantages: it is usually not performed on children with very large ducts (more than 7 mm), this operation is paid for parents, since, unlike the first, the Ministry of Health does not pay for it, moreover, as and after any intervention there may be complications, primarily related to the fact that a device that is quite large in diameter needs to be passed through small children’s vessels. The most common of these is thrombosis (formation of a blood clot) in the femoral artery.
Atrial septal defect
It is a communication between two atria (chambers of the heart in which blood pressure is low). Everyone has such a message (open oval window) in utero. After birth, it closes: in more than half - in the first week of life, in the rest - up to 5-6 years. But there are people who have an open oval window for life. If its size is small (up to 4-5 mm), then it does not have a negative effect on the functioning of the heart and human health. In this case, a patent foramen ovale is not considered a congenital heart defect and does not require surgical treatment. If the size of the defect is more than 5-6 mm, then we are talking about a heart defect - atrial septal defect. Very often there are no external manifestations of the disease until 2-5 years, and for small defects (up to 1.0 cm) - much longer. Then the child begins to lag behind in physical development, increased fatigue, frequent bronchitis, pneumonia (pneumonia), and shortness of breath appear. The disease is due to the fact that “extra” blood enters the vessels of the lungs through the defect, but since the pressure in both atria is low, the discharge of blood through the hole is small. Pulmonary hypertension develops slowly, usually only in adulthood (at what age this will occur primarily depends on the size of the defect and the individual characteristics of the patient). It is important to know that atrial septal defects can significantly decrease in size or close spontaneously, especially if they are less than 7-8 mm in diameter. Then surgical treatment can be avoided. Moreover, as a rule, people with small atrial septal defects are no different from healthy individuals; their risk of bacterial endocarditis is low - the same as in healthy people. Surgical treatment is also possible in two types. The first is with artificial circulation, cardiac arrest and sewing in a patch or suturing of the atrial septal defect. The second is endovascular closure using an occluder that is inserted into the heart cavity using a guidewire through the vessels.
Ventricular septal defect
This is a communication between the ventricles (chambers of the heart), in which, unlike the atria, the pressure is high, and in the left ventricle it is 4-5 times higher than in the right. The presence or absence of clinical manifestations depends on the size of the defect and in what area of the interventricular septum it is located. This defect is characterized by a loud heart murmur. Pulmonary hypertension can develop quickly, starting in the second half of life. It should be noted that with the formation of pulmonary hypertension and increased pressure in the right side of the heart, the heart murmur begins to decrease, since the discharge through the defect becomes less. This is often interpreted by the doctor as a reduction in the size of the defect (its healing), and the child continues to be observed at the place of residence without being referred to a specialized institution. As pulmonary hypertension progresses to its irreversible stages, the pressure in the right ventricle becomes greater than in the left, and venous blood from the right parts of the heart (carrying blood to the lungs for oxygenation) begins to flow into the left (from which oxygen-rich blood is sent to all organs and tissues). The patient develops bluish skin (cyanosis), and physical activity decreases. In this condition, the patient can only be helped by a heart and lung transplant, which is not done for children in our country.
On the other hand, ventricular septal defects are prone to spontaneous closure, which is associated with the growth characteristics of intracardiac structures in the baby, so they are usually not in a hurry to be eliminated surgically immediately after birth. In the presence of heart failure, the signs of which are determined by the doctor, drug therapy is prescribed to support the functioning of the heart and the dynamics of the development of the process is monitored, examining every 2-3 months and conducting echocardiography. If the size of the defect decreases to 4-5 mm or less, then such defects, as a rule, are not operated on, since they do not affect health and do not cause pulmonary hypertension. If it comes to surgery, then ventricular septal defects are closed in the vast majority of cases using artificial circulation, cardiac arrest using a patch. However, over the age of 4-5 years, with a small size of the defect and its specific localization, endovascular closure is possible using an occluder passed through the vessels. It should be noted that it is better to be observed in a cardiovascular surgery center (the doctors there, including echocardiographers, which is very important, have more experience). If the size of the defect decreases to 4-5 mm or less, then such defects, as a rule, are not operated on, since they do not affect health and do not cause pulmonary hypertension.
Heart defect questionable
If a child is suspected of having a heart defect, it is necessary to make an appointment with the child as soon as possible for a consultation with a pediatric cardiologist or pediatric cardiac surgeon, preferably at a cardiovascular surgery center, where high-quality echocardiographic and electrocardiographic studies can be performed and the child will be examined by an experienced cardiologist. The indications and timing of the operation are always determined strictly individually. During the neonatal period and up to six months, the risk of complications after surgery in children is higher than at an older age. Therefore, if the child’s condition allows, he is given the opportunity to grow up, prescribed drug therapy if necessary, to gain weight, during which time the nervous, immune and other systems of the body become more mature, and sometimes the defects close, and the child no longer needs to be operated on.
In addition, if there is a congenital heart defect, it is necessary to examine the child for the presence of anomalies and disorders of other organs, which are often combined. Often, congenital heart defects occur in children with genetic and hereditary pathologies, so it is necessary to consult a geneticist. The more that is known about the baby's health before surgery, the lower the risk of postoperative complications.
In conclusion, I would like to note that if, nevertheless, a child with the defects that we talked about cannot avoid surgical treatment, in the vast majority of cases after the operation the child recovers, is no different from his peers, tolerates physical activity well, and will have no limitations. at work, school and family life.
Ekaterina Aksenova, pediatrician, Ph.D. honey. Sciences, NTsSSKh them. A.N. Bakulev RAMS, Moscow
And in the maternity hospital I heard that the child was breathing loudly and quickly, I asked the pediatrician - they told me it seemed like it. Before discharge, I again asked the neonatologist to examine her - everything was fine, they said. Then she complained to the district pediatrician that the child was breathing noisily in his sleep - everything was fine! and only at two months did the cardiologist find out that we have a heart defect, a VSD of 5*6 mm, that is, threshold!!! Thank God, we managed with medications and observation, but it was possible to miss the child!!!
What do you think of Vika Ivanova’s story? She underwent a heart transplant in India, everything went well. And so her mother writes about this [link-1] and says that there is a sponsor for the operation. Read it.
12/30/2015 20:50:16, ArianoannaShe was born with only one half of her heart, and doctors didn't give her much chance of survival. To date, nine-year-old Bethan Edwards has undergone several major surgeries, including three at the age of five. Her family says Betan is a warrior who doesn't give up.
Congenital heart disease in newborns is the formation of various anatomical defects in the elements of the heart. Typically, such pathologies begin to develop in the prenatal period. In newborns, clinicians identify about 20 types of different defects.
For convenience, they were all divided into three groups:
- congenital heart defects in children of the “white type”. This group includes defects, as a result of the formation of which there is a reflux of blood from the arterial circulation into the venous one. These include aortic defects, patent ductus arteriosus, ventricular and atrial septal defects;
- “Blue type” congenital heart disease. A characteristic symptom of pathologies of this group is persistent cyanosis. It progresses due to the reflux of venous blood into the arterial bloodstream. Such congenital defects include tetralogy of Fallot, transposition of the great blood vessels, atresia of the aorta, pulmonary artery and venous ostium (right);
- CHD, in which there is the formation of an obstruction to normal blood flow, but this is not associated with an arteriovenous shunt. These include stenosis, coarctation, ectopia of the heart, hypertrophy of cardiac elements, etc.
Etiology
Heart defects in newborns can develop due to:
- various mutations at the gene level;
- unfavorable environmental situation in the area where the pregnant woman lives;
- the woman has a history of abortions, miscarriages, and stillborn children;
- the use of certain groups of pharmaceuticals during pregnancy. Antibiotics, antiviral and other drugs with strong effects pose a particular danger to the fetus;
- hereditary predisposition. The risk that a baby will develop a heart defect increases many times if the pregnant woman has close relatives with the same pathology;
- illnesses of an infectious nature that a woman suffered while carrying a child. Particularly dangerous include cytomegaly. The risk especially increases if these pathologies affect a woman in the early stages of pregnancy. The fact is that it is during this period that all organs are formed;
- age of the pregnant woman. Scientists have noticed a trend that the older a woman is, the higher the likelihood that she will have a child with a heart defect. Currently, the risk group includes representatives of the fair sex who have crossed the 35-year mark;
- strong x-ray training;
- consumption of large doses of alcoholic beverages by a woman while carrying a child. Recently, this reason has come to the fore in the development of heart defects. Alcohol has a detrimental effect not only on the mother’s body, but also on the body of her unborn baby.
Symptoms
Symptoms indicating a heart defect in newborns directly depend on the type of defect, as well as on the severity of the pathological process. Small-sized defects practically do not manifest themselves at all, which greatly complicates their timely diagnosis. But it is worth noting that even severe forms of anomalies can be completely asymptomatic, which often causes the death of a newborn in the first days of his life. It is possible to save the life of a baby with severe defects that prevent the heart from functioning normally only through surgical intervention. Conservative therapy is out of the question.
The main signs that may indicate the presence of abnormalities in the baby’s cardiovascular system:
- increased respiratory movements per minute;
- the formation of edema (especially in the legs);
- weakness;
- lethargy;
- the child sucks weakly at the breast and may even refuse it completely;
- expressed;
- frequent regurgitation;
- cyanosis. It is especially pronounced on the limbs and in the area of the nasolabial triangle;
- heart murmurs. They can only be identified by a qualified doctor during auscultation.
Degrees
The degree of the disease is determined depending on the severity of the symptoms. In total, clinicians distinguish 4 of them:
Grade 1 – the baby’s condition is relatively stable. Cardiac activity is within normal limits. Typically, no specific treatment is required at this stage;
Stage 2 – symptoms gradually increase. Problems arise with feeding the child, and respiratory function is also impaired;
3rd degree - the clinic is supplemented by neurological manifestations, since the brain is not sufficiently supplied with blood;
4th degree – terminal. If it progresses, the patient experiences depression of respiratory and cardiac activity. It usually ends in death.
Diagnostics
Today, the most informative method that makes it possible to identify the presence of anomalies in the structure of the heart is ECHO cardiography. This method gives the doctor the opportunity to assess the condition of all elements of the heart - chambers, septa, valves, holes. Doctors also often resort to Doppler ultrasound. The method makes it possible to obtain information about the intensity of blood flow and its turbulence.
Additional diagnostic methods:
- radiography;
Therapeutic measures
For heart defects, the only correct method of treatment is surgical intervention. Medication can only dull the severity of symptoms. Now they resort to two types of operations: open and minimally invasive.
Minimally invasive surgeries are more suitable for correcting abnormalities of the septa between the atria and ventricles. The X-ray endovascular method allows the surgeon to install an occluder that will close the formed defect.
Open surgical intervention is performed in case of detection of severe combined defects. During the operation, the sternum is opened. Thus, the doctor has direct access to the patient's heart. These interventions, although traumatic, are very effective.
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Diseases with similar symptoms:
Heart defects are anomalies and deformations of individual functional parts of the heart: valves, septa, openings between vessels and chambers. Due to their improper functioning, blood circulation is disrupted, and the heart ceases to fully perform its main function - supplying oxygen to all organs and tissues.
A disease that is characterized by the formation of pulmonary insufficiency, presented in the form of a massive release of transudate from the capillaries into the pulmonary cavity and ultimately promoting infiltration of the alveoli, is called pulmonary edema. In simple terms, pulmonary edema is a condition where fluid stagnates in the lungs and has leaked through the blood vessels. The disease is characterized as an independent symptom and can develop on the basis of other serious ailments of the body.
Undoubtedly, all developmental defects must be diagnosed in the fetus in utero. An important role is also played by the pediatrician, who will be able to promptly identify and refer such a child to a pediatric cardiologist.
If you are faced with this pathology, then let’s look at the essence of the problem, and also tell you the details of the treatment of children’s heart defects.
Congenital and acquired heart defects occupy the second position among all developmental defects.
Congenital heart disease in newborns and its causes
Organs begin to form in the 4th week of pregnancy.
There are many reasons for the appearance of congenital heart disease in a fetus. It is impossible to single out just one.
Classification of defects
1. All congenital heart defects in children are divided according to the nature of the blood flow disturbance and the presence or absence of cyanosis of the skin (cyanosis).
Cyanosis is a blue discoloration of the skin. It is caused by a lack of oxygen, which is delivered with the blood to organs and systems.
Personal experience! In my practice, there were two children with dextracardia (the heart is located on the right). Such children live normal healthy lives. The defect is detected only by listening to the heart.
2. Frequency of occurrence.
- Ventricular septal defect occurs in 20% of all heart defects.
- Atrial septal defect accounts for 5 - 10%.
- Patent ductus arteriosus accounts for 5 - 10%.
- Pulmonary stenosis, stenosis and coarctation of the aorta account for up to 7%.
- The remaining part is accounted for by other numerous, but rarer defects.
![](https://i1.wp.com/kroha.info/wp-content/uploads/2017/05/wheezy-baby.jpg)
Symptoms of heart defects in newborns
In newborns we evaluate the act of sucking.
You need to pay attention to:
![](https://i0.wp.com/kroha.info/wp-content/uploads/2017/05/heart-disease-newborn.jpg)
If a baby has a heart defect, he sucks sluggishly, weakly, with breaks of 2 - 3 minutes, shortness of breath appears.
Symptoms of heart disease in children older than one year
If we talk about older children, here we evaluate their physical activity:
- Can they climb the stairs to the 4th floor without shortness of breath? Do they sit down to rest during games?
- whether respiratory diseases, including pneumonia and bronchitis, are common.
With defects with depletion of the pulmonary circulation, pneumonia and bronchitis are more common.
Clinical case! In a woman at 22 weeks, an ultrasound of the fetal heart revealed a ventricular septal defect and hypoplasia of the left atrium. This is a rather complex vice. After the birth of such babies, they are immediately operated on. But the survival rate, unfortunately, is 0%. After all, heart defects associated with underdevelopment of one of the chambers in the fetus are difficult to treat surgically and have a low survival rate.
Komarovsky E. O.: “Always watch your child. A pediatrician may not always notice changes in health status. The main criteria for a child’s health are: how he eats, how he moves, how he sleeps.”
The heart has two ventricles, which are separated by a septum. In turn, the septum has a muscular part and a membranous part.
The muscular part consists of 3 areas - inflow, trabecular and outflow. This knowledge of anatomy helps the doctor make an accurate diagnosis according to the classification and decide on further treatment tactics.
Symptoms
If the defect is small, then there are no special complaints.
If the defect is medium or large, then the following symptoms appear:
- retardation in physical development;
- decreased resistance to physical activity;
- frequent colds;
- in the absence of treatment - development of circulatory failure.
Defects in the muscle part close on their own due to the child’s growth. But this is subject to small sizes. Also, in such children it is necessary to remember about lifelong prevention of endocarditis.
For large defects and the development of heart failure, surgical measures should be performed.
Atrial septal defect
Very often the defect is an accidental discovery.
Children with atrial septal defect are prone to frequent respiratory infections.
With large defects (more than 1 cm), the child may experience poor weight gain and the development of heart failure from birth. Children undergo surgery when they reach five years of age. The delay in surgery is due to the likelihood of spontaneous closure of the defect.
Open duct of Botall
This problem accompanies premature babies in 50% of cases.
The ductus botallus is a vessel that connects the pulmonary artery and the aorta in the fetal life of the baby. After birth it tightens.
If the size of the defect is large, the following symptoms are detected:
![](https://i2.wp.com/kroha.info/wp-content/uploads/2017/05/open-bottles-duct.jpg)
We wait up to 6 months for spontaneous closure of the duct. If in a child older than one year it remains unclosed, then the duct must be removed surgically.
When diagnosed in the maternity hospital, premature babies are given the drug indomethacin, which scleroses (glues) the walls of the vessel. This procedure is not effective for full-term newborns.
Coarctation of the aorta
This congenital pathology is associated with a narrowing of the main artery of the body - the aorta. In this case, a certain obstacle to blood flow is created, which forms a specific clinical picture.
Happening! A 13-year-old girl complained about a promotion. When measuring pressure on the legs with a tonometer, it was significantly lower than on the arms. The pulse in the arteries of the lower extremities was barely palpable. Cardiac ultrasound revealed coarctation of the aorta. For 13 years, the child has never been examined for congenital defects.
Usually, narrowing of the aorta is detected at birth, but may occur later. Such children even have their own peculiarity in appearance. Due to poor blood supply to the lower part of the body, they have a fairly developed shoulder girdle and puny legs.
It occurs more often in boys. As a rule, coarctation of the aorta is accompanied by a defect in the interventricular septum.
Normally, the aortic valve should have three cusps, but it so happens that there are two of them from birth.
![](https://i1.wp.com/kroha.info/wp-content/uploads/2017/05/bicuspid-aortic-valve-300x300.jpg)
Children with a bicuspid aortic valve do not particularly complain. The problem may be that such a valve will wear out faster, which will cause the development of aortic insufficiency.
When grade 3 insufficiency develops, surgical valve replacement is required, but this can happen by the age of 40-50.
Children with a bicuspid aortic valve should be monitored twice a year and endocarditis should be prevented.
Sports heart
Regular physical activity leads to changes in the cardiovascular system, which are referred to as “athletic heart.”
An athletic heart is characterized by an increase in the cavities of the cardiac chambers and myocardial mass, but cardiac function remains within the age-related norm.
Athletic heart syndrome was first described in 1899, when an American doctor compared a group of skiers and people with a sedentary lifestyle.
Changes in the heart appear 2 years after regular training 4 hours a day, 5 days a week. Athletic heart is more common among hockey players, sprinters, and dancers.
Changes during intense physical activity occur due to the economical work of the myocardium at rest and the achievement of maximum capabilities during sports activities.
Sports heart does not require treatment. Children should be examined twice a year.
Due to the immaturity of the nervous system, preschoolers experience unstable regulation of its functioning, so they adapt less well to heavy physical activity.
Acquired heart defects in children
The most common acquired heart defect is a valve defect.
![](https://i2.wp.com/kroha.info/wp-content/uploads/2017/05/rheumatism-child.jpg)
Of course, children with an unoperated acquired defect must be observed by a cardiologist or therapist throughout their lives. Congenital heart defects in adults are an important problem that should be reported to your physician.
Diagnosis of congenital heart defects
- Clinical examination by a neonatologist of the child after birth.
- Fetal ultrasound of the heart. Conducted at 22-24 weeks of pregnancy, where the anatomical structures of the fetal heart are assessed
- At 1 month after birth, ultrasound heart screening, ECG.
The most important examination in diagnosing the health of the fetus is ultrasound screening in the second trimester of pregnancy.
- Assessment of weight gain in infants, feeding patterns.
- Assessment of exercise tolerance, physical activity of children.
- When listening to a characteristic heart murmur, the pediatrician refers the child to a pediatric cardiologist.
- Ultrasound of the abdominal organs.
In modern medicine, if you have the necessary equipment, diagnosing a congenital defect is not difficult.
Treatment of congenital heart defects
Heart disease in children can be cured surgically. But, it should be remembered that not all heart defects need to be operated on, since they can heal spontaneously and take time.
The determining tactics of treatment will be:
![](https://i2.wp.com/kroha.info/wp-content/uploads/2017/05/treatment-congenital-heart-disease.jpg)
Surgical intervention can be minimally invasive, or endovascular, when access occurs not through the chest, but through the femoral vein. This is how small defects, coarctation of the aorta, are closed.
Prevention of congenital heart defects
Since this is a congenital problem, prevention should begin in the prenatal period.
- Elimination of smoking and toxic effects during pregnancy.
- Consultation with a geneticist if there are congenital defects in the family.
- Proper nutrition for the expectant mother.
- Treatment of chronic foci of infection is mandatory.
- Physical inactivity worsens the functioning of the heart muscle. Daily gymnastics, massages, and work with a physical therapy doctor are required.
- Pregnant women should definitely undergo ultrasound screening. Heart defects in newborns should be monitored by a cardiologist. If necessary, it is necessary to promptly refer to a cardiac surgeon.
- Mandatory rehabilitation of operated children, both psychological and physical, in sanatorium-resort conditions. Every year the child must be examined in a cardiology hospital.
Heart defects and vaccinations
It should be remembered that it is better to refuse vaccinations if:
- development of heart failure of the 3rd degree;
- in case of endocarditis;
- for complex defects.