Open aortic heart disease. How to recognize congenital heart disease in a child? Practical recommendations from a pediatric cardiologist

Heart disease is a structural defect of this organ. If your child has a congenital heart disease, it means that he was born with a violation of the anatomical structure of the heart.

Some congenital heart defects in children are mild and do not need to be treated. For example, a small opening between the chambers of the heart that spontaneously closes over time. Other congenital heart defects in children are more complex and may even require a series of surgeries performed in stages over several years.

A thorough diagnosis of the type and characteristics of congenital heart disease is necessary in order to determine the further tactics of its management, the need and extent of surgical interventions, and the expected prognosis.

Symptoms of congenital heart disease

Severe congenital heart defects (CHDs) usually become apparent shortly after birth or within the first few months of life. Symptoms of CHD may include:

Less severe congenital heart diseases may remain undetected for many years, as they often do not have any external manifestations. If CHD symptoms appear in older children, they may include:

Rapid onset of shortness of breath during exercise
Rapid fatigue during physical exertion
Swelling of the hands, ankles, or feet

When to See a Doctor

Severe congenital heart disease is often diagnosed before delivery, or shortly after the birth of a child. However, if a heart defect has not been previously identified in your child, but you notice any of the "severe" symptoms listed above, contact your pediatrician.

If your child has any of the "mild" CHD symptoms listed above, you should also contact your pediatrician. The doctor will examine the child and help determine whether these symptoms are caused by CHD or some other disease.

Causes of congenital heart defects

How does the heart work?

The heart consists of four hollow chambers - two on the right and two on the left. In doing its job of pumping blood throughout the body, the heart uses its left chambers for certain tasks and its right chambers for others.

From the right side of the heart, blood moves to the lungs through vessels called the pulmonary arteries. In the lungs, the blood is oxygenated and then returned to the left side of the heart through the pulmonary veins. The left side of the heart sends this blood through the aorta to the rest of the body.

Why do congenital heart defects occur?

During the first six weeks of pregnancy, the laying, the formation of the heart and the heartbeat begins. In the same period of time, all large blood vessels that carry blood to and from the heart are laid.

It is during this period of development of the child that anatomical defects of the heart can occur. Currently, scientists do not know the immediate causes of most heart defects, but it is believed that the main risk factors are genetic predisposition, certain diseases, certain medications, and some environmental factors (for example, parental smoking).

Types of heart defects

There are many different types of congenital heart defects. They are divided into the following main categories:

Holes in the heart. Holes can form in the walls that separate the chambers of the heart, or between the main blood vessels leaving the heart. These holes allow oxygen-rich blood to mix with oxygen-poor blood. If the holes are large, and the blood is mixed in large volumes, then oxygen deficiency develops in the body.

Chronic oxygen deficiency can cause cyanosis of the skin or nails in a child (they become bluish in color). The child may also develop other signs of heart failure such as shortness of breath, irritability, and swelling in the legs.

Ventricular septal defect called a hole in the wall separating the right and left ventricles (lower chambers of the heart). An atrial septal defect is a hole between the upper chambers of the heart (atria).

open ductus arteriosus called a condition in which the opening between the pulmonary artery (containing venous blood) and the aorta (containing oxygen-rich blood) does not close in time. Open atrioventricular canal(atrioventricular septal defect) is a large hole in the very center of the heart.

Difficulty in blood flow. When the blood vessels or valves in the heart become constricted due to congenital heart disease, the heart needs to work harder to pump blood through them. The most common defect of this type is pulmonary stenosis. This condition occurs when the valve that carries blood from the right ventricle to the pulmonary artery and then to the lungs is too narrow to function properly.

Another type of obstructive heart disease is aortic valve stenosis. This condition develops when the valve that allows blood to pass from the left ventricle to the aorta and then to the rest of the body is too narrow. Narrowed valves cause the heart muscle to work harder, eventually causing the heart to thicken and expand.

abnormal blood vessels. Some congenital heart disease are caused by an abnormal arrangement or change in the structure of the blood vessels that carry blood to and from the heart.

Transposition of the great vessels: a condition in which the pulmonary arteries and aorta "swap" and come out of the wrong sides of the heart.

Coarctation of the aorta: a condition in which the largest vessel in the human body has a pronounced narrowing, which leads to a serious overload of the heart and high blood pressure.

A total anomaly of the connection of the pulmonary veins is a defect in which the blood vessels coming from the lungs flow into the wrong part of the heart (into the right atrium instead of the left).

Anomalies of the heart valves. If the valves of the heart cannot open and close properly, adequate blood flow is not possible.

One example of this type of defect is Ebstein anomaly. The essence of this UPU is the deformation of the tricuspid valve located between the right atrium and the right ventricle.

Another example is pulmonary atresia, a defect in which blood flows to the lungs in an abnormal way.

Underdevelopment of the heart. Sometimes a large part of the heart undergoes underdevelopment. For example, in hypoplastic left heart syndrome, the left half of the heart is not sufficiently developed to effectively pump the volume of blood needed by the body.

combination of defects. Some babies are born with multiple heart defects. The most famous of the combined defects is the tetralogy of Fallot, which is a combination of four defects: a hole in the wall between the ventricles of the heart, right ventricular outflow stenosis, aortic shift to the right, and muscle thickening in the right ventricle.

Risk Factors for Congenital Heart Disease

Most congenital heart defects result from problems in the early stages of a child's heart development, the cause of which is unknown. However, some environmental factors and genetic risks that can provoke defects are still known to science. They include the following:

Rubella (German measles). Getting rubella during pregnancy can lead to heart failure in the baby. That is why doctors recommend that women who are planning a pregnancy get vaccinated against rubella in advance.

Diabetes. The presence of this chronic disease in a pregnant woman can interfere with the development of the fetal heart. You can reduce this risk by carefully managing your diabetes before and during pregnancy. Gestational diabetes (diabetes that occurs only during pregnancy) usually does not increase a child's risk of heart disease.

Medicines. Certain medications taken during pregnancy can cause birth defects, including congenital heart defects. Be sure to check with your doctor about all medications you are taking before planning a pregnancy.

The most well-known drugs that cause heart defects are thalidomide, isotretinoin, lithium preparations, and anticonvulsants containing valproate.

Alcohol during pregnancy. Avoid drinking alcohol during pregnancy because it increases the risk of congenital heart defects.

Smoking. Smoking during pregnancy increases the risk of congenital heart defects in the baby.

Heredity. Congenital heart defects are more likely in families where the parents have some genetic syndromes. For example, many children with Down syndrome (trisomy 21 chromosomes) have heart defects.

Genetic testing can detect such abnormalities in a fetus during fetal development. If you already have a child with a congenital heart disease, a geneticist can assess the likelihood of developing a heart defect in the next child in the family.

Complications of congenital heart defects

Complications that can occur in a child with CHD include:

Chronic heart failure. This is a severe complication in which the heart is unable to adequately pump blood throughout the body; it develops in children with severe heart defects. Signs of congestive heart failure are rapid breathing and poor weight gain.
Slow growth and development. Children with moderate and severe heart defects often lag behind in physical development. They can not only lag behind their peers in growth and strength, but also lag behind in neuropsychic development.
Problems with heart rhythm. Heart rhythm disturbances (arrhythmias) can be caused by both the congenital heart disease itself and the scars that form after surgery to correct this heart disease.
Cyanosis. If a heart defect causes oxygen-rich blood to mix with oxygen-poor blood, the baby develops a greyish-blue skin color, a condition called cyanosis.
Stroke. Rarely, some children with congenital heart defects develop a stroke, due to blood clots that form in pathological holes in the heart and enter the brain through the bloodstream. Stroke is also a potential complication of some corrective surgeries for congenital heart disease.
Emotional problems. Some children with congenital heart defects develop a sense of self-doubt and many emotional problems because they have physical limitations and often have learning difficulties. If you notice a long-term depressed mood in your child, discuss this with your doctor.
The need for lifelong monitoring by doctors. Treatment for children with CHD may not end after radical surgery, but may continue for the rest of their lives.

Such people require a special attitude to health and treatment of any diseases. For example, they have a significant risk of heart tissue infections (endocarditis), heart failure, or heart valve problems. Most children with congenital heart defects will need regular follow-up with a cardiologist throughout their lives.

Preparing for a doctor's visit

If your baby has a life-threatening congenital heart disease, it will most likely be detected shortly after birth, or even before birth, during routine pregnancy screening.

If you suspect a child has a heart defect later in life (infancy or childhood), talk to your child's doctor.

Your doctor will want to ask you about any illnesses you had during your pregnancy, whether you used any medications, whether you drank alcohol during your pregnancy, and will ask questions about other risk factors.

In anticipation of a visit to the doctor, write down all the symptoms that seem suspicious to you, even if you think they are not related to the suspected heart disease. Write down when you first noticed each of these symptoms.

Make a list of all medications, vitamins, and dietary supplements you took during your pregnancy.

Write down in advance the questions you would like to ask your doctor.

For example, you might ask:

What tests and tests does my child need? Do they require any special training?
Does my child need treatment, and what kind?
What long-term complications can I expect for my child?
How will we monitor these possible complications?
If I have more children, what is the risk of them developing congenital heart disease?
Do you have any printed materials on this issue that I could study at home? What sites would you advise me to visit in order to better understand this problem?

Your doctor will likely ask you a series of questions. Prepare in advance for them so as not to waste precious reception time on remembering. For example, the doctor might ask:

When did you first notice these symptoms in your child?
When do these symptoms occur?
Are these symptoms consistent or intermittent? What provokes them?
Are there people with congenital heart defects among your closest relatives?
What do you think relieves your child's symptoms?
Has your child previously lagged behind in physical and neuropsychic development?

Diagnosis of congenital heart defects

A doctor may suspect a heart defect by chance, during a routine physical examination, during auscultation of the heart. He can hear a specific heart murmur that occurs when blood flows through a defective heart and/or blood vessels. These noises are often heard through a conventional stethoscope.

Most baby heart murmurs are "innocent" - meaning that they are not caused by congenital heart disease and do not pose any danger to the child's health. However, some murmurs may indicate an abnormal flow of blood in the heart, and therefore a congenital heart disease.

If, after a physical examination and history taking, the doctor suspects a heart defect, the doctor may order certain tests and tests to clarify his suspicions, for example:

Echocardiography (ECHO-KG, ultrasound of the heart). This examination method allows the doctor to see the heart defect, sometimes even before the baby is born. This will help you choose the best tactics, hospitalize you in advance in a specialized clinic, and so on. This method uses ultrasonic waves that penetrate tissue but do no harm to you or your baby.

The doctor may prescribe an ECHO-KG after the birth of a child with a certain frequency in order to observe the dynamics of changes in the heart - in cases where the operation is not indicated immediately.

Electrocardiogram (ECG). This non-invasive test records the electrical activity of your child's heart and can help diagnose some heart defects or heart rhythm problems. The electrodes connected to the device are placed on your child's body in a certain order and pick up the finest electromagnetic waves that come from your child's heart.

Chest X-ray. The doctor may need an x-ray of your child's chest to see if there is an enlarged heart, as well as fluid in the lungs. These symptoms may indicate the presence of heart failure.

Pulse oximetry. This test measures the amount of oxygen in your child's blood. The sensor is placed on the tip of your child's finger, or attached to his foot, and by the degree of penetration of red light through the tissues - determines the level of oxygen in the blood (saturation). Lack of oxygen in the blood can indicate heart problems.

Cardiac catheterization. Sometimes a doctor needs an invasive procedure, such as a cardiac catheterization. To do this, a thin, flexible tube (catheter) is inserted into a large blood vessel in the child's groin, and is passed through the vessels up to the heart.

Catheterization is sometimes necessary because it can give the doctor much more information about the features of the heart disease than echocardiography. In addition, during cardiac catheterization, some medical procedures can be performed, as will be discussed below.

Treatment of congenital heart defects

In some cases, congenital heart disease does not pose any long-term health risks to your child and does not require any treatment. Moreover, many congenital heart defects in the form of small defects, such as small holes in the inner walls of the heart, may even resolve on their own with age.

However, other heart defects are dangerous and require treatment soon after they are diagnosed. Depending on the type of heart defect your child has, doctors may use the following treatments:

Procedures using cardiac catheterization

In some children and adults, congenital heart defects can be closed using catheterization techniques, without surgical opening of the chest and heart. During catheterization, as already explained, the doctor inserts a catheter into the femoral vein, conducts it to the heart under the control of x-ray equipment.

As soon as the catheter is placed exactly in the place of the defect, special micro-instruments are removed through it, allowing you to close the hole or expand the narrowing zone.

For example, to repair a hole in the inner wall of the heart, such as an atrial septal defect, a catheter is passed through a blood vessel into the hole, then it releases an umbrella-like device that closes the hole and detaches from the catheter while remaining in the heart. This "umbrella" closes the hole, and over time, normal tissue develops over it, which finally corrects this defect.

If it is necessary to expand narrowed areas, such as stenosis of the pulmonic valve, the catheter is equipped with a small balloon, which is inflated at the right time. This creates an expansion in the right place, and improves blood flow, correcting the congenital heart disease.

open heart surgery

In some cases, the doctor will not be able to correct your child's heart defect with catheterization. Then you will have to apply open-heart surgery to eliminate the defect.

The type of surgery your child needs depends on the type and extent of the defect. But all these types of operations have one thing in common: cardiac surgeons will need to temporarily stop the heart, and use a heart-lung machine (ABC) to keep the blood circulating in the body while the heart is temporarily turned off and the operation is performed on it. In some cases, surgeons will be able to correct the defect using minimally invasive devices inserted between the ribs. In others, you will need to open the chest wide, to access the heart directly from the surgeon's hands.

Cases where heart disease can be corrected with catheterization or minimally invasive operations are rather an exception and a rarity. In most cases, surgeons will still need open-heart surgery.

Heart transplant. If a severe defect in the heart cannot be corrected, a heart transplant may be a treatment option.

Medical treatment

Some mild congenital heart defects, especially those found in late childhood or adulthood, can be treated with drugs that help the heart work more efficiently. In addition, in some cases, the operation is impossible for a number of objective reasons, or the operation did not bring a radical improvement. In all of these cases, drug therapy may be the main treatment option.

Angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), beta-blockers, and drugs that cause fluid loss (diuretics) can help ease the workload on the heart by lowering blood pressure, heart rate, and chest fluid volume. Some medications may also be prescribed to correct abnormal heart rhythms (arrhythmias).

Sometimes combined treatment is needed. For example, several phased steps may be prescribed during the year: catheterization, and then open-heart surgery. Some operations will need to be repeated as the child grows.

Duration of treatment

Some children with congenital heart defects require several procedures and surgeries throughout their lives. Although the results of surgical interventions for children with heart defects have improved significantly in recent decades, most people who have undergone surgery for congenital heart disease, with the exception of patients with very simple defects, will require constant monitoring by doctors, even after complete surgical correction of the defect.

Continuous monitoring and treatment. Even if your child has undergone radical heart surgery and his defect is completely corrected, his health should be monitored by doctors for the rest of his life.

First, the control is carried out by a pediatric cardiologist, and then by an adult cardiologist. A congenital heart defect can affect your child's adult life, such as contributing to the development of other health problems.

Limitation of physical exercise. Parents of children with CHD may worry about the risks of rough play and physical activity, even after radical treatment. Be sure to check this with your doctor. However, you should be aware that only a small part of these children will need to limit physical activity, the rest may have full or almost full physical activity, along with healthy peers.

Prevention of infections. Depending on the type of congenital heart disease your child has and the type of surgery they have, your child may need to take additional steps to prevent infection.

Sometimes surgery for congenital heart disease can increase the risk of infections of the heart, lining, or valves (infective endocarditis). Because of this risk, your child may need to take antibiotics for some elective surgeries or dental procedures.

Children with artificial heart valves have the highest risk of secondary heart infections. Ask the cardiologist about situations in which your child will need prophylactic antibiotics.

Family support

It is only natural that you will feel great anxiety about the health of your child, even after radical treatment for a congenital heart disease. Although many children after radical treatment of congenital heart disease are no different from healthy children, you should be aware of some features:

Difficulties of development. Since a child with congenital heart disease often has to recover for a long time after surgery, he may lag behind peers in mental and physical development. Some children's problems may spill over into the school years, such children experience difficulties in school. Talk to your child's doctor about how to help your child overcome these woes.

Emotional difficulties. Many children who experience developmental difficulties may feel insecure, and in addition to physical and cognitive problems, emotional problems are added. This is especially true at school age. Talk to your child's doctor about how you can help your child deal with these problems. He may also recommend support groups for the parents themselves, as well as a family or child therapist.

Support groups. The birth of a child with a serious illness is a serious test for any family, and depending on the severity of the defect, it can bring you difficulties of varying strength and duration. Do not refuse help and support for yourself. It may be helpful for you to talk to other parents who have gone through a similar situation - this can bring you comfort and encouragement. Ask your doctor where there are support groups in your city for parents with CHD in their child.

Prevention of congenital heart defects

Because the exact cause of most congenital heart defects is not known, there are few ways to prevent CHD. However, there are some things you can do to help reduce the risk of birth defects in your unborn child, such as:

Get vaccinated against rubella on time. Do this before pregnancy.
Treat your chronic diseases. If you are a diabetic, strictly follow your doctor's instructions and try to achieve maximum blood sugar control, this will reduce the risk of congenital heart disease in the fetus. If you have other chronic conditions, such as epilepsy, that require the use of teratogenic drugs, discuss the risks and benefits of these drugs with your doctor when planning a pregnancy.
Avoid harmful substances. During pregnancy, avoid contact with paints and other strong-smelling substances. Do not take any medications, herbs, or dietary supplements without talking to your doctor. Avoid smoking and drinking alcohol during pregnancy.
Take folic acid supplements during pregnancy. A daily intake of 400 micrograms of folic acid has been shown to reduce the risk of birth defects of the brain, spinal cord, and heart disease, according to current research.

If changes in the structure of the valve, opening, septum of the heart and large vessels do not occur during the period of embryonic development, but after infections, injuries or against the background of atherosclerosis, connective tissue diseases, then such defects are considered acquired. Clinical manifestations with compensated defects may be absent, with worsening hemodynamics, shortness of breath, heart pain, and weakness increase, in such cases, surgical treatment is prescribed.

Read in this article

Classification of acquired heart defects

Depending on the localization, violations of the structure of valves and blood circulation, there can be various types of classifications of these diseases. These options are used in the diagnosis.

According to the location of the vice

Mitral (in the left half) and tricuspid (on the right) valves are located between the atria and ventricles, therefore, taking into account the large vessels that are associated with the heart, defects are distinguished:

mitral (most common);
tricuspid;
aortic;
malformations of the pulmonary artery.

Anatomy of the heart

By type of valve or orifice defect

A structural defect can be manifested by a narrowed (stenotic) opening due to the inflammatory process, deformed valves and their non-closure (insufficiency). Therefore, there are such variants of vices:

stenosis of the holes;
valvular insufficiency;
combined (insufficiency and stenosis);
combined (several valves and holes).

As a result of damage to the valve, its parts can turn out into the cavity of the heart, this pathology is called valve prolapse.

According to the degree of hemodynamic disturbance

The blood flow is disturbed inside the heart and throughout the cardiovascular system. Therefore, depending on the effect on hemodynamics, the defects are divided into:

does not disturb blood circulation inside the heart, moderate, with pronounced disturbances.
according to general hemodynamic parameters - (no insufficiency), subcompensated (decompensation with increased loads), decompensated (severe hemodynamic insufficiency).

Under increased stress means intense physical activity, elevated body temperature, adverse climatic conditions.

Causes of acquired heart defects

Most often, defects develop against the background of inflammatory and sclerotic processes in the endocardium (the inner lining of the heart). For adults and children, there are differences in the significance of these factors.

In adults

The structure of morbidity varies depending on age. After 60 years, atherosclerosis and concomitant coronary disease predominate, and at a younger age, the occurrence of valvular pathology is associated with endocarditis. It is divided into the following groups:

after rheumatism;
against the background of a bacterial infection;
traumatic (including postoperative);
tuberculosis;
syphilitic;
autoimmune;
postinfarction.

Infective endocarditis a) of the aortic valve and b) of the tricuspid valve

In children

In childhood, defects most often occur between 3 and 10 years of age. The most common cause is rheumatic endocarditis, followed by bacterial inflammation of the inner lining of the heart. The role of other factors is insignificant. Difficulties in diagnosis occur when identifying the time of development - a congenital or acquired structural anomaly.

Symptoms of acquired heart defects

The clinical picture is determined by the type and degree of hemodynamic disorders. Typical signs depending on the location and variant of the defect:

Mitral insufficiency- there are no symptoms for a long period of time, then cyanotic coloration of the skin, shortness of breath, rapid pulse, swelling in the legs, pain and heaviness in the liver, swelling of the jugular veins.
mitral stenosis- cyanosis of the fingers and toes, lips, blush of the cheeks (like a butterfly), children are lagging behind in development, the pulse on the left hand is weak, atrial fibrillation.

Aortic insufficiency- headaches and heart pains, throbbing in the neck and head, fainting, pale skin, a large difference between the indicators (upper and lower) of blood pressure.
aortic stenosis- attacks of pain in the heart, behind the sternum, dizziness, fainting with psycho-emotional or physical overstrain, a rare and weak pulse.
Tricuspid insufficiency- shortness of breath, arrhythmia, pain in the right hypochondrium, heaviness in the abdomen.
Stenosis of the right atrioventricular orifice- swelling in the legs, yellowing of the skin, no shortness of breath, arrhythmia.
Pulmonary artery insufficiency- persistent dry cough, hemoptysis, fingers like drumsticks, shortness of breath.
Stenosis of the orifice of the pulmonary trunk- swelling, pain in the liver, rapid pulse, weakness.

The symptomatology of acquired heart defects in the combined variant depends on the predominance of stenosis or insufficiency in the place where the disorders are more pronounced. With such options, the diagnosis can only be made on the basis of instrumental research methods.

Diagnosis of acquired heart defects

An approximate examination algorithm for suspected acquired heart disease is as follows:

Questioning: complaints, their connection with physical activity, past infectious diseases, injuries, operations.
Inspection: the presence of cyanosis or yellowing of the skin, pulsation of the veins of the neck, lower extremities, swelling.
Palpation: size of the liver.
Percussion: borders of the heart and liver.
Auscultation: weakening or strengthening of tones, the presence of an additional tone in mitral insufficiency, noise and its appearance in systole or diastole, where it is better heard and where it is carried out.
ECG with monitoring - arrhythmias, signs of myocardial hypertrophy and ischemia, conduction disturbances.
The phonocardiogram confirms the listening data.
X-ray of the chest cavity in 4 projections - stagnation in the lungs, thickening of the myocardium, configuration of the heart.

ECG monitoring

The main method for detecting a defect is echocardiography, which shows the size of valves, orifices, blood flow disturbances, pressure in the vessels and chambers of the heart. If doubts remain after the diagnosis, then computed tomography may be prescribed.

With the help of blood tests, the degree of the inflammatory process, the presence of rheumatism, atherosclerosis, and the consequences of heart failure are determined. To do this, a study of cholesterol, rheumatoid and liver tests is carried out.

About EchoCG data for various acquired heart defects, see this video:

Treatment of acquired heart defects

The choice of treatment method depends on the degree of circulatory disorders. All patients are referred for a consultation with a cardiac surgeon to determine the urgency of surgical treatment.

Medical therapy

It is of secondary importance, since it cannot eliminate the cause of hemodynamic disturbances. Therefore, it is used to prepare for surgery or temporarily alleviate the condition of patients.

Drugs are prescribed to prevent the recurrence of infections, rheumatism, cardiac glycosides, medicines to lower cholesterol in the blood (with atherosclerosis).

Surgical intervention

The extent of the operation depends on the type of acquired heart disease. In the presence of stenosis, the parts of the valve are separated () and the opening to which the valve is attached is expanded. If significant mitral stenosis is detected, then surgical intervention is performed on an emergency basis. Usually, this type of treatment does not require a heart-lung machine, and the operation itself is considered safe.

With prevailing insufficiency, artificial valves are installed. This is much more difficult than the elimination of stenosis. Therefore, the indication is low exercise tolerance, they are prescribed with caution to the elderly. In the presence of combined defects, the dissection of the valve with prosthetics is performed simultaneously.

Heart valve prostheses: A and B — bioprostheses; C - mechanical valve

How long do patients with acquired heart disease live

Heart defects are heterogeneous diseases according to clinical manifestations. In some patients, they are diagnosed during examination for other
diseases. Such variants of the course of the pathology may not affect the well-being and life expectancy, and do not require treatment.

If decompensation occurs, then circulatory failure progresses, the result of which may be the death of the patient.

This can occur with exacerbations of the rheumatic process, severe poisoning and infections, the addition of concomitant diseases, nervous or physical overload, in women during the period of bearing or giving birth.

The most unfavorable for patients are defects with a predominance of mitral stenosis, since the cardiac muscle of the left atrium cannot withstand an increased load for a long time.

Prevention

The main directions for preventing the development of defects include:

Treatment of rheumatism, tuberculosis, syphilis,.
Lowering cholesterol in the blood - the exclusion of saturated animal fats, drugs.
After severe infectious diseases, a cardiological examination is indicated.
Lifestyle modification - hardening, physical activity, good nutrition with salt restriction and enough protein, quitting smoking, alcohol.

In the presence of a defect, it is necessary to abandon intensive sports activities, a sharp change in climatic conditions. Observation by a cardiologist and timely surgical treatment are shown.

Thus, acquired heart defects can have an erased clinical picture or lead to severe circulatory failure with a fatal outcome. It depends on the type and localization of the violation of the structure of the valvular apparatus. For radical treatment, dissection or prosthetic valves are used. Preventive measures are aimed at eliminating the infection, lowering cholesterol in the blood, and eliminating bad habits.

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 the fetus. It is impossible to single out just one.

Classification of vices

1. All congenital heart defects in children are divided according to the nature of blood flow disorders 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 blood to organs and systems.

Personal experience! In my practice, there were two children with dextrocardia (the heart is located on the right). These kids live normal healthy lives. The defect is revealed only by auscultation of the heart.

2. Frequency of occurrence.

Ventricular septal defect occurs in 20% of all heart defects.
Atrial septal defect takes from 5 - 10%.
The open ductus arteriosus is 5-10%.
Stenosis of the pulmonary artery, stenosis and coarctation of the aorta occupy up to 7%.
The remaining part falls on other numerous, but rarer vices.

Symptoms of heart disease in newborns

In newborns, we evaluate the act of sucking.

You need to pay attention to:

If the baby has a heart defect, he sucks sluggishly, weakly, with interruptions of 2-3 minutes, shortness of breath appears.

Symptoms of heart disease in children older than a year

If we talk about older children, then here we evaluate their physical activity:

whether they can climb the stairs to the 4th floor without the appearance of shortness of breath, whether they sit down to rest during the games.
whether frequent respiratory diseases, including pneumonia and bronchitis.

With defects with depletion of the pulmonary circulation, pneumonia and bronchitis are more common.

Clinical Case! In a woman at the 22nd week, ultrasound of the fetal heart revealed a ventricular septal defect, left atrial hypoplasia. This is a fairly complex flaw. After the birth of such children, they are immediately operated on. But the survival rate, unfortunately, is 0%. After all, heart defects associated with the underdevelopment of one of the chambers in the fetus are difficult to surgically treat 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: 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 in anatomy helps the doctor to 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:

lag in physical development;
decreased resistance to physical activity;
frequent colds;
in the absence of treatment - the development of circulatory failure.

Defects in the muscle part due to the growth of the child close on their own. But this is subject to small sizes. Also, in such children, it is necessary to remember about lifelong prevention of endocarditis.

With large defects and with the development of heart failure, surgical measures should be carried out.

Atrial septal defect

Very often the defect is an accidental find.

Children with an atrial septal defect are prone to frequent respiratory infections.

With large defects (more than 1 cm), the child from birth may experience poor weight gain and the development of heart failure. Children are operated upon reaching the age of five. The delay of the operation is due to the probability of self-closing of the defect.

Open Botallov duct

This problem accompanies premature babies in 50% of cases.

The ductus arteriosus is a vessel that connects the pulmonary artery and the aorta in the intrauterine life of a baby. After birth, it tightens.

If the size of the defect is large, the following symptoms are found:

Spontaneous closure of the duct, we wait up to 6 months. If in a child older than a year it remains unclosed, then the duct must be removed surgically.

Premature babies, when detected in the maternity hospital, are given the drug indomethacin, which scleroses (sticks together) the walls of the vessel. For full-term newborns, this procedure is ineffective.

Coarctation of the aorta

This congenital pathology is associated with a narrowing of the main artery of the body - the aorta. This creates a certain obstruction to blood flow, which forms a specific clinical picture.

Happening! A 13-year-old girl complained of high blood pressure. When measuring the 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. When diagnosing an ultrasound of the heart, coarctation of the aorta was detected. The child for 13 years has never been examined for congenital defects.

Usually narrowing of the aorta is detected from birth, but may later. These children even in appearance have their own peculiarity. Due to poor blood supply to the lower 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 leaflets, but it happens that two of them are laid from birth.

Children with 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.

With the development of grade 3 insufficiency, surgical valve replacement is required, but this can happen by the age of 40-50.

Children with bicuspid aortic valve should be observed twice a year and endocarditis prophylaxis should be carried out.

sports heart

Regular physical activity leads to changes in the cardiovascular system, which are denoted by the term "sports heart".

An athletic heart is characterized by an increase in the cavities of the heart chambers and myocardial mass, but at the same time, cardiac function remains within the age 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 after 2 years after regular training for 4 hours a day, 5 days a week. Athletic heart is more common in hockey players, sprinters, 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 loads.

Athlete's heart does not require treatment. Children should be examined twice a year.

In a preschooler, due to the immaturity of the nervous system, unstable regulation of its work occurs, so they adapt worse to heavy physical exertion.

Acquired heart defects in children

Most often among the acquired heart defects there is a defect of the valvular apparatus.

Of course, children with an unoperated acquired defect must be observed by a cardiologist or general practitioner throughout their lives. Congenital heart disease in adults is an important issue that should be reported to the physician.

Diagnosis of congenital heart defects

Clinical examination by a neonatologist of a child after birth.
Fetal ultrasound of the heart. It is carried out at 22-24 weeks of pregnancy, where the anatomical structures of the fetal heart are assessed
At 1 month after birth, ultrasound screening of the heart, ECG.
The most important examination in diagnosing the health of the fetus is ultrasound screening of the second trimester of pregnancy.
Assessment of weight gain in infants, the nature of feeding.
Assessment of exercise tolerance, motor activity of children.
When listening to a characteristic murmur in the heart, the pediatrician refers the child to a pediatric cardiologist.
Ultrasound of the abdominal organs.

In modern medicine, with the necessary equipment, diagnosing a congenital defect is not difficult.

Treatment of congenital heart defects

Heart disease in children can be cured with surgery. But, it should be remembered that not all heart defects need to be operated on, since they can spontaneously heal, they need time.

Determining in the tactics of treatment will be:

Surgical intervention can be minimally invasive, or endovascular, when access is made not through the chest, but through the femoral vein. This closes small defects, coarctation of the aorta.

Prevention of congenital heart defects

Since this is a congenital problem, prevention should begin from the prenatal period.

Exclusion of smoking, toxic effects during pregnancy.
Consultation of a geneticist in the presence of congenital defects in the family.
Proper nutrition of the expectant mother.
Mandatory treatment of chronic foci of infection.
Hypodynamia worsens the work of the heart muscle. Daily gymnastics, massages, work with an exercise therapy doctor are necessary.
Pregnant women should definitely undergo ultrasound screening. Heart disease in newborns should be observed 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 should be examined in a cardiological hospital.

Heart defects and vaccinations

It should be remembered that it is better to refuse vaccinations in case of:

development of heart failure of the 3rd degree;
in case of endocarditis;
for complex defects.

Which arise in a person with an initially healthy heart, as a result of past diseases, are called acquired. The lesion concerns the valvular anatomical structures of the heart. The leaflets and the tendon cords attached to them, which control the process of closing and opening, become functionally untenable. In this case, a state of insufficiency develops. If the valve leaflets do not reach the phase of full disclosure, then we are talking about a narrowing of the opening (stenosis). Sometimes both defects are present at the same time. Defects as a result of diseases can develop in children and adults.

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What causes heart defects

The most common reason for the formation of pathological changes in the valves and orifices of the heart is rheumatism, in particular - rheumatic heart disease (an infectious-toxic process localized in the heart tissue).

Less common causes of malformations are:

progressive atherosclerotic processes;
chest trauma;
organic lesion of the heart of syphilitic origin.

What changes occur in the heart as a result of a developing defect

Narrowing (stenosis) can occur through the formation of connective tissue fibers in the valve leaflets and cicatricial processes in the tendon chords that regulate the synchronous operation of the valve apparatus.

Failure valvular structures is the result of the destruction and replacement of the valvular apparatus with scar tissue. Pathologically altered valves disrupt the physiological flow of blood. The problem is that from the main volume of blood that has passed into the next chamber, part of it comes back. This occurs as a result of the fact that the valves cannot close completely, and a gap or other defect is observed between the valves.

The portion thrown back is added to the normal volume of blood. This process leads to an adaptive expansion of the heart chamber, then to a thickening of the muscle wall (hypertrophy). Over time, the heart muscle "gets tired" of constant overload and its weakening occurs, which leads to flabbiness (dilation). As a result, chronic heart failure is formed with the inability of normal "pumping" of blood.

Features of the diagnosis of acquired heart defects

When establishing the presence of a defect, it is necessary to find out its cause, the existing form of heart failure, to assess the degree of its development. The first person to detect a defect is a doctor who listens (auscultates) the heart. It is he who, thanks to acoustic changes in heart tones and emerging noises, makes the primary diagnosis.

Next, an ultrasound of the heart is performed, which allows you to determine the exact location, shape of the defect, the degree of severity of the process by measuring the area of the valve openings. Doppler of the heart is performed to establish the fact of retrograde blood reflux (regurgitation), due to insufficiency.

Remains indispensable and. A careful dynamic examination of the patient during fluoroscopy allows you to consider all the details of the developed pathology.

Laboratory methods should be used to confirm possible changes in other organs that may have been affected as a result of circulatory problems.

More details about the diagnosis (ECG) of acquired heart defects are described in the video review:

The main provisions of the treatment of acquired defects

Important:To completely get rid of such an ailment as heart disease is possible only by surgery.

Drug treatment is indicated only in the case of mild variants and degrees of malaise, to maintain the work of the heart, prevent the development of possible complications and prevent the formation of heart failure.

In severe patients, conservative therapy is used to prepare the body for the transfer of surgical treatment and to relieve symptoms of heart failure.

After the surgical intervention, it is worth remembering the need for household and labor rehabilitation of the patient. Specific types of treatment for acquired defects will be described in particular cases of varieties of the disease.

The main types of acquired heart defects

The variety of vices does not allow describing them in one article, so only the most common ones will be presented here.

note : The human heart is made up of 4 chambers - two atria (left and right) and two ventricles. From the left ventricle, scarlet arterial blood enters the systemic circulation to supply oxygen to all tissues of the body, then it is collected in the superior and inferior vena cava and already saturated with carbon dioxide enters the right atrium. From it - into the right ventricle. Between these two chambers is the tricuspid valve. From the right ventricle (pulmonary circulation), blood through the pulmonary trunk (artery) is supplied to the lung system, where gas exchange occurs - carbon dioxide is released and blood is saturated with oxygen. Further, enriched blood enters through the pulmonary veins into the left atrium and through the bicuspid (mitral) valve into the left ventricle, where it again enters the large circle. The task of the valves is to restrain the backflow of jerkily moving blood. If the structure of the valves and formations that regulate their functions is disturbed, defects and heart failure develop, that is, the impossibility of normal blood flow.

Video "Circulation of blood":

Acquired mitral valve disease

The most common defects mitral valve. This valve apparatus is located between the left atrium and the left ventricle. Its defeat by a painful process in most cases forms a simultaneous insufficiency and stenosis. The form of heart failure develops both in the systemic and pulmonary circulation.

At first, the patient experiences an increase in pressure in the pulmonary circulation.

With defects in the mitral valve, patients experience:

The X-ray picture of the disease is formed by enlarged heart chambers, displacement of position and visible phenomena of stagnation in the lungs. Additional data in the diagnosis of mitral valve disease gives electrocardiography.

Isolated mitral stenosis or insufficiency is rare. As a rule, their combination with prevalence of narrowing or insufficiency takes place.

Mitral stenosis manifests itself:

specific (diastolic) noise, which is well heard at the apex of the heart. It occurs during the period of relaxation of the heart (diastole) due to the passage of blood through the narrowed opening, the "cat's purr" is also determined - the trembling of the fused valve leaflets, the I tone is loud with a clapping;
pulse with low filling;
the general symptoms mentioned above;
a specific sign is a blush on the child's cheeks - a "butterfly".

Heart failure with stenosis develops early, but it is long and well amenable to medical correction. The defect is often complicated by thromboembolism (separation of blood clots from the walls of the right atrium), rhythm disturbances and the development of pulmonary infarction with hemoptysis.

Video "Mitral stenosis":

Surgical treatment - commissurotomy is performed in patients with mitral valve disease with increasing heart failure. The valve leaflets separate and blood flow is restored.

Mitral insufficiency is defined by:

systolic murmur, which is caused by the passage of blood back into the left atrium through a valve defect;
general complaints, characteristic of all vices.

The disease remains in the compensated phase for a long time, since the left ventricle has the greatest ability to adapt to pathological changes. Surgical treatment of the defect is offered in case of an increase in the clinic of chronic circulatory insufficiency. Surgery involves the installation of an artificial valve (prosthesis).

Video "Treatment of mitral insufficiency":

Acquired tricuspid valve defects

Tricuspid valve insufficiency rare isolated defect. Usually it is combined with a combined pathology. With tricuspid insufficiency, congestion of the venous bed develops rapidly. Increased organs with specific parenchymal tissue (liver, spleen). Fluid leaks into the abdominal cavity, ascites develops. Tricuspid disease often occurs with a bicuspid valve defect. In this case, the pressure in the pulmonary circulation decreases, due to the reflux of blood through the tricuspid valve into the right ventricle.

Tricuspid (tricuspid) stenosis extremely rare on its own. Accompanies combined defects, combined with mitral defects. The right atrium with this pathology is expanded, due to the difficulty in the passage of blood into the right ventricle. Patients develop early shortness of breath with physical exertion, a feeling of heaviness in the pit of the stomach, swelling. There is cyanosis of the skin with an icteric tint. The liver increases in size and pulsates. Heartbeat quickened.

Acquired aortic valve disease

Aortic stenosis often occurs in combination with aortic valve insufficiency. Usually remains unrecognized. With this defect, blood from the cavity of the left ventricle enters the aorta through a narrowed opening. The obstacle does not allow it to completely come out, and the rest is mixed into the usual portion. As a result, excess blood leads to an increase in the cavity and hyperextension of the walls of the left ventricle, which responds to an increase in the mass of the myocardium, and then its relaxation (dilation).

Patients rarely complain about health problems. Sometimes there are heartaches, fainting. The pulse is slow, the skin is pale in color, since less blood is supplied to the tissues than it should be. There are specific murmurs in the heart. A disease with slow progress. If a phase of heart failure occurs, then it is manifested by cardiac asthma.

Aortic valve insufficiency also often combined with other vices. Blood from the aorta through the defect of the valves again flows back into the left ventricle. Ventricular hypertrophy compensates for the problem for a long time, so this type of defect rarely causes complaints. Over time, patients develop headache and heart pain, throbbing in the neck, with the development of insufficiency – dyspnea. These symptoms are the result of weakened ventricular contractility.

Important:treatment of aortic defects is carried out according to the same principles as for valves between the atria and ventricles - separation of valve adhesions, prosthetics, and expansion of the hole are used.

Combined vices occur with a predominance of changes and complaints of the main type of defect, which is complemented by secondary signs of the disease.

Heart defects and pregnancy

In pregnant women with heart defects, childbirth occurs with complications. More often there are late toxicoses. In comparison with healthy women, in patients with heart defects, the percentage of untimely discharge of water increases, and weakness of labor activity develops. In childbirth, circulatory failure often occurs (about half). Therefore, such patients require constant monitoring by a gynecologist and a cardiologist. In severe cases, termination of pregnancy is recommended.

The Pediatric Cardiology Department of Israel's leading private clinic Herzliya Medical Center specializes in the diagnosis and treatment of all types of heart defects in children. The doctors of the hospital have accumulated vast experience in conservative and surgical treatment in order to fully restore cardiac function in children and adolescents.

What is a heart defect?

Heart disease is a violation of the structure of the chambers of the heart, its valves and areas of exit to the main vessels (aorta and pulmonary artery). As a rule, these anatomical defects entail functional disorders, expressed to one degree or another, which lead to an overload of the heart muscle, as well as to a decrease in the compensatory abilities of the heart. Hemodynamic disorders are manifested by 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 are formed during the period of intrauterine development. Possible causes of birth defects include:

genetic mutations
exposure to teratogenic substances (including drugs)
radiation
severe metabolic disease of the mother
infectious diseases during pregnancy

Features of the placental circulation of the fetus in most cases allow you to continue 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 (white defects) and defects with reduced pulmonary circulation (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 malformations in which there is a complex of structural disorders (Fallot's triad, Fallot's tetrad, transposition of the main arteries)

Acquired heart defects in children

Acquired heart defects in children are a complication of various diseases and develop throughout the life of the child. The main cause of acquired heart valve disease in children is streptococcal infection (rheumatic disease). Functional and anatomical changes in the valvular 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. Much less common are lesions caused by trauma and tumors.

Among the acquired heart defects in children, the most common are:

Stenosis and insufficiency of the bicuspid (mitral) valve
Stenosis and insufficiency of the tricuspid (tricuspid) valve
Stenosis and valvular insufficiency of the aorta
Stenosis and valvular insufficiency of the pulmonary artery

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. Violations of perfusion of organs and tissues, as well as congestion in the small and large circles of blood circulation lead to severe dysfunction of almost all systems of a growing organism. Symptoms of heart disease in children include:

Low physical endurance. Increased fatigue and weakness do not allow you to lead an active lifestyle
Slowdown of physical development, malnutrition
Shortness of breath on exertion, and in severe cases even at rest
Discoloration of the skin - pallor or blueness
Signs of chronic hypoxia (oxygen deficiency) of the brain such as irritability, insomnia or excessive sleepiness, memory impairment, learning delay, 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 the coronary circulation

Diagnosis of congenital and acquired heart defects in children

All types of functional and invasive diagnostics of diseases of the cardiovascular system in children are carried out at the Herzliya Medical Center clinic. In case of clinical suspicion of a heart disease, experienced cardiologists of the hospital will prescribe an individual examination program in order to determine the exact diagnosis and the degree of functional disorders. Among the main methods of instrumental diagnosis of heart defects in children, it is important to note:

Electrocardiography and continuous (including remote) heart rate monitoring
Echocardiography (ultrasound) at rest and under exercise
Tomography of the heart - cardio CT and MRI
Isotope scanning of the heart

Treatment of congenital and acquired heart defects in children

Making an accurate diagnosis helps the cardiologists of the Herzliya Clinic to 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 for the symptoms of heart failure and stabilizing the patient's general condition. Medical 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 interventions require a high level of professionalism, experience and technological capabilities to safely transfer the patient to extracoronary circulation during the procedure. In the private clinic "Herzliya Medical Center" operations of any degree of complexity are successfully performed.
Minimally invasive procedures for the elimination of congenital and acquired heart defects using catheterization. Innovative methods of endoscopic surgery allow for effective and safe intervention on a beating heart.

Cardiologists of 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 the diagnosis and treatment of heart defects.