Causes of VPS. Review of congenital heart defects. Metabolic disorders as a cause of congenital fetal heart defects

Congenital heart defects in children are a group of pathological conditions of the cardiovascular system that arose in the perinatal period. Depending on the type of disease, characteristic symptoms arise, which are accompanied by various complications. CHD in children must be monitored and treated in a timely manner, to give the child a chance to live without restrictions.

Development mechanism

For the full development of the fetus, its own blood circulation is necessary, therefore the cardiovascular system develops earlier than others - the formation begins already on the 14th day after conception. After 22 days, the heart begins to pulsate, and after a few more days, the blood begins to circulate. And, although the cardiac system during this period is still only at the initial stage of formation, much depends on how the processes of fetal development, the state of the mother and external factors proceed.

Congenital malformations of the cardiovascular system develop from 14 to 60 days from conception. With the normal course of pregnancy and the correct development of the fetus, by the second month the baby's heart should be formed:

• septa grow, the heart becomes four-chambered;
• there is a division of the arterial trunk into the aorta and the pulmonary artery;
• the ventricle is divided into two halves;
• heart valves are formed.

But, the influence of negative factors leads to the fact that a failure occurs in the development of the cardiac system - this is how congenital defects are formed.

From the 12th week of pregnancy, you can determine what pathologies can develop in a child. This allows the parents to decide whether to terminate or maintain the pregnancy. But, it should be borne in mind that there is a possibility of medical error and the child can be born healthy. In any case, the suspicion of CHD in a child makes it possible to prepare for possible operations that must be carried out immediately after birth in order to save his life.

Factors affecting the development of CHD

In most cases, congenital heart disease in children occurs as a result of a genetic predisposition. If someone in the family has been diagnosed with congenital diseases of the heart system, then with a high probability they will be passed on to the child.

The presence of defects in parents and the likelihood of their development in a child is considered as a percentage. So, it occurs in 13% of couples if one of the parents has a history of congenital heart disease. Other types of pathologies occur with a probability of 1-10%.

The development of CHD in a child is influenced by the mother's lifestyle during pregnancy planning and gestation. This includes not only nicotine and alcoholic beverages, but also taking medications. What medications are unsafe:

• blood thinners with the active substance warfarin sodium (Warfarin, Marevan, Warfarex);
• anticonvulsant and antiepileptic drugs;
• corticosteroid drugs;
• immunosuppressants;
• psychostimulants;
• barbiturates.

There is a high risk of developing congenital heart and other organ pathologies in children whose mothers worked in unfavorable conditions. Lifting weights or inhaling chemical fumes negatively affects the development of the fetus. The infectious diseases carried by the mother are very dangerous for the child's cardiac system.

Even a mild illness in the first trimester can affect the development of the heart and circulatory system.

The transfer of infectious diseases by the mother during pregnancy, such as toxoplasmosis, measles, herpes, rubella and chickenpox, affects the overall development of the fetus, including the circulatory system.

Chronic diseases of the mother play an important role in the formation of defects:

• diabetes;
• autoimmune diseases;
• epilepsy;
• phenylketonuria;
• nephrogenic hypertension;
• severe kidney pathology.

A high risk of developing CHD in a child, if the mother is under 17 or over 40, women of this age should visit the doctor more often and undergo examinations than others. Abnormal development of the cardiac system can occur with severe toxicosis of the first trimester, prolonged stress and the threat of early miscarriage.

Types of UPU

More than a hundred CHD are known, and in order to accurately describe the state of the cardiac system, these pathologies are usually divided according to several criteria. First of all, defects are determined by the place of localization:

• in the valve apparatus;
• in the heart vessels;
• in the walls of the heart muscle;
• in the interventricular septum.

Scientists have proposed several classifications of CHD based on similar features, but the most generalizing systematization is “blue” - with the presence of cyanosis and “white” - without cyanosis of the skin. "Blue" defects are diagnosed when venous blood, entering the systemic circulation, penetrates into all body tissues, causes a lack of oxygen, which leads to cyanosis.

There are two subspecies: with enrichment and impoverishment of the pulmonary circulation. The "blue" vices include:

• transposition of great vessels;
• double vessels of the right ventricle;
• abnormal drainage of the pulmonary veins;
• Ebstein's vice;
• common arterial trunk.

"White" defects are characterized by the release of arterial blood into the venous. Most children look completely healthy for many years, and symptoms only appear during periods of active growth, puberty and prolonged stress.

Anomalies without cyanosis are divided into 4 subspecies:

• with enrichment of the small circle of blood circulation;
• with the impoverishment of the small circle;
• with the impoverishment of a large circle;
• defects associated with misalignment of the heart, without circulatory disorders.

White vices include:

• open oval window;
• coarctation of the aorta;
• stenosis of the bicuspid, valves and pulmonary artery.

There is an international classification of CHD, which distinguishes not only "white" and "blue" anomalies, but also the following types:

• with cross-ejection of blood (a combination of cyanotic and non-cyanotic defects);
• valvular heart disease;
• hemodynamic abnormalities;
• defects of the muscles of the ventricles;
• heart rhythm disturbances;
• defects of the coronary arteries.

Based on circulatory disorders, 4 degrees are distinguished according to the increase in signs:

• minor changes;
• moderate manifestations;
• sudden;
• terminal.

If the terminal stage occurs, then often even surgical intervention is powerless, therefore treatment of CHD should begin in a timely manner.

The big picture of the UPU

Symptoms of CHD in childhood can manifest themselves in different ways, depending on the type of pathology. In some children, from the first day of life, characteristic signs of heart disease are noticeable, in others, the symptoms of CHD occur in early preschool age, in others, the first manifestations of congenital anomalies develop only by adolescence, and most often these are "white" defects.

There are common symptoms of congenital heart defects:

• discoloration of the skin and mucous membranes - they either acquire a bluish tint or become much paler than usual;
• constantly cold extremities;
• excessive sweating;
• pulsation and swelling of the cervical vessels;
• fast fatiguability;
• restless sleep;
• persistent "bruises" under the eyes;
• frequent shortness of breath, even at rest.

An additional sign in infants is blue lips and cheeks during feeding and when crying. Children with CHD are very restless, they often refuse to breast and sleep restlessly. All this affects their development, in comparison with healthy peers, babies with defects later begin to master the necessary skills, gain little weight.

In severe conditions, asthma attacks and short-term loss of consciousness are observed. But it is impossible to diagnose CHD only on these grounds, children with diseases of the central nervous system have similar symptoms.

In children with CHD, it is observed, which is characterized by shortness of breath, increased heart rate, edema and plethora of internal organs. I distinguish 4 degrees of this state:

• A mild degree that often does not require treatment. The child's condition is stable, minor deviations are diagnosed during the examination.
• At this stage, the symptoms are more pronounced, breathing problems are observed, the child loses his appetite.
• Lack of oxygen affects the functioning of the nervous system - developmental problems are added to cardiac pathology.
• The severe (terminal) stage is characterized by respiratory depression and.

Insufficient oxygen supply to organs and tissues affects metabolism. In the child's body, toxic metabolic products with an acid reaction begin to accumulate. Increased acidity occurs - acidosis, the decompensatory stage of which can be fatal, especially in infancy.

Open oval window

Of all types of CHD, this type of pathology is much more common than others. Normally, every child in the perinatal period has a hole between the right and left atrium, but after birth it overgrows within several months. In some children, the oval window can be open until the age of two, but if it does not increase, but, on the contrary, becomes smaller, then this condition does not require treatment.

Children with this atrial septal defect need to undergo an ultrasound of the heart every 6 months in order to monitor its condition in dynamics. In most children, an open oval window does not manifest itself in any way, and many find out about their defect only in adulthood.

An open oval window may be accompanied by the following symptoms:

• Cyanosis;
• fast fatiguability;
• dizziness;
• short-term loss of consciousness.

Children with such a defect are prone to colds, so they need to be taken care of, since during the illness the load on the heart and blood vessels increases.

Open arterial defect

The arterial duct is located between the aorta and the pulmonary artery, and it is only needed during pregnancy to transport blood. If the birth took place on time without complications and the child was born with normal weight, then this duct closes within a few days. In premature babies, the closure of the ductus arteriosus may take up to three months. If, after this time, closure has not occurred, then they speak of the presence of a congenital defect.

A small duct does not manifest itself in any way, and it can only be identified with the help of ultrasound. Indirectly, the following signs indicate a wide duct:

• lagging behind in height and weight from the norm;
• difficulty breathing
• pale skin;
• restless sleep;
• poor appetite.

All these signs can accompany other diseases not related to the cardiac system, therefore, a thorough examination of the child is required. If you do not take up treatment in a timely manner, then a small protrusion appears on the child's chest. Noises are heard when listening, but only an experienced technician can listen to them. Children with this anomaly often develop, which can lead to the death of the child.

Transposition of the great vessels is a serious defect in which the aorta and pulmonary artery are not located correctly - the aorta departs from the right heart, and the pulmonary artery from the left. With such a structure, the large and small circulatory systems do not communicate with each other and the venous blood is not saturated with oxygen.

From birth, the child is observed, although in the first days the condition is satisfactory. Symptoms gradually increase:

• shortness of breath occurs;
• pulse quickens;
• puffiness is formed.

The child's body is trying to make up for the defect by an increase in blood volume, which leads to an overload of the heart and severe heart failure.

The heart begins to grow in size, on examination, changes in the lungs are visible, the liver begins to malfunction and also increases. This defect is incompatible with life and requires urgent surgery to move the vessels.

Diagnostics

A heart defect in a child is often detected even during pregnancy, then an examination is carried out immediately after birth to confirm or remove the diagnosis. In some children, heart defects are detected at a pediatrician's appointment during listening - a heart murmur is heard, which should not be.

If you suspect CHD, the child is prescribed a comprehensive examination, which may include the following methods:

• Fetal echocardiography is an ultrasound examination that is performed during the perinatal period, when the child is in the womb.
• Ultrasound of the heart - is performed to identify pathologies of the heart, determine its structure, size and check the condition of blood vessels and valves.
• - allows you to assess the condition of the heart muscle.
• Holter monitoring - detects latent rhythm and cardiac conduction disturbances.
• Chest X-ray - reveals the size of the heart and lungs. Sometimes it is performed with the introduction of a contrast agent through the catheter.
• Pulse oximetry - checks the level of oxygen saturation in the blood.
• MRI and CT are performed when in doubt about the diagnosis.

For diagnostics, the results of studies of general and biochemical blood tests are needed in order to understand how much the chemical composition of the blood changes, and to identify violations of internal organs.

How is CHD treated?

Treatment of CHD depends on the severity of the pathology, the age of the child and concomitant diseases. In most people, congenital heart disease is in the stage of compensation and does not threaten health throughout their lives. To maintain this condition, monitor your health and adhere to several rules:

• Timely undergo heart examinations.
• Give up heavy physical activities, limit yourself to light sports: gymnastics, swimming or physiotherapy exercises.
• Observe the daily regimen, get enough sleep.
• Eat right, limit the intake of foods high in cholesterol. Control the amount of salt consumed and observe the drinking regime.
• Avoid nervous overstrain, protect yourself from stressful situations.

Drug therapy is aimed at reducing the symptoms of the disease. To do this, prescribe drugs aimed at normalizing breathing, reducing pressure, eliminating tachycardia. Defects of the "white" appearance can be constantly maintained with drug therapy without surgery.

"Blue" anomalies in 90% of cases require surgery in early childhood. The success of the operation depends on the timeliness of its implementation. More than 70% of operations guarantee a complete recovery of the child. There are cases when operations on the heart of a child were performed in the womb. But these very complex manipulations are not used as often as necessary, since most hospitals do not have the necessary equipment and highly qualified specialists.

There is a way to carry out operations with CHD:

• closed - the intervention is performed on the vessels without affecting the heart;
• open - abdominal heart surgery is performed.

If the patient's life is threatened, emergency operations are performed. In most cases, they are performed at an early age or immediately after birth. Emergency interventions are also carried out in severe conditions, but at the same time it is possible to prepare for the operation and conduct all the necessary examinations.

Planned interventions are carried out if there is no direct threat to life, but the operation is necessary so that the child's condition does not worsen. In some cases, one surgical intervention is sufficient, but, in difficult situations, repeated operations may be required.

After the operation, a relapse of the defect may occur - vascular stenosis, valve insufficiency, coarctation of the aorta. According to statistics, less than half of children with relapses live for more than 10 years. During prosthetics, the following problems arise - the child grows out of prostheses and there is a need for repeated intervention, therefore, if there is an opportunity to delay the operation, it is carried out as late as possible.

Children with congenital heart defects often have complications of infectious diseases of the respiratory system. Colds almost always occur with complications that cause increased stress on the heart. Pulmonary stenosis and combined defects increase the risk of developing tuberculosis. Due to impaired blood circulation, the child's immunity is not able to cope with the disease, which leads to death.

After prosthetics, children have a high risk of blood clot formation at the site of the prosthesis, so they have to constantly take drugs that thin the blood, the greatest likelihood of such a complication after tricuspid valve replacement.

Children with CHD are often insecure and emotionally unstable - due to physical limitations, relationships in the children's team do not develop. Many have difficulties in learning, which is associated not only with the effect of defects on the central nervous system, but also with frequent absences due to illness.

Some congenital heart diseases, for example, an atrial septal defect or, provided a healthy lifestyle, do not have a negative effect on the child's condition. Most of them learn about their defect only as adults.

If congenital heart disease significantly affects the health of the child, then the issue of establishing disability is decided. Depending on the type and severity of the anomaly, a lifelong or temporary disability is established. Sometimes, after the operation, the disability is removed or a less severe group is established.

During the intrauterine development of the fetus, under the influence of predisposing factors, the normal formation of the cardiovascular system may be disrupted. As a result, congenital malformations are formed, which can be compatible and incompatible with life. The development of pathology is often associated with the mother's improper lifestyle during pregnancy, although in some cases heredity plays an important role.

Congenital heart defects (CHD) are a defect condition that affects various parts of the heart and large vessels close to it, which is determined immediately after birth. Many children with such disorders do not survive, but in some cases, surgical treatment can be carried out, which allows the child to continue to lead a normal life.

Among children, congenital heart defects are relatively common, in about 1% of the total number of newborns.

Timely assistance to a sick child is based on timely and correct diagnosis. In some cases, a very quick surgical intervention is required, which allows you to save a person's life. Defects can be acquired, so it is important to know how they differ from congenital ones.

Video: Congenital heart defects in children

Congenital heart disease statistics

Heart defects are among the most severe developmental disabilities, as reported by WHO in an April 2015 newsletter. For example, they are the second most common after congenital malformations of the nervous system. There are many different types of CHD and their percentages are as follows:

• Ventricular septal defect occurs most often - in 31% of the total number of newborns with heart defects.
• Aortic stenosis is determined in almost 8% of newborns.
• Stenosis of the pulmonary valve, non-closure of the ductus arteriosus and a defect in the septum located between the atria account for 7% each.
• Aortic valve stenosis occurs in almost 6% of cases.
• Fallot's tetrad accounts for up to 5%.

Classification

According to the International Classification of Diseases, revision 10 distinguishes “Congenital anomalies (malformations) of the circulatory system (Q20-Q28)”. According to this classification, congenital heart defects include the following diseases:

• Q20 - Congenital malformations of the heart chambers and joints.
• Q21 - Congenital.
• Q22 Congenital malformations of pulmonary and tricuspid valves
• Q23 - Congenital malformations of the aortic and
• Q24 - Other congenital malformations of the heart

According to another widely used classification, the UPU is divided into two groups:

1. White defects - during their development, venous blood does not mix with arterial blood, since blood is discharged from the left side to the right.
2. Blue defects - their occurrence is accompanied by mixing of venous blood with arterial. The discharge of blood occurs from the right side to the left.

Causes

In most cases, hereditary factors are considered that cause congenital heart defects. Also, the fetus can be influenced by external factors of influence, which are often combined with the same hereditary predispositions.

Genetic predisposition

Most often it is presented in the form of local mutations or chromosomal changes that lead to more or less malformations. Today, trisomies of different pairs of chromosomes are distinguished, which cause CHD in almost 8% of cases. The most common, occurring against the background of gene mutations, are atrial septal defects, ventricular septal defects, electrical conduction disorders, and blood outflow disorders.

Etiological factors of influence

In the development of congenital heart defects, unfavorable factors of influence play a significant role, most often directed from the outside to the organism developing in the womb. Under their action, certain parts of DNA mutate, resulting in disruption of the normal formation of the cardiovascular system.

Adverse factors of influence are:

• Physical phenomena, among which radioactive radiation has a particularly negative effect on the fetus.
• Chemical components included in various alcoholic beverages, cigarettes, some medicines, and mutagens are also found in low-quality paints and varnishes.
• Biological influence can be carried out through various infectious diseases that occur in a pregnant woman. Most often, rubella causes heart defects, and diabetes mellitus, systemic lupus erythematosus, phenylketonuria can also lead to congenital changes.

The relationship of the UPU with the floor

In the 70s of the last century, studies were carried out that confirmed the connection between heart defects and gender. For this, more than 30 thousand patients with CHD were examined, as a result of which congenital heart defects were divided into "neutral", "female" and "male". For example, girls are more likely to have Lautembacher's disease, patent ductus arteriosus, and there is also a greater likelihood of developing an atrial septal defect of a secondary type. In boys, stenosis and coarctation of the aorta are more common. Ebstein's anomaly, complete atrioventricular septal defect, pulmonary stenosis, aortic-pulmonary septal defect, and ventricular septal defect are considered “neutral”.

Pathogenesis

The heart muscle completes the main stages of its formation until the end of the first trimester of pregnancy. Already at 20 weeks, ultrasound can be used to determine most of the congenital heart defects. In the development of pathology, the following stages are distinguished:

• First, in the absence of severe hemodynamic disturbances, compensatory mechanisms are triggered, providing more or less normal heart activity. The presence of significant changes in hemodynamics leads to myocardial hypertrophy and decompensation.
• The second is a relative compensation when the child's physical activity improves somewhat.
• The third is the terminal state. It manifests itself in significant dystrophic and destructive disorders caused by developing decompensation. The addition of infections or diseases of other organs brings death closer.

Views

Atrial septal defect

Quite often found in the female part of the population. It is characterized by the presence of an opening or multiple defects in the septum separating the right and left atrium. Depending on the location of the defect, its size, the strength of the blood flow from the left atrium to the right, more or less pronounced clinical signs are determined. Also, the presence of other anomalies or congenital defects affects the patient's condition. For example, a defect in the MPP can be detected in Down syndrome and be combined with other cardiac abnormalities.

Ventricular septal defect

During an abnormal intrauterine formation of the heart, a defect in the interventricular septum may form, due to which blood from the left ventricle enters the right. The presented CHD can occur both isolated and together with other heart and developmental defects. The frequency of occurrence among boys and girls is almost the same. The defect is dangerous in that it can cause pulmonary hypertension with all the ensuing consequences, therefore, it must respond in a timely manner to surgical treatment.

Coarctation of the aorta

7.5% of all CHD cases are due to the presented pathology. It is more often determined in boys and is often combined with other congenital heart defects. Coarctation of the aorta is characterized by segmental narrowing of its lumen, as a result of which blood from the left ventricle cannot normally enter the systemic circulation.

Patent ductus arteriosus

It is considered a congenital heart disease, in which the Botall's duct, determined in newborns, does not overgrow in the future, due to which arterial blood from the aorta is partially discharged into the pulmonary artery. In most cases, the pathology does not cause severe clinical manifestations, but it requires surgical correction, since in adulthood it can cause sudden cardiac arrest.

Pulmonary atresia

It is a complete or partial underdevelopment of the pulmonary valve cusps, due to which the pulmonary opening does not completely close. The blood pushed by the right ventricle into the pulmonary artery partially returns back through the loosely closed valves, as a result of which the ventricle needs to exert more force each time to push out a large portion of the blood. In addition, an insufficient amount of blood enters the lungs, which in turn leads to a lack of oxygen in the body.

Pulmonary valve stenosis

For various reasons, the pulmonary opening may be smaller than normal. In addition, the leaflets of the pulmonary valve themselves may have abnormalities, due to which the lumen is narrowed, or their opening does not occur completely, as a result of which blood flow cannot normally move from the right ventricle to the pulmonary trunk. To push blood through the narrowed opening of the ventricle, you have to work with greater force, which affects its functionality.

Fallot's tetrad

Congenital malformation is very difficult because it combines four separate cardiovascular abnormalities. In particular, with Fallot's tetrad, it is determined:

• pulmonary artery stenosis;
• hypertrophy of the right ventricle;
• dextraposition of the aorta.

In this pathology, arterial blood is mixed with venous blood. Also, through the narrowed opening of the pulmonary artery, it is difficult for blood to pass into the pulmonary circulation. All this leads to oxygen deficiency, which is expressed in the appropriate clinic.

Transposition of great vessels

Refers to very complex congenital malformations, occurs in 5% of the total number of cases. The main vessels are the main vessels of the heart, which are the aorta and the pulmonary trunk. With this pathology, they are located relative to the ventricles differently than in the norm: the pulmonary trunk departs from the left ventricle (normally from the right), and the aorta from the right (normally from the left). Since oxygen-rich blood does not enter the systemic circulation, newborns with such a pathology die very quickly.

Dextrocardia

Congenital developmental anomaly, which is characterized by right-sided placement of the heart as opposed to the left-sided one, which is normally determined. That is, the heart, together with all the vessels extending from it, is located mostly in the right side of the chest. This pathology is often combined with a "mirror" arrangement of other unpaired internal organs. If dextracardia is not combined with other congenital heart defects, then there are no life-threatening or health-threatening changes in hemodynamics.

Ebstein's anomaly

A rare anomaly, accounting for about 1% of all CHD. With this pathology, there is a change in the location of the tricuspid valve cusps. Normally, they come from the atrioventricular ring, and in this pathology - from the walls of the right ventricle. As a result, it turns out that the right ventricle is smaller, and the right atrium is elongated to abnormally located valves. A valve defect can be combined with other defects such as non-closure of the foramen ovale, etc. Lack of timely surgical assistance leads to the immediate development of heart failure and death of the patient.

Diagnostics

It is carried out through a survey, examination, instrumental and laboratory examination of the patient. In some cases, it is very important to make a diagnosis in the early stages, since the patient's life may depend on it.

Clinic

Early diagnosis of congenital heart defects in a number of cases allows the life of the baby to be saved, therefore, in the first days after birth, CHD can be determined by the following signs:

• the child has very pale or, conversely, cyanotic skin;
• cyanosis often intensifies when the baby is straining (while screaming or sucking);
• the arms and legs are cool, even if the child is warmly dressed.

Medical examination is based on a more thorough examination of the patient. An objective examination can identify the symptoms listed above. Auscultation of the heart reveals more characteristic signs of congenital heart disease:

• heart sounds can be muffled and weakened;
• the first and second tones can be bifurcated, which leads to the formation of a three-membered or four-membered rhythm;
• additional tones can be defined in the form of third and fourth.

Additionally, there may be frequent breathing, with the expansion of the intercostal spaces, as well as different blood pressure when comparing it on the arms and legs. In some cases, the borders of the heart and liver are enlarged.

In general, the clinical symptoms of CHD are combined into the following syndromes:

• Cardiac - associated with complaints from the cardiovascular system.
• Heart failure - can occur in both acute and chronic form.
• Respiratory disorders - manifested by signs of oxygen enrichment in the pulmonary circulation.
• Chronic systemic hypoxia - there are signs of drumsticks, watch glasses, lag in physical development.

Instrumental examination methods

Accurate diagnosis of congenital heart defects is based on the use of instrumental and laboratory research methods. First of all, it is done:

• Electrocardiography - with its help, hypertrophy of the right and left ventricles, hypertrophy of the right atrium are determined, and dilatation of the right atrium can also be determined in the stage of decompensation.
• X-ray of the chest cavity organs is mainly done in the anteroposterior projection and then structural changes such as dextracardia, cardiomegaly become visible. There may also be an increase in the right atrium, a narrow vascular bundle, etc.
• Echocardiography - allows you to assess intracardiac hemodynamics, as well as to find out the nature of congenital anomalies. An echocardiogram is performed together with an ECG or PCG, then maximum information can be obtained.
• Cardiac catheterization - performed to determine the pressure in various parts of the heart along with an intracavitary ECG. Also, the gas composition of the blood is found out, which in case of defects can be at the level of arterial hypoxemia.
• Angiocardiographic examination - with congenital malformations, a large dilated right atrial cavity is often determined. In such cases, the contrast agent is removed from the right atrium for a long time, which is mainly associated with pathological hemodynamics.
• Electrophysiological study - this method is shown to all patients for heart defects, since it helps to determine the localization of the pathological focus along with abnormal blood flow paths.

Treatment

The main help to patients with congenital heart defects is provided through surgical intervention. Ancillary therapy is the use of medications.

Drug therapy

It is carried out in exceptional cases. For example, radical medication is used when the aortic duct is open. Then indomethacin is prescribed for its infection.

Symptomatic treatment is carried out with the development of such complications of CHD as heart failure (acute and chronic course), arrhythmia, dyspnea-cyanotic attack, ischemic heart disease.

Surgery

It is carried out in order to eliminate cardiac abnormalities, which helps to improve intracardiac hemodynamics. When determining a heart defect in the prenatal period, the question of the volume and optimal method of surgical intervention is being resolved.

There are three phases of CHD, according to which surgical treatment is selected:

• The first phase is considered emergency, so the operation is performed on an emergency basis. Much depends on the individual characteristics of the patient, but in standard cases, when the pulmonary circulation is depleted, an artificial botallus duct is created, and when it is enriched, stenosis of the pulmonary artery is created.
• The second phase corresponds to those defects that are slowly progressing, therefore, surgical treatment can be carried out in a planned manner. The more accurate technique depends on the specific hemodynamic disorder.
• The third phase is characterized by the progression of cardiosclerosis, which is accompanied by general exhaustion. Dystrophic and atrophic changes in the internal organs are observed, as well as other irreversible changes, as a result of which surgical treatment is not carried out in this phase.

Video: Treatment of congenital heart defects in adults

Complications

In almost all congenital heart defects, heart failure develops, which can be acute or chronic. In addition, blue defects (that is, those in which there is cyanosis of the skin) can be complicated by bacterial endocarditis.

In newborns with congestion in the pulmonary circulation, pneumonia often develops, while an increase in pressure in the pulmonary artery, on the contrary, leads to pulmonary hypertension.

With various violations of the localization and structure of the aorta with arteries extending from it, angina pectoris, myocardial ischemia up to a heart attack, may occur. If the stenosis of the aorta is so pronounced that the blood does not enter the brain in sufficient quantities, then fainting and semi-fainting occurs.

Dyspnea attacks with cyanosis are the result of various severe disorders like Fallot's tetrad and disturbed location of large vessels.

Forecast and prevention

The predictive conclusion largely depends on how early the correct diagnosis was made and whether radical treatment is possible. If the operation was successful, then the prognosis is considered relatively favorable. The presence of contraindications to performing surgery in most cases is the reason for the formulation of a disappointing prognostic conclusion.

There are no specific preventive measures. The only thing, if there are congenital heart defects in the family, it is worth taking a balanced approach to the question of procreation.

There is a very high probability of having a child with CHD in the presence of any congenital pathology in the mother or father, and even more so in both parents at the same time.

If a pregnant woman is aware of a hereditary predisposition to malformations, then doctors from the antenatal clinic should be notified of this. In such cases, an ultrasound scan is mandatory, with several times at different periods of intrauterine development of the fetus. Genetic tests can also be performed, which allow a high degree of probability to assume the birth of a child with a developmental defect.

Additionally, during pregnancy, adverse factors of influence should be avoided, for which it is important to adhere to the following recommendations:

• Before pregnancy, you need to be screened for TORCH infections, the presence of which increases the risk of congenital malformations, including the heart.
• If a girl did not suffer from rubella in childhood, then long before pregnancy she should be vaccinated against this disease so as not to get sick with it during the period of gestation.
• During pregnancy, you should be very careful about taking various medications, so it is better to ask and recheck several times than to harm the health of the child.
• Pregnant women, and even better before conception and during breastfeeding, are strictly prohibited from smoking or drinking alcohol.

Video: Heart disease

Heart disease - what is it? The general name means a group of cardiac diseases, united by the presence of pathologies in the structure of the heart muscle, valves and blood vessels. Congenital and acquired heart defects are diagnosed. Acquired pathology can develop at any age. It appears as a complication after infectious diseases or due to many factors. Congenital heart disease is formed during fetal development and is often found on screening before birth. Differences in symptoms are due to the type of pathology, but the most specific are pallor of the skin, the presence of a murmur in the heart, heart or pulmonary failure, delayed physical development. To establish this diagnosis, modern research methods are used. Surgical operation is the main way to improve congenital heart disease. If this pathology is a threat to life, the operation is done in the first hours or days.

Congenital heart defect

The main factor provoking the formation of a congenital defect is anomalies in the formation of blood flow, accompanied by heart failure. About 1% of babies are born with a congenital heart defect. This is an insignificant deviation in the anatomy of the heart and blood vessels or a complex pathology of the heart muscle that poses a serious threat to a person. Congenital heart disease is an independent organ deviation, but it can be accompanied by various disorders of the nervous, musculoskeletal or digestive systems.

Commonly observed congenital heart defects:

• ventricular septal defect;
• atrial septal defect;
• narrowing and overgrowth of the aorta;
• overgrowth of the pulmonary artery;
• unclosed arterial duct;
• displacement of the main vessels.

Ventricular septal defect

VSD is a congenital heart disease that manifests itself as a hole in the muscle between the ventricles. A similar defect is usually observed in newborns - in about a third of all congenital heart defects. The main place of its localization is the upper (membranous) third of the interventricular septum directly under the cusps of the aortic valve and next to the tricuspid valve. In 2% of cases, the holes are located in the middle muscle part. It is extremely rare that both defects are observed at the same time.

Hole sizes vary from 1 to 30 mm and larger. Defects are classified into large (equal to or greater than the aortic lumen), medium (a quarter to half aortic lumen diameter), and small. Large oval or round holes are found in the upper membrane region of the septum. In the middle part there are small round holes. VSD is often combined with other defects: open ductus arteriosus, ASD, narrowing of the aorta, mitral valve pathology, and decreased lumen of the aorta or pulmonary artery.

Atrial septal defect

ASD is a pathology of heart development, in which an opening appears in the septum between the atria. With this anomaly, a certain amount of blood from the left atrium constantly flows into the right. Because of this, the pressure in the pulmonary circulation increases and, accordingly, the load on the right ventricle increases. This congenital anomaly can develop on its own or be accompanied by other disorders.

Lack of treatment leads to wasting of the heart muscle, rhythm disruption and possible blood clot formation, which can cause stroke or myocardial infarction. With this congenital pathology, life expectancy does not exceed 50 years.

There are 3 modifications of DMPP:

• open oval window. This hole is formed in the prenatal period. After birth, it is closed by a special valve, which is completely overgrown by the year. Sometimes, due to a congenital anomaly, the valve leaflets do not close, and at the slightest increase in pressure, some blood can flow from the left to the right ventricle.
• The primary septal defect is located in the lower third of the interatrial septum above the valves between the atria and ventricles. In some cases, the pathology extends to the valves, which cease to function normally.
• The secondary defect of the septum is formed in its upper part. The opening connects the upper atria. At the same time, pathologies of the formation of the superior vena cava can be observed.

Coarctation and stenosis of the aorta

Coarctation of the aorta is a congenital developmental pathology that manifests itself as complete or partial closure of the lumen of the aorta on its isthmus or in the thoracic and abdominal regions. Objectively, it is a congenital vascular defect in which the heart develops normally. Its classification as a congenital heart disease is explained by a deviation in the dynamics of the cardiovascular system, and the closure of the aorta develops simultaneously with other defects in the structure of the heart.

The localization of closure is known - this is the area of ​​transition of the aortic arch into the downward part of the vessel. This location is explained by the natural decrease in the lumen of the vessel on the arch.

Distinguishes between "adult" or "child" type of pathology. In the first case, the narrowing of the vessel occurs below the branch of the left subclavian artery with a closed arterial duct. In the second, the ductus arteriosus is not closed.

There are also 3 types of coarctation caused by anatomical features:

• Isolated - unaccompanied by other heart pathologies;
• Combined with an open ductus arteriosus - postductal, juxtaductal, preductal.
• Accompanied by congenital heart diseases - ASD, VSD, etc.

Aortic stenosis is a narrowing (thickening of the walls) of a vessel near the aortic valve. Because of it, blood flow from the left ventricle slows down. This anomaly is accompanied by a mitral valve defect. The disease is congenital or acquired. Congenital abnormalities are found after birth or at an older age.

Pulmonary artery stenosis

This is a congenital heart disease, manifested in the overgrowth of the pulmonary artery. Narrowing the lumen of the vessel slows down blood flow and raises the load on the ventricle. As a result, ventricular hypertrophy with hemodynamic deviations develops.

There are several types of arterial stenosis:

• valvular — the constriction is adjacent to the valve of the right ventricle. It is caused by a defect in the valve;
• subvalvular - narrowing in the right ventricle;
• supravalve - constriction below the valve.

Stenosis types 1 and 3 are sometimes accompanied by VSD.

Patent ductus arteriosus

This is a congenital pathology of the development of the heart, in which there is a communication between the pulmonary artery and the aorta along the botall's vessel. In a normal state, its overgrowth occurs in the first 2-4 months. With such an anomaly, arterial and venous blood is mixed, which leads to an increase in the load on the ventricle and pressure in the pulmonary circle.

Transposition of great vessels

This pathology of the cardiovascular system is determined by a change in the location of the main vessels. In this case, the aorta with the pulmonary artery changes position. During transposition, they are located in parallel, and in the normal state they should intersect. Abnormal vascular displacement is a congenital blue-type heart defect that requires immediate surgery.

There are two types of transposition:

• with normal pulmonary blood flow. May be accompanied by ASD, VSD, open ductus arteriosus;
• with a decrease in pulmonary blood flow. It may be accompanied by a narrowing of the pulmonary artery or its combination with PSMG.

Causes of congenital heart defects

The reason for the development of congenital heart disease in newborns is:

• Chromosomal pathology;
• Mutational deformation of genes;
• The impact of external factors;
• Polygenic multifactorial predisposition.

All kinds of deviations in chromosomes lead to an abnormal development of their structure and quantity. This provokes numerous polysystem pathologies of the formation of the body, for example, congenital heart defects. The appearance of an additional chromosome in a pair leads to the development of the following deviations - defects of the interventricular and interatrial septa or their various combinations. Sex chromosome abnormalities lead to openings in the interventricular septum or narrowing of the aortic lumen.

Of the factors of the harmful effects of the environment, special attention should be paid to viral diseases that are dangerous for pregnant women, radiation exposure, the use of specific drugs, bad habits and work in harmful conditions. They are the cause of congenital heart defects in newborns, especially if they are present before the 20th week of intrauterine development, when the internal organs are laid. Particularly dangerous are: rubella, herpes, tuberculosis, cytomegaly, toxoplasmosis and others.

Classification of congenital heart defects

In practice, methods of classifying congenital heart defects based on hemodynamic pathology are used. Given its effect on the pulmonary circulation, congenital heart defects are classified:

• with slight deviations in the pulmonary circulation - congenital mitral valve defect of the heart, overgrowth of the aortic valve, deficiency of the pulmonary valve, etc.
• with an increase in blood flow without cyanosis - an unclosed arterial duct, aorto-pulmonary fistula, VSD, ASD and others.
• with insufficient blood flow without cyanosis - narrowing of the pulmonary artery, with the development of cyanosis - Fallot's, Ebstein's disease, underdevelopment of the right ventricle.
• with impaired connections between the parts of the heart and the main vessels - displacement of the arteries, a single arterial trunk, deviation of the aorta and pulmonary trunk from the ventricle, Taussing-Bing disease, etc.

• "Blue" congenital heart defects - the triad or tetrad of Fallot, clogging of the tricuspid valve, displacement of the main vessels. Blue lips and nail plates are characteristic.
• "Pale" type of congenital malformation with arteriovenous discharge - unclosed arterial duct. The symptom is pallor of the skin.
• The formation of an obstacle in the path of blood flow - the closure of the lumen of the aorta.

According to statistics, more than 50% of children die without the necessary treatment before the age of one year. Early diagnosis and timely intervention can significantly reduce the mortality rate.

Symptoms

The symptomatology of congenital heart disease is very diverse, and it can be easily confused with some other ailments of the body. It is not at all necessary that congenital heart disease will manifest itself immediately after birth. Often there is a case when ultrasound devices fail to determine this defect in the development of a young heart during pregnancy. A child born into the world can please parents for some time, who will not even guess about the baby's discomfort.

Symptoms of congenital heart disease in newborns.

The main symptom at such an early age is heart murmur. At this stage of life, only timely visits to the pediatrician will help determine it. With careful listening to the heart, an experienced doctor can easily diagnose signs of congenital heart disease. Also, mothers should observe the color of the child's skin. As a rule, due to insufficient active blood circulation and oxygen saturation, the skin may acquire a pale, and in some cases even bluish tint. Other symptoms of congenital heart disease include lethargy and palpitations. Nursing mothers should pay attention to the baby's appetite. If the newborn frequently spits up and does not suckle well, consult a specialist immediately. However, the most noticeable sign of congenital heart disease is crying. In the first days of life, children are often capricious, since their body is just getting ready for stable work, but if the baby starts to turn blue at the same time, this should already be a wake-up call.

Symptoms of congenital heart disease in children.

The main symptoms of congenital heart disease can appear only at the age of two. The most noticeable sign of heart disease in children is shortness of breath, and strong physical activity is not at all necessary. It is enough for a kid to just tell a rhyme or chat for a while to feel the lack of air.

At the stage from 8 to 12 years old, a child may show such a sign of a congenital heart defect as frequent headaches. As a rule, they are accompanied by weakness and dizziness and even fainting, especially in exciting or emergency situations, so you should not expose the child to emotional stress and changes. It is also worth paying attention to the child's complaints. Too frequent heart and pulse rhythms are just a few concomitant signs of the disease. In addition to the general picture of ailment, periodic pains of the heart, abdomen and the entire lower body as a whole may also be added. As a result of these symptoms, even a delay in mental and physical development (both of the whole organism and of individual organs) is possible. Most often, the growth and development of the limbs of the body, both bone and soft muscle tissues, freeze partially or completely.

Symptoms of congenital heart disease in adolescents.

According to the symptoms of congenital heart disease, it is possible to determine the disease not only in a baby, but also in a teenager. As a rule, the main difference in the patient's appearance is the blue discoloration of the skin around the mouth. In some cases, the blueness can spread to the ears and nose. The fingers and toes are also blue. In addition, the outer phalanges thicken, and the nail plates become almost round. This symptom is usually called the syndrome of "watch glasses" or "drumsticks".

Unreasonable swelling of the feet and legs can also indicate disturbances in the work of the heart.

However, the external difference is not the only sign of congenital heart disease. It is worth paying attention to human behavior. As a rule, people with such ailment are rarely "ringleaders". Most often these are inactive phlegmatic adolescents. They prefer a quiet rest in the shade to outdoor games.

Symptoms of congenital heart disease in an adult.

An adult with symptoms of congenital heart disease can also be recognized by such a sign as a "hump of the heart". It is customary to call this concept a change in the volume of the chest upward.

A person with congenital heart disease should constantly monitor the level of hemoglobin. As a rule, such people have it above the norm.

There is another symptom that is characteristic of all ages and categories - this is susceptibility to viral lung diseases. Pulmonary diseases will haunt a person at all stages of his life until surgery occurs and congenital heart disease is eliminated.

In other words: whoever you are, an adult or a toddler, you should not overestimate your health. Listen to your body and pay attention to changes in it, because it may be a symptom of a particular disease.

Diagnostics

Nowadays, it is possible to identify congenital heart defects even during the intrauterine development of the fetus. The traditional method of examination at this stage is an ultrasound examination of the fetus. The doctor pays attention to the position of the heart, the symmetry and size of the heart chambers with valves, the distance between the main vessels and their direction. If a pathology is detected, the pregnant woman is sent for a specialized fetal echocardiography. It allows you to identify only a certain number of heart defects: disorders that change the size of the heart chambers, defects in the septa between the chambers of the heart, transposition of the main arteries. For various reasons, not all heart defects can be detected at the stage of intrauterine development.

Methods for the diagnosis of congenital heart defects

Medical examination

At the birth of a child, the primary diagnosis is made when the child is examined by a pediatrician or pediatric cardiologist. The doctor performs auscultation (listening) of the heart and lungs, which makes it possible to identify murmurs - extraneous sounds that differ from the rhythm of the heartbeat. Also, a specialist can identify violations by external signs: the color of the skin, the shape of the chest, the inconsistency of height and weight with age norms, shortness of breath, rapid breathing.

If deviations from the norm are detected, the child is sent for additional examinations. Some particularly serious and life-threatening congenital heart defects appear in the first hours of life. Less serious disorders are diagnosed during the first years of life, when complications appear against the background of circulatory disorders. And some defects that do not pose a great danger are revealed only at a fairly adult age during preventive examinations. It all depends on the type of heart disease and the compensatory abilities of the body.

Additional research methods

• Echocardiography. Echocardiography, carried out for an already born child, allows you to see a more accurate picture of the structure of the heart, identify defects and anomalies in it, evaluate the work of the heart, and measure the diameter of the great vessels. And when using Doppler devices, you can also assess the speed and direction of blood flow in the vessels and the heart itself.
• Electrocardiography. Electrocardiography records the work of the heart, allows you to diagnose irregularities in the rhythm and conduction. By the electrocardiogram, one can judge the presence of an increase in the chambers of the heart, which may be a consequence of the development of an organ defect.
• Blood chemistry. A biochemical blood test helps to assess the dysfunction of other organs in the development of heart disease.
• Chest X-ray. To determine the change in the shape of the heart, its size and the ratio of these sizes to the volume of the chest, an X-ray examination of the chest cavity organs is used. Also, an x-ray allows you to identify stagnation of fluid in the lungs, which is a sign of a number of congenital defects. This study can be supplemented by the introduction of contrast agents through femoral artery catheterization (angiography, ventriculography). As a result, you can see the shape of the heart and blood vessels, assess their patency, and identify narrowing (stenosis). Through this catheter, it is possible to insert a sensor that estimates the blood pressure in the cavity of the heart and blood vessels. It is also possible to take blood, by analysis of which it is possible to reveal whether there is mixing of venous and arterial blood, which indicates the presence of pathological formations connecting the structures of the heart.
• Pulse oximetry. Pulse oximetry is done to assess oxygen saturation in the blood. For this, a special sensor is used, which is put on the finger. Information from it is transmitted to a device that calculates the oxygen concentration in the erythrocyte.
• Magnetic resonance imaging. Magnetic resonance imaging allows to create a volumetric image of the heart, to reveal the location and nature of the heart defect.

This disease is the most common intrauterine abnormality in children. Therefore, parents faced with this problem ask themselves whether congenital heart disease can be treated?

Some complex heart defects are diagnosed in newborns immediately in the hospital. In this regard, instead of being discharged, the child is sent to the cardiology department. Treatment methods and patient care will depend on the severity and complexity of the disease. The clinical picture with such a diagnosis is always different.

Treatment of congenital heart defects in children

Treatment is aimed at improving the patient's condition, correcting defects in the cardiac cavity, so that the child in the future can lead a normal life, that is, to achieve the optimal level of the patient's quality of life.

Depending on the patient's age, he will be observed by a pediatrician, pediatric cardiologist, in adulthood - by an ordinary cardiologist.

It is possible to completely heal some heart defects with the help of surgery. Operations are performed by cardiac surgeons: both in the first days of a child's life and during the first year of life. If patent ductus arteriosus is diagnosed, in the absence of life-threatening symptoms, expectant tactics are possible. There is a possibility of spontaneous closure of the defect in the first two years of a child's life.

During cardiac surgery, the chest wall is dissected or a probe is inserted into the vessels.

Unfortunately, when diagnosing a three-chambered heart (characterized by the presence of one atrium and two ventricles, or two atria and one ventricle), surgical intervention is impossible. Such a vice is incompatible with life.

The treatment process includes not only surgical correction, but also therapeutic methods.

Therapeutic methods in the treatment of congenital heart defects are aimed at strengthening the heart muscle and ensuring a normal blood supply. Therapeutic treatment methods:

• drug therapy (taking medications);
• physiotherapy procedures (therapeutic massage, small physical activity).

Surgical treatment of congenital heart defects is aimed at eliminating the developed defects in the heart. Surgical treatment methods:

• removal and replacement of damaged valves;
• connection of areas of the heart muscle;
• installation of a pacemaker;
• transplantation.

Therapeutic treatment

The basis of this treatment is the regular intake of medications prescribed by a doctor. Most often, a cardiologist prescribes the following drugs:

vasodilators;

nootropic;

heart;

diuretics;

hypotensive;

vitamins.

The period of taking medication depends on the severity of the disease. The action of medicines helps to lower blood pressure, normalize brain function, improve blood circulation in the heart arteries, and increase immunity.

Important!

The dosage of drugs and the duration of the course should be prescribed by a cardiologist. Otherwise, self-medication can provoke a deterioration in the patient's condition, as well as the development of complications.

Medicines

Congenital heart disease is a very serious disease, which in its absolute majority can be cured only by surgery.

Some patients with congenital heart disease do not need to take medication (for example, with a diagnosis such as a ventricular septal defect). With such a defect, treatment is usually not indicated. In such cases, the doctor recommends reduced physical activity and preventive measures.

The rest of the patients with congenital heart disease take medications (mostly of the supportive type). The following groups of drugs are used:

• Diuretics - for fluid regulation of the body. They are used for heart failure.
• Cardiac glycosides - to increase the energy of the heart.
• Vasodilators - to facilitate the work of the heart by dilating blood vessels.
• Antiarrhythmic drugs - used in cases where the patient has an uneven heartbeat.
• Antibiotics - used to prevent the occurrence of endocarditis.
• Prostaglandin inhibitors - to increase blood flow to the lungs and to improve blood flow throughout the body.

Medication is often used as a supportive agent (both before and after surgery). Some patients with heart defects that do not completely correct even after surgery are forced to use supportive drugs for a long time (and sometimes throughout their life).

• Antibiotics can be used before surgery that is not related to the underlying disease (for example, in dentistry and other side operations). These drugs are prescribed to prevent the occurrence of endocarditis.
• Anticoagulants are mainly used after surgery - when there is a possibility of blood clots. For this, aspirin can be used in small doses, or the more effective remedy is warfarin.

As a radical remedy, drugs are rarely used to treat congenital heart defects. And only with the appointment of the attending physician.

Medicines for heart disease are very powerful and must be used with great care. This is especially true for children who receive medicines from their parents' hands. It is absolutely necessary to know exactly what remedy should be given to the child, in what dosage and at what time. Improper reception can be very dangerous for a child.

In any case, drugs for the treatment of congenital heart disease should be prescribed by a doctor, and only a doctor! This disease is so serious that self-medication is simply unacceptable.

Folk remedies

If we are dealing with such a type of heart defect as cardiac enlargement, then it is imperative to follow the following general rules: it is necessary to reduce the amount of food, remove the afternoon nap, and also be sure to regularly walk in the fresh air. It is necessary to minimize water intake and quench your thirst with special valerian tea and milk.

In folk medicine, the following remedies are known that are used for congenital heart defects:

• Lily of the valley drops. To prepare them, you need a jar with a small neck, in which you need to place fresh buds or lily of the valley flowers. After that, you should fill them almost completely with alcohol and let it brew.
• Lily of the valley infusion is made by mixing flowers and boiling water. The infusion must be infused for about an hour, and it is used approximately every couple of hours.
• Motherwort drops (with the addition of lily of the valley tincture) have a number of positive properties useful for patients with heart disease. To make these drops, you will need to mix the herbal infusion with drops of lily of the valley tincture.
• Red wine with the addition of rosemary is also considered a faithful folk remedy. Such a medicine is pre-insisted, avoiding direct sunlight, and shaken from time to time. Before use, the resulting drug is cleaned, and the treatment period is at least a couple of months. To increase the effectiveness of such treatment, it is repeated several times during the year.
• In the case when the defect is associated with the appearance of shortness of breath, a gruel is made, the ingredients of which are nettle leaves and honey in approximately equal proportions. The resulting mixture is insisted, stirring the contents from time to time. At the final stage of manufacturing, the mixture is heated over steam to the state of liquid water, and then filtered through a bandage or gauze. Store this drug only in a cool place (preferably in the refrigerator). To achieve positive results of such treatment, the mixture is taken for about a month.

Do not forget that such methods are mostly rejected by traditional medicine, and their use must necessarily be agreed with the attending physician.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, see your doctor.

Congenital heart defects occur during the prenatal period of the child's development. Anatomically, they are anomalies in the formation and growth of the heart and its structural elements - muscular septa between chambers, valve cusps between the cavities of the ventricles and atria, aorta and pulmonary artery.

The data obtained from different sources regarding the incidence of this type of pathology differ from each other. Some authors claim about 5-10 cases of defects per 100 newborns, others - about 1 in 300.

Note:the prognosis of the disease depends on the type of defect and the timing of the start of radical treatment. Some types of disease are recognized by chance during a medical examination. Without treatment, such patients live to old age.

About 30 percent of patients with a defect cannot be saved due to the severity of the disease. The rest can be cured by early surgery. In addition to the risk of possible complications, their high cost is considered a negative aspect of surgical interventions. Simply, not all patients and their relatives have the financial opportunity to afford such an expensive type of treatment as cardiac surgery.

Video "Congenital heart defects in a child":

Predisposing conditions and causes of congenital heart defects

Pathologies arise as a result of hereditary predisposition and exposure to harmful environmental conditions, infectious diseases, bad habits of a pregnant woman, while taking certain medications. Congenital heart defects in children are often the result of the damaging effect of these causes in the first trimester of pregnancy.

The risk of a child developing one of the variants of a congenital defect increases when the pregnant woman is less than 17 years old and in the category over 40. The disease also develops in cases of burdened heredity. If there were cases of vices in the family, then the probability of their occurrence among the heirs is quite high.

Endocrine diseases of the mother are considered to be a contributing factor in the formation of a defect in the fetus:

• diabetes;
• thyrotoxicosis and other diseases;
• adrenal pathology;
• pituitary neoplasms.

Infectious diseases can become the cause of defects:

• measles;
• some types;
• systemic connective tissue diseases (lupus);
• household and industrial poisons, various types of radiation;
• pathological habits (alcohol consumption, smoking, uncontrolled intake of medications, drugs, etc.)

Joint systematization of vices

The most important criterion by which a congenital malformation should be assessed is the state of blood circulation (hemodynamics), especially its effect on the blood flow of the pulmonary circulation.

This property divides vices into 4 main groups:

• defects that do not entail a change in blood flow in the pulmonary circulation (ICC);
• vices that increase pressure in the ICC;
• pathologies that reduce blood flow in the ICC;
• combined violations.

Defects that do not cause changes in blood flow in the ICC:

• abnormal options for the location of the heart;
• atypical position of the aortic arch;
• coarctation of the aorta;
• varying degrees of narrowing of the aorta;
• atresia (specific narrowing of the tricuspid aortic valve itself);
• pulmonary valve insufficiency;
• mitral stenosis (narrowing of the so-called mitral valve, which allows blood to flow from the left atrium to the left ventricle);
• insufficiency of the mitral valve with atresia (expressed in incomplete closure of the valve cusps, which provokes a reverse flow of blood from the ventricle into the atrium during systole;
• a heart with three atria;
• defects of the coronary arteries and the conducting system.

Defects provoking an increase in pressure and blood flow in the ICC:

• not accompanied by cyanosis(cyanosis) - open (open) arterial (botalov) duct, defect of the septum between the atria, defect of the septum between the ventricles, Lutembashe complex (congenital narrowing of the opening between the left atrium and the left ventricle and a defect of the septum between the atria), fistula between the aorta and the pulmonary artery, children's coarctation;
• with cyanosis- atresia of the tricuspid valve and narrowing of the opening in the septum between the ventricles, open botallic duct, which provides a return flow of blood into the aorta from the pulmonary artery.

Defects causing a decrease in blood circulation (hypovolemia) in the ICC:

• narrowing (stenosis) of the pulmonary artery (trunk) without blue discoloration (cyanosis);
• with blue discoloration (cyanosis) - triad, tetrad, pentad of Fallot, atresia of the tricuspid valve with stenosis of the pulmonary artery. Anomaly (disease) of Ebstein, accompanied by "failure" of the tricuspid valve leaflets into the right ventricular cavity, underdevelopment (hypoplasia) of the right ventricle.

Combined defects that form due to the anatomically atypical location of blood vessels and cardiac structures:

• transposition of the artery of the lung and the aorta (the aorta departs from the right ventricle, and the pulmonary trunk from the left);
• discharge of the aorta and the trunk of the pulmonary artery from one ventricle (right, or left). Can be complete, partial with different options;
• Taussig-Bing syndrome, a combination of a high interventricular septal defect with aortic transposition, left pulmonary trunk and right ventricular hypertrophy, a common vascular trunk, a heart consisting of three chambers with one ventricle.

note:the main types and groups of defects are listed. In fact, there are more than a hundred of them. Each vice is individual in its own way. Also specific is the diagnosis, examination and treatment methods, which we will talk about below.

How long do patients with congenital heart disease live?

The duration and quality of life depends on the type of defect and its severity. With some vices, people live to old age, with others, death occurs during the first year of life. The main problem is late surgical treatment. Unfortunately, the cost of heart surgery is very high and, in the absence of material resources, not all patients can afford it. The problem is also complemented by the lack of medical personnel and hospitals working in this area.

How to identify a congenital heart disease?

Complex heart defects are determined in newborns even in utero. At an older age, mild degrees of congenital heart disease can be detected, which are in a compensated state and are not felt by patients in any way. The first to determine the existing congenital defect can be ultrasound specialists who are examining a pregnant woman.

The study of the heart consists of a set of diagnostic methods, including:

• examination of the patient... At this stage of diagnosing a congenital defect, the appearance, physique, and color of the skin are assessed. Already on the basis of the results obtained, one can suspect the presence of a disease;
• listening to heart valves(auscultation). By the presence of extraneous noises and splitting tones, it is possible to determine the variant of the existing heart defect in a child and an adult;
• finger tapping of the chest(percussion). This method allows you to determine the boundaries of the heart, its size.

In outpatient and hospital conditions, the following are used:

• electrocardiography;
• Doppler echocardiographic examination;
• Ultrasound of the heart and blood vessels;
• laboratory types of diagnostics to determine the presence of existing complications;
• angiographic techniques.

Complaints and symptoms of congenital heart disease

The manifestations of the disease depend on the type of defect and the severity. Symptoms can be detected immediately after the birth of a child, and sometimes in different age groups: in adolescents, at a young age and even in elderly patients who have not been examined before and have a compensated, mild form of congenital defect.

Patients most often have the following complaints:

• , interruptions and palpitations;
• "Stagnant" phenomena in which there is an accumulation of blood in certain organs and parts of the body. Due to the inability of the heart to perform the function of a "pump" appears pallor or cyanosis of the skin, acrocyanosis (cyanosis of the fingers, nasolabial triangle), the formation of a chest protrusion (heart hump). There are attacks of shortness of breath, fainting, weakness, dizziness, general physical weakness, up to the inability to move. There is an increase in the liver, swelling, accumulation of stagnant fluid in the abdominal cavity, between the membranes of the pleura, cough with expectoration of sputum, sometimes mixed with blood, shortness of breath;
• symptoms of oxygen starvation of tissues, causing physical underdevelopment, metabolic disorders (fingers resembling drumsticks, nails in appearance similar to watch glasses).

As a rule, the development of a congenital defect occurs in three phases:

• Phase I - adaptation of the body. With a minor defect, minor symptoms of the disease are also observed. Serious defects lead to the rapid formation of signs of cardiac decompensation.
• Phase II - compensatory, which includes all the protective reserves of the body and is invariably accompanied by an improvement in the general condition of the patient.
• III phase - terminal, caused by the depletion of internal reserves of the body and the development of incurable pathologies and formidable symptoms of circulatory disorders

Treatments for congenital heart disease

A person can live his whole life with mild vices. But the severe ones are subject to compulsory surgical treatment, otherwise it will be a big problem to live with a congenital heart defect even to adulthood.

What types of treatments are applicable:

• medicinal(conservative). Its purpose is to reduce the phenomena of chronic heart failure, to prepare the patient for surgery;
• surgical. The only method that enables the patient to live. The operation can be carried out on an emergency basis, if there is a momentary threat to the patient's life, or as planned.

A certain time is prepared for planned surgical interventions, which is necessary to improve the patient's well-being, to increase the resistance to infections.

The choice of treatment method largely depends both on the type of congenital malformation present and on the phase of development it is in. As a rule, in the first phase of the disease, surgery is prescribed only if there are symptoms that threaten the patient's life. The patient is shown limiting physical and mental stress, monitoring his condition, proper nutrition, emotional peace.

With the development of stage II, the entire treatment process is aimed at keeping the patient's condition in the compensatory phase. If necessary, prescribe drug treatment, carry out planned operations.

III phase of the disease is a period of a sharp deterioration in the condition, the appearance of severe symptoms of heart failure. The main treatment for this phase of congenital malformation is taking medications to improve heart function.

Can be assigned:

• cardiac glycosides, which provide increased heart rate;
• diuretics that remove excess fluid from the body;
• vasodilators that dilate blood vessels;
• prostanglandins (or their inhibitors), which improve blood flow to the lungs and other organs and systems;
• antiarrhythmic drugs.

Surgical intervention at this stage is extremely rare, due to the extremely poor general condition of the patient.

Important: in the presence of a serious defect, surgical treatment should be carried out as early as possible, which reduces the risk of complications and avoids serious changes in the functioning of organs caused by the consequences of the defect.

Often, when treating congenital heart defects, two-stage operations are used. Especially when it comes to a patient in a decompensated state. The first stage is facilitating operation(palliative), which, with a small amount of trauma, makes it possible to improve the patient's well-being and prepare him for the next stage.

Radical operation allows you to completely eliminate the defect and related consequences.

In this case, several types of operations can be applied:

• X-ray surgical interventions- low-trauma operations, implying the introduction of specially folded tubes and a balloon into the heart cavity through the vessels, which, if necessary, can both increase the lumen of the vessel, apply "patches" to pathological openings or create missing "holes", remove valve stenosis.
• Closed operations- operations without opening the cardio cavity. With this method, the revision and loosening of stenoses is performed with the surgeon's fingers or with a special instrument, and the doctor enters half of the heart through the atrial ears.
• Open operations- operations involving the temporary shutdown of pulmonary and cardiac activity, transfer of the patient to a heart-lung machine, subsequent opening of the cardiac cavity and elimination of existing defects

In cases where the operation cannot eliminate the congenital defect, and the patient's condition is very serious, a heart transplant can be used.

Modern technologies sometimes make it possible to perform an operation and eliminate a congenital malformation even at the stage of intrauterine development.

Video "Surgical treatment of congenital malformation":

What are the complications of congenital heart defects?

The consequences of an untreated defect can be as follows:

• acute and chronic heart failure;
• infectious toxic endocarditis (inflammatory process in the endocardium - the inner cardiac membrane);
• cerebral circulation disorders;
• caused by insufficient blood supply to the heart muscle;
• heart failure.

Prophylaxis

Prevention of congenital malformations includes preparing a pregnant woman for childbirth, excluding bad habits, good nutrition, walks, careful use of medications, avoiding foci of measles rubella, and treatment of concomitant diseases.

Data on the most common types of congenital heart defects

Ventricular septal defect- occurs very often. In severe cases, the septum is completely absent. With this pathology, oxygen-enriched blood from the cavity of the left ventricle enters the right ventricle in portions. Its accumulation leads to an increase in blood pressure in the pulmonary circle. The defect in children is gradually increasing. Patients look lethargic, pale, and cyanosis appears with exertion. When listening to the heart, specific murmurs appear. Without treatment, babies develop severe deficiency, and they die in early childhood. The operation involves suturing holes, or applying patches of plastic materials.

Atrial septal defect - a common type of defect in which the increased pressure created in the right atrium is well compensated. Therefore, non-operated patients can live to adulthood. The operation removes the defect as well as in the case of problems in the interventricular septum – suturing or patches.

Non-clogging of the arterial (botallic) duct - Normally, after birth, the duct that connected the aorta and the pulmonary artery in the developing fetus collapses. Failure to clog it contributes to the discharge of blood from the aorta into the lumen of the pulmonary trunk. There is an increase in pressure and an excess of blood in the pulmonary circle of the circulatory cycle, which causes a sharply increasing load on both ventricles of the heart. Treatment consists of ligating the duct.

Stepanenko Vladimir, surgeon