DChildren's diseases are generally a very difficult topic. It is even more difficult to talk about serious illnesses that threaten the health, and sometimes the life of the little man. It is these pathologies that include a large group of diseases, united by the name of congenital heart disease. However, it is necessary to talk about this - this is necessary, first of all, for those parents whose children were born with congenital heart disease, and for those women who are at risk of having children with such a disease. People who are faced with this disease need to know both its causes and characteristics of the course, and the methods of treatment. The modern level of development of medicine allows mankind to cope with many previously incurable ailments - the main thing, faced with a serious illness, is not to give up, but to fight. And first of all, a clear idea of the nature of the disease and an understanding of the meaning of certain medical manipulations... That is why, I think, this article, which may seem "too medical" and special to someone, is necessary not for professionals, but for parents.
What is congenital heart disease?
Congenital heart disease (CHD) is an anatomical change in the structures of the heart. CHD occurs in 8-10 out of 1000 children. V last years this figure is growing (mainly due to improved diagnostics and, accordingly, an increase in the frequency of cases of CHD recognition).
Heart defects are very diverse. Allocate defects "blue" (accompanied by cyanosis, or cyanosis) and "pale" type (pale skin). More dangerous are defects of the "blue" type, since they are accompanied by a decrease in blood oxygen saturation. Examples of "blue" type of defects are: serious illnesses like Fallot's tetrad 1
, transposition of great vessels 2
, pulmonary atresia 3
, and defects of the "pale" type - atrial septal defect, ventricular septal defect 4
other.
Vices are also subdivided into ductus-dependent (from lat. ductus- duct, i.e. compensated by the patent ductus arteriosus) and ductus-independent (in this case, the patent ductus arteriosus, on the contrary, interferes with the compensation of blood circulation). The former includes, for example, Fallot's tetrad, the latter - a defect of the interventricular septum. The relationship between the CHD and the patent ductus arteriosus determines the prognosis, the timing of the development of decompensation ( defense mechanisms) and principles of treatment.
In addition, the CHD includes the so-called valvular defects - pathology of the aortic valve and valve pulmonary artery 5
... Valvular defects can be associated with underdevelopment of the valve leaflets or with their adhesion as a result of intrauterine transferred inflammatory process... Such conditions can be corrected with the help of gentle operations, when the instruments are brought to the valve through large vessels flowing into the heart, that is, without cutting the heart itself.
What are the causes of CHD?
The formation of the heart occurs at 2-8 weeks of pregnancy, and it is during this period that defects develop. They can be hereditary, or they can arise under the influence negative factors... Sometimes CHD are combined with malformations of other organs, being a component of some hereditary syndromes (fetal alcohol syndrome, Down syndrome, etc.).
The risk groups for having a child with CHD include women:
with a history of spontaneous abortions (miscarriages) and stillbirths;
over 35 years old;
smoked and drank alcohol during pregnancy;
in families whose CHD is noted as hereditary disease, i.e. either they themselves or their relatives have CHD; this also includes cases of stillbirths in the family and other anomalies;
living in ecologically unfavorable areas;
suffered during pregnancy infectious diseases(especially rubella);
have used certain medications during pregnancy, such as sulfa drugs, some antibiotics, aspirin.
Prenatal diagnosis of congenital heart disease
It is difficult to overestimate the importance of prenatal (i.e. prenatal) diagnosis of CHD. Although many defects are radically treated with surgery in the first days of life, some do not require surgical intervention, there are a number of situations when a child will have a large number of life-saving operations up to a heart transplant. Such a child is literally chained to hospital bed, its growth and development are disrupted, social adaptation is limited.
Fortunately, it is possible to predict the birth of a child with CHD. For this every woman must undergo an ultrasound examination of the fetus from the 14th week of pregnancy. Unfortunately, the information content of this method depends on the qualifications of the doctor performing the study. Not every ultrasound specialist in antenatal clinics is able to recognize CHD, and even more so its type. However, he is obliged on the basis of the relevant signs to suspect him and at the slightest doubt, as well as if a woman belongs to one or more of the above risk groups, send the pregnant woman to a specialized institution, whose doctors are specifically engaged in diagnostics congenital diseases hearts.
When CHD is detected in the fetus, the parents receive information about the child's supposed viability, the severity of his pathology, and the forthcoming treatment. In this situation, the woman has the opportunity to terminate the pregnancy. If she decides to give birth to this child, childbirth takes place in a specialized hospital under the close supervision of specialists, and the child is operated on as soon as possible. In addition, in some cases, the mother begins to take certain medications even before childbirth, which, penetrating the placental barrier to the baby, will "support" his circulatory system until delivery.
What allows the doctor to suspect CHD in a newborn?
There are a number of signs that suggest that a child has a CHD immediately or a few days after birth.
1. Heart murmurs arising when the normal blood flow is disrupted (blood either passes through abnormal openings, or meets narrowings in its path, or changes direction) - that is, pressure drops are formed between the cavities of the heart and turbulent (vortex) flows are formed instead of a linear blood flow. However, in children of the first days of life, murmurs are not a reliable sign of CHD. Due to the high pulmonary resistance during this period, the pressure in all cavities of the heart remains the same, and the blood flows through them smoothly, without creating noise. The doctor can hear noises only for 2-3 days, but even then they cannot be considered as unconditional sign of pathology if you remember about the presence of fetal messages. Thus, if an adult has a heart murmur, it almost always indicates presence of pathology, in newborns they become diagnostically significant only in combination with other clinical manifestations. However, a child with noises must be observed. If the murmurs persist after 4-5 days, the doctor may suspect CHD.
2. Cyanosis, or cyanosis of the skin. Depending on the type of defect, the blood is more or less depleted in oxygen, which creates a characteristic color of the skin. Cyanosis is a manifestation of not only pathology from the heart and blood vessels. It also occurs in diseases respiratory organs, central nervous system... There are a number of diagnostic techniques to determine the origin of cyanosis.
3. Heart failure. Heart failure is understood as a condition resulting from a decrease in the pumping function of the heart. Blood stagnates in the venous bed, and the arterial blood supply to organs and tissues decreases. With CHD, the cause of heart failure is the overload of various parts of the heart with abnormal blood flows. It is quite difficult to recognize the presence of heart failure in a newborn, since its classic signs such as increased heart rate, respiratory rate, enlarged liver, swelling are generally characteristic of the state of the newborn. Only being overly pronounced can these symptoms be signs of heart failure.
4. Spasm peripheral vessels.
Usually a spasm of peripheral vessels is manifested by pallor and coldness of the extremities, the tip of the nose. It develops as a compensatory response in heart failure.
5. Violations of the characteristics of the electrical activity of the heart (rhythm and conduction). The doctor can determine them either by auscultation (using a phonendoscope) or by an electrocardiogram.
What can allow parents to suspect a child of CHD?
Severe heart defects are usually recognized already in the maternity hospital. However, if the pathology is implicit, the child can be discharged home. What can parents notice? If the child is lethargic, does not suck well, often spits up, turns blue when screaming or at the time of feeding, his heart rate is higher than 150 beats / min., Then you definitely need to pay the attention of the pediatrician.
How is the diagnosis of CHD confirmed?
If the doctor suspects that the child has a heart defect, the main method of instrumental diagnostics is an ultrasound examination of the heart, or echocardiogram... The doctor will see on his monitor the anatomical structure of the heart, the thickness of its walls and partitions, the size of the heart chambers, the location of large vessels. In addition, ultrasound can determine the intensity and direction of intracardiac blood flows.
In addition to ultrasound, a child with suspected CHD will undergo electrocardiogram... It will allow you to determine the presence of rhythm and conduction disturbances, overload of any parts of the heart and other parameters of its work.
Phonocardiogram(PCG) allows you to register heart murmurs with a high degree of accuracy, but it is used less often.
Unfortunately, it is not always possible to establish an accurate diagnosis of CHD using these techniques. In such cases, to clarify the diagnosis, one has to resort to the help of invasive examination methods, which include transvenous and transarterial intubation... The essence of the technique is that a catheter is inserted into the heart and great vessels, with the help of which the pressure in the cavities of the heart is measured and a special radiopaque substance is injected. At this time, X-rays are recorded on film, as a result of which a detailed image of the internal structure of the heart and great vessels can be obtained.
Congenital heart defect - not a sentence!
Congenital heart defects are mostly treated with surgery. Most of the CHD are operated on in the first days of a child's life, and in the further growth and development, he is no different from other children. To perform heart surgery, it must be stopped. To do this, under conditions of intravenous or inhalation anesthesia, the patient is connected to a heart-lung machine (AIC). During the operation, the AIK takes over the functions of the lungs and heart, i.e. enriches the blood with oxygen and carries it throughout the body to all organs, which allows them to function normally during execution surgical intervention on the heart. Alternative method is deep cooling of the body (in-depth hypothermic protection - UGZ), during which the need of organs for oxygen decreases several times, which also allows you to stop the heart and perform the main stage of the operation.
However, it is not always possible to make a radical correction of the defect, and in this case, first a palliative (facilitating) operation is performed, and then a series of interventions until the defect is completely eliminated. The earlier the operation was performed, the more chances the child has for a full life and development. There are often cases when a radical operation performed in the shortest possible time allows you to forget about the existence of a defect forever. As for drug treatment, its goal is to eliminate not the defects themselves, but their complications: rhythm and conduction disturbances, heart failure, malnutrition of organs and tissues. After the operation, the child will be recommended restorative treatment and a protective regime with mandatory dispensary supervision... In later life, such children should not attend sports sections, at school in the classroom physical culture they must be exempted from competition.
FEATURES OF BLOOD CIRCULATION OF FRUIT AND NEWBORNPlacental circulation. While in the womb, the fetus does not breathe on its own and its lungs do not function. Oxygenated blood enters it from the mother through the umbilical cord into the so-called venous duct, from where it enters the right atrium through the vascular system. Between the right and left atria, the fetus has a hole - an oval window through which blood enters the left atrium, from it - into the left ventricle and then into the aorta, from which branches of the vessels depart to all parts of the body and organs of the fetus.Thus, the blood bypasses the pulmonary artery without participating in the pulmonary circulation, the function of which in adults is to saturate the blood with oxygen in the lungs. In the fetus, blood still enters the lungs through the patent ductus arteriosus, which connects the aorta to the pulmonary artery. The ductus venosus, foramen ovale and ductus arteriosus are referred to as fetal messages, that is, they are available only in the fetus. Once the obstetrician cuts the umbilical cord, the fetal circulation changes dramatically. The beginning of the functioning of the small circle of blood circulation. With the first breath of the child, his lungs expand, and pulmonary resistance (pressure in the pulmonary vascular system) falls, creating conditions for the blood filling of the lungs, that is, the pulmonary circulation. Fetal messages lose their functional significance and gradually overgrow (the ductus venous - by the month of life, the oval window and the ductus arteriosus - by 2-3 months). If fetal messages continue to function after the specified periods, this is considered as the presence congenital heart disease. |
| 1 This defect includes four elements (hence the tetrad): stenosis (narrowing) of the pulmonary artery, ventricular septal defect, hypertrophy (enlargement) of the right ventricle, dextraposition of the aorta (displacement of the aortic opening to the right). 2 Transposition of great vessels is one of the most complex and severe "blue" heart defects. Differs in a wide variety of anatomical options, additional anomalies, early developing heart failure. 3 Pulmonary atresia is the absence of a lumen or opening at the level of the pulmonary artery valves. 4 This is the most common CHD (26% of all CHD). In this disease, there is a constant communication of the left and right ventricles through a defect in the interventricular septum. Ventricular septal defects can be single or plural, localized in any part of the septum. In this case, there is a constant discharge of blood either from left to right or from right to left. The direction of the discharge depends on whether the resistance is greater in the systemic (left) or pulmonary (right) circulation. The clinical manifestations of the defect and the prognosis depend on the magnitude of the discharge. Small defects sometimes do not require treatment; large ones are corrected only by surgery, as a rule, in conditions of artificial circulation. 5 A heart valve is a mechanism that consists of a valve ring and leaflets that open in one direction only. It provides unidirectional blood flow. |
Introduction
Obstructive shock is a condition in which a decrease in cardiac output is caused by a physical obstruction to blood flow. The reasons for the development of obstructive shock include:
- Heart tamponade
- Tension pneumothorax
- Ductus-dependent congenital heart defects
- Massive pulmonary embolism
Physiology and clinical manifestations of obstructive shock
The physiological features and clinical manifestations of obstructive shock depend on the cause that caused it. This chapter describes the 4 main causes of obstructive shock and the main distinguishing features of each of them.
Heart tamponade
Cardiac tamponade is caused by accumulation of fluid, blood, or air in the pericardial space. An increase in pressure in the pericardial cavity and compression of the heart leads to a decrease in venous return from the large and pulmonary circulation, a decrease in the end-diastolic volume of the ventricles, and to a decrease in cardiac output. Left untreated, cardiac tamponade results in cardiac arrest, which is characterized as pulseless electrical activity.
In children, cardiac tamponade is most often found in penetrating wounds or in cardiac surgery, although the cause of this condition may be pericardial effusion as a complication of the inflammatory process.
- Muffled heart tones
- Paradoxical pulse(decrease in systolic blood pressure during inspiration by more than 10 mm Hg.)
- Swelling of the neck veins (may be difficult to see in children with severe hypotension)
Tension pneumothorax
Tense pneumothorax is caused by accumulation of air in pleural cavity... Air can enter the pleural space from a damaged lung, which can occur with an internal rupture or with a penetrating chest wound. With a simple pneumothorax, a limited amount of air enters the pleural cavity, followed by the closure of the defect. With the continued supply and accumulation of air, the pressure in the pleural cavity becomes positive. This can occur as a result of positive pressure ventilation barotrauma, where air from a damaged lung enters the pleural space. With an increase in pressure in the pleural cavity, the lung collapses, and the mediastinum shifts in the opposite direction. The collapse of the lung quickly leads to the development of respiratory failure, and high pressure in the pleural cavity and compression of the structures of the mediastinum (heart and large vessels) reduce venous return. This leads to a rapid drop in cardiac output. If untreated, tension pneumothorax leads to cardiac arrest, which is characterized by pulseless electrical activity.
Suspect a tension pneumothorax in a victim with a chest trauma, as well as in any intubated child whose condition suddenly worsens during positive pressure ventilation (including overly vigorous ventilation with a mask bag).
Typical signs of tension pneumothorax:
- Tympanic percussion sound on the affected side
- Decreased breathing on the affected side
- Swelling of the neck veins (may be difficult to see in infants or if hypotension is severe)
- Tracheal deviation to the opposite side of the lesion (may be difficult to assess in young children)
- Tachycardia, quickly replaced by bradycardia and a rapid deterioration of blood circulation with a drop in cardiac output
Ductus-dependent congenital heart defects
Ductus-dependent defects are congenital heart defects in which the life of a child is possible only with the functioning of the ductus arteriosus (ductus arteriosus). As a rule, clinical manifestations of ductus-dependent defects occur in the first week of life.
Ductus-dependent defects include:
- A group of cyanotic congenital heart defects in which pulmonary blood flow depends on the functioning of the ductus arteriosus
- Congenital heart defects with obstruction of the left heart, in which systemic blood flow depends on the functioning of the ductus arteriosus (coarctation of the aorta, break of the aortic arch, critical aortic stenosis, and left heart hypoplasia syndrome)
Distinctive signs of defects with obstruction of the left heart:
- Rapid deterioration of systemic perfusion
- Congestive heart failure
- Different levels of blood pressure in the vessels proximal and distal to the ductus arteriosus (coarctation of the aorta, break of the aortic arch)
- Cyanosis of the lower half of the body - areas of postductal blood flow (coarctation of the aorta, break of the aortic arch)
- Lack of pulse in the femoral arteries (coarctation of the aorta, break of the aortic arch)
- A rapid decline in the level of consciousness
- Respiratory failure with signs of pulmonary edema or insufficient respiratory effort
Massive pulmonary embolism
Pulmonary embolism is a complete or partial obstruction of the pulmonary artery or its branches by a blood clot, fat, air, amniotic fluid, a catheter fragment, or an intravenous substance. The most common reason pulmonary embolism is a thrombus that migrates into the pulmonary circulation. Pulmonary embolism can lead to pulmonary infarction.
In childhood, pulmonary embolism is relatively rare, but there are conditions that predispose to the development of pulmonary embolism in children. Examples of such conditions and predisposing factors are indwelling central venous catheters, sickle cell anemia, malignancies, diffuse diseases connective tissue, hereditary coagulopathies (for example, deficiency of antithrombin, protein S, and protein C).
With pulmonary embolism, a vicious circle of disorders is formed, including:
- Violation of the ventilation-perfusion ratio (proportional to the size lung infarction)
- Systemic hypoxemia
- Increased pulmonary vascular resistance, resulting in right ventricular failure and a drop in cardiac output
- Displacement of the interventricular septum to the left, which leads to a decrease in left ventricular filling and a further decrease in cardiac output
- Rapid drop in end-expiratory CO2 concentration
conclusions
The choice of treatment for obstructive shock depends on the underlying cause. Quickly identifying and treating the cause of the obstruction can be life-saving. Therefore, the most important tasks of a resuscitator are rapid diagnosis and treatment of obstructive shock. With absence emergency care, the condition of patients with obstructive shock progresses rapidly to cardiopulmonary failure and cardiac arrest.
Bibliography
- Carcillo JA. Pediatric septic shock and multiple organ failure. Crit Care Clin. 2003; 19: 413-440, viii.
- Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6: 2-8.
(manifested by arterial hypoxemia, "ductus-dependent")
Transposition of the great arteries (TMA) 0.22-0.33 per 1000 newborns, 6-7% of all CHD, 23% among critical CHD.
Anatomy of the defect: the pulmonary artery is the outflow tract of the left ventricle, the aorta is the outflow tract of the right ventricle. This disrupts hemodynamics: arterial blood circulates in the system of the small circle, and venous blood in the system of the large circle. The supply of oxygen to the life-supporting organs is possible only under the condition of functioning fetal communications - the ductus arteriosus, the oval window, or in the presence of an atrial defect. At birth, the child immediately has diffuse cyanosis, a state of extreme severity, severe arterial hypoxemia. With survival for several weeks, heart failure and severe malnutrition increase. When the communications are closed, acute hypoxia leads to the development of multiple organ failure and death of the newborn within several hours. Optimal timing of surgical correction : with intact IVS in the first 3-4 weeks of life, an arterial switch operation (radical) can be performed, which has better results than the Rastelli procedure. With the combination of TMA + VSD, arterial switching can be performed within 1 year of life.
Atresia (critical stenosis) of the pulmonary artery with an intact interventricular septum (ALA + PVI) 0.06-0.07 / 1000, 1-3% of all CHD, 3-5% of critical CHD.
Anatomy : there is no exit from the pancreas, LA is hypoplastic, hypoplasia of the right heart. Hemodynamics: blood does not enter the pulmonary artery, it is shunted to the left heart through the LLC (PDA), that is, the condition for survival is "ductus-dependent" blood circulation. The left ventricle pumps blood into both circles of the blood circulation. A full-term baby is born. In the first hours of life, the condition worsens. Increasing cyanosis from birth, shortness of breath, tachycardia, hepatomegaly, peripheral edema. The condition is very serious. The noise of the PDA is heard. Anxiety or lethargy of hypoxic genesis may be accompanied by a "cry of pain" in coronary disorders, loss of consciousness. A similar violation of hemodynamics, and a similar clinical picture noted with atresia of the tricuspid valve. Optimal timing of surgical correction: in the first months of life, the problem of decompression of the right ventricle with the restoration of effective blood flow through it should be solved, which will contribute to the growth and development of its cavity by creating intersystem anastomoses, pulmonary valvotomy.
Left heart hypoplasia syndrome (LHSS) 0.12-0.21 / 1000 newborns, 3.5-7.5% of all CHD, 16% - among critical CHD.
Anatomy: Various combinations of atresia, stenosis or hypoplasia of the aortic and / or mitral valve, hypoplasia or absence of the left ventricle, hypoplasia of the aorta. Hemodynamics: a pronounced obstruction of blood flow through the left heart, blood from the left atrium through the oval window enters the right sections, the pulmonary artery, then a small volume of blood through the PDA - into the descending aorta and big circle, which is accompanied by a pronounced impoverishment of the small circle. Immediately after birth, the clinic resembles RDS, CNS damage and / or septic shock: gray skin, weakness, cold extremities, cyanosis (more on the legs), severe shortness of breath, oligo-, anuria. Optimal timing of surgical correction: if a decision is made about surgical correction, it is performed in the first 3-4 weeks of life in the form of: heart reconstruction, when the functions of the systemic ventricle are transferred to the right ventricle, heart transplantation, or (in case of moderate hypoplasia - as biventricular correction).
Severe preductal coarctation / break of the aortic arch (CA) 0.02 / 1000 newborns, 0.4% of all CHD, 1-10% among critical CHD.
Anatomy: the blood flow from the proximal part of the aorta to the distal one (below the place of origin of the arterial duct) is sharply limited or is completely absent. Hemodynamics: in the descending aorta (into the great circle), a small volume of blood comes only from the pulmonary artery through the ductus arteriosus. When the arterial duct closes, hypoperfusion of organs and tissues and multiple organ failure develop. .
Clinic. Outwardly safe newborn with a sharp deterioration in the first 1-3 days of life - weakness, cold extremities, symptom " white spot», Pulse of small filling, high blood pressure on the arms and low (not determined) on the legs, shortness of breath, tachycardia, oliguria with increasing azotemia, hepatomegaly with an increase in transaminases, necrotizing enterocolitis. Optimal terms of surgical correction: after reaching the stabilization of the child's condition, surgical correction of the defect is performed - the creation of a direct anastomosis between the segments of the aorta or the interposition of a synthetic prosthesis in the event of a break in the arc, similar correction tactics for preductal coarctation.
Even highly qualified cardiologists with a huge practical experience... The reasons for the development of pathology are varied, as are its manifestations. Sometimes the disease proceeds calmly and does not make itself felt long years... Serious defects require lifelong therapy, and sometimes urgent surgical intervention. But it's one thing when a person finds himself in such a situation for reasons beyond his control. And it is completely different - if the threat to his life arose due to inaction, delay or some kind of prejudice.
What is heart defect
Heart disease is a pathology characterized by anatomical disorders of the structures of the heart muscle, valves, septa or large vessels supplying it with blood. The heart cannot cope with its job of supplying organs with oxygen. They experience oxygen deprivation and are in serious danger. Distinguish between acquired and congenital heart defects.
Congenital defect
Congenital heart disease - an anomaly in the structure of blood vessels and the heart, according to different reasons arisen during intrauterine development fetus. Pathology is one of the first places in the number of congenital deformities of organs that can cause the death of newborns before they reach one year of age.
Often, congenital heart disease does not manifest itself in the intrauterine phase. It happens that the pathology remains unnoticed during the first years of a baby's life. But over time, she will definitely remind of herself.
Responsibility for the appearance of pathology lies, first of all, with the parents of the child. Their diseases, heredity and lifestyle directly affect the health of the unborn baby. The development of heart disease can be triggered by:
- infectious diseases;
- taking certain medications;
- addiction to alcohol;
- drug use;
- exposure to radiation;
- endocrine system pathology;
- severe toxicosis while carrying a child;
- middle age of the mother;
- poor heredity;
- chromosomal abnormalities.
There are several types of congenital heart defects:
- open holes in the heart muscle;
- difficulty with blood flow;
- pathology of the blood vessels;
- heart valve defects;
- Fallot's tetrad;
- aortic stenosis;
- common trunk of arteries;
- Ebstein's anomaly;
- simultaneous manifestation of several types.
An anomaly detected immediately after birth will allow it to start treatment in a timely manner and reduce the threat of death of the baby during the first days of life. Before planning offspring, you need to find out how healthy the future parents are. You should ask the second "halves" if they have genetic problems and cases of congenital heart disease in their next of kin.
If, during the development of the fetus, a pathology of the heart is found, the mothers are prescribed appropriate therapy during pregnancy. It should support the baby's heart function before birth.
Heart disease in children
Timely treatment of pathology prevents the occurrence of complications. Children can grow and develop along with healthy peers. Not all heart defects require emergency surgery. If so, specialists adhere to a wait-and-see attitude, keeping the cardiac activity of the wards under control. But in any case, a child with a heart defect needs special conditions growing up.
Visually, the symptoms of pathology usually appear when the baby is three years old. At this time, considerate parents may notice:
- slow physical development baby;
- pallor of the skin, sometimes their cyanosis;
- the appearance of shortness of breath during habitual movements.
Children with congenital heart disease are characterized by psycho-emotional experiences due to developmental and learning problems. Usually, sick children begin to walk, talk, read and write later than their healthy peers. Over time, the situation can be aggravated by the appearance of excess weight, although initially babies with congenital heart disease have a reduced body weight. A sick child's immunity is low, so he is at risk of infectious diseases.
But children are not only affected by congenital heart defects. Acquired defects are often diagnosed in adolescents. This type of pathology can occur with exacerbation of various ailments. Harmful bacteria can enter the bloodstream:
- by infection through injection (contaminated syringes and needles);
- in case of sanitation violations during medical procedures (including dental procedures);
- when abscesses occur.
Blue and white vices
Distinguish between blue and white heart defects. With blue, venous blood is thrown into the arterial bed. In this case, the heart muscle "pumps" oxygen-depleted blood. Pathology is inherent early manifestation symptoms of heart failure:
- cyanosis (cyanosis);
- dyspnea;
- nervous overexcitement;
- fainting.
With white defects, venous and arterial blood do not mix, oxygen is supplied to the organs in the required amount. Pathology is characterized by the same attacks that are observed with blue defects, but they appear later - at 8-12 years old.
Medical practice testifies: often people with heart disease live a full life, without suffering and discomfort.
Acquired vice
Acquired heart defects affect the heart valves. Serious pathologies become a "trigger" to their development:
- chronic vascular disease (atherosclerosis);
- systemic lesions of connective tissues (rheumatism, dermatomyositis, scleroderma);
- endocardial inflammation (infective endocarditis);
- systemic diseases of the joints (ankylosing spondylitis);
- systemic sexually transmitted diseases (syphilis).
The cause of acquired heart defects is often the death of heart valve cells. Injuries can provoke the course of pathology.
There are compensated and decompensated acquired defects. In the first case, there are no obvious symptoms of circulatory failure, in the second, these symptoms are present.
Symptoms of the pathology are similar to the manifestations of other vascular and heart diseases. Therefore, the diagnosis is made only based on the results of the examination, which includes echo and electrocardiography. Among the acquired heart defects are:
- Mitral - manifested by prolapse (sagging of the leaflets) of the mitral valve. Treatment is symptomatic. In parallel with him, drug therapy is carried out for the pathology that caused the heart defect. In case of serious lesions of the valve, its surgical correction is indicated;
- Aortic - the aortic valve is affected. The main pathology is treated with medication. Therapy for heart disease may require surgical intervention - up to a valve transplant;
- Combined - two or more valves of the heart muscle are affected. Mitral, tricuspid and aortic valves can undergo deformations, which will cause difficulties in the diagnosis and treatment of pathology. Most often, mitral valve insufficiency and mitral stenosis are simultaneously manifested. Under similar circumstances, cyanosis and severe shortness of breath appear;
- Combined - one valve is exposed to several violations. This is usually stenosis and insufficiency. When diagnosing this type of heart disease, they find out the severity of the lesions and the predominance of one of them. This is necessary in order to prescribe adequate treatment and the type of possible surgical intervention;
- Compensated - difficult to diagnose asymptomatic pathology... Dysfunctions of some parts of the heart muscle in to the fullest are compensated by the increased load on other parts of the heart. Only an experienced cardiologist, who has high-tech special equipment at his disposal, is capable of diagnosing this defect.
"Simple", isolated heart defects are much less common than "complex", combined. Infectious ailments follow patients for years, affecting muscle tissue. As a result, one vice is added to another.
Life expectancy with heart disease
Even a very competent cardiologist will not undertake to predict how long a patient with a heart defect can live. You need to make efforts for the sake of recovery and prevention of complications of pathology on your own - sometimes overcoming a bad mood and a banal reluctance.
Uncomplicated heart disease
Often people do not even know that they are living with a disease under the formidable name "heart disease". The life expectancy of patients with heart defects is influenced by objective and subjective factors. A huge role is played by the characteristics of the patient's body and the conditions of his life. They will reduce the likelihood of developing pathology or even reduce its manifestations to a minimum:
- strict adherence to all the doctor's recommendations;
- healthy lifestyle;
- rejection of addictions;
- regular exercise;
- dosage of physical activity;
- full sleep.
A balanced approach to the course of the disease will save the patient from pain, discomfort and other consequences. Meticulous medical examination will help determine the severity of the pathology, and modern medications and physiotherapy will improve the patient's condition.
Complicated forms of pathology
For many types of heart defects, surgery is unnecessary or impossible. Under such circumstances, the body needs medication support. If there is no treatment, the pathology progresses. The only outcome in this case is fatal. The heart muscle refuses to perform its direct functions, disrupting the body's supply of blood. If surgery is the only possible chance to prolong life or improve its quality, you should not give it up. A very small percentage of surgical treatment for heart defects is fatal. Over 97% of operated patients live a full life in the future.
What is this “heart threshold”, how long do they live with diagnosed heart disease? These questions are troubling to many. Some are worried about their own diagnosis, while others are concerned about the health of their future children. In any case, you should not tune in to the worst outcome. There are reasons for a positive outlook on the situation. The latest equipment, advanced medical technologies and a high level of medical qualifications can ensure a long and fulfilling life even for people with severe forms of heart disease.
Congenital heart disease is an anatomically altered structure of the cardiovascular system. In medicine, two types of defects are distinguished - these are defects of blue and pale skin.
They are also divided into ductus-dependent, in other words, compensating PDA, and ductus-independent, in which the patent ductus arteriosus, on the contrary, interferes with full blood circulation.
Defects in the provision of pulmonary blood flow through the patent ductus arteriosus
- A fairly common defect of the cardiovascular system that occurs in the fetus during intrauterine development. If we lean towards statistics, then today the number of registered congenital heart defects in newborns has significantly decreased due to early diagnosis by echocardiography.
- All information on the site is for informational purposes only and DOES NOT ARE a guide to action!
- Provide an EXACT DIAGNOSIS you can only a DOCTOR!
- We kindly ask you NOT to self-medicate, but make an appointment with a specialist!
- Health to you and your loved ones!
High qualifications of neonatologists and modern medical equipment are important aspects for early detection of heart defects.
In the first hours of a child's life, CHD may be accompanied by critical condition and without surgical intervention can lead to his death.
In order to prevent this risk, specialists adhere to the following research algorithm even before discharge:
- spend comparative analysis skin;
- measure the pulsation of the peripheral sections;
- measure blood pressure on the leg and arm;
- auscultation of the lungs and heart;
- identify defects in the location of the heart and liver;
- identify congenital malformations.
An open oval window is a cardiac abnormality in which communication between the right and left atrium persists. A similar case can be observed in a fetus developing in utero. After the baby is born, the edges of the valves should fuse with the edges of the wide oval window in the heart.
After six months, the oval window should close completely. In other cases, a similar anomaly can disappear in a child after some time. Today, cardiologists diagnose an open oval window that is not overgrown in ten percent of adults.
Patent ductus arteriosus should be referred to as white defects. This disease can be successfully treated, both surgically and medically. During intrauterine development in the fetus, a similar duct provides communication between the right ventricle and the descending aorta. This message should persist for several hours and days after the baby is born.
After a certain period of time, complete closure of the patent ductus arteriosus should occur. The premature closure of the PDA has a very negative effect, this factor can lead to death.
Ductus-dependent heart disease is a disease where the PDA is the only source of blood supply to the aorta or pulmonary artery. After complete closure of the duct in infants, it worsens significantly general state which leads to death.
Defects with pulmonary atresia or critical pulmonary stenosis
Pulmonary atresia is a neonatal malformation characterized by a lack of direct interaction between the right ventricle and the pulmonary artery. In this case, pulmonary circulation decreases or ceases to circulate altogether and the child dies.
All the reasons for such a developmental disorder have not been fully identified, but doctors put forward the main version - this is a mutation that occurs under the influence of mutagens. If surgical intervention is not performed in a timely manner, then there is a huge risk of death.
In the first days of life in newborns, pulmonary blood flow supports the ductus arteriosus, which connects the pulmonary trunk and the dorsal aorta. But soon this duct overgrows, which leads to oxygen starvation, and later on to death.
The main symptoms of pulmonary atresia are primarily hypoxemia (oxygen starvation). During oxygen starvation, the newborn has a bluish skin. Also, with such a disease, the child's chest is deformed, left-hand side protrudes forward.
During feeding, the baby may experience shortness of breath, increased sweating. In this case, the skin becomes grayish and becomes sticky to the touch. If you look at the X-ray, you can clearly see changes in the contour of the lungs, possibly the presence of an asymmetric pattern.
To identify atresia of the pulmonary artery, fluoroscopy is carried out, if the diagnosis was made correctly, then catheterization and angiocardiographic examination are additionally done. The latter type will most accurately determine the type of disease.
The most effective treatment for this malformation is surgery, which is divided into two types:
- radical;
- palliative.
Allows you to completely eliminate the cause of the disease. Surgical intervention is performed when the patient's pulmonary artery belongs to the first type of development. In the second type, this operation is also performed, but using an artificial trunk and pulmonary artery valves.
After the operation, doctors carry out a second examination in order to make sure that all sections have access to blood flows. Palliative surgery does not cure the disease in general. Its main purpose is to increase the blood supply to the lungs, thereby promoting the growth of new pulmonary arteries.
To prevent the development of such an anomaly in newborns, pregnant women should adhere to several rules:
- exclude the effects of chemical and physical mutagens;
- completely stop drinking alcohol and antibiotics;
- avoid pregnancy if you have rubella;
- if there were similar diseases in the family, then you should turn to the genetics.
Transposition of the great arteries
It is the most dangerous congenital heart disease. It can be characterized by an abnormal arrangement of the cardiac vessels, also affecting the pulmonary artery trunk and aorta. With this pathology in a newborn, the aorta leaves the right ventricle, and the pulmonary artery from the left.
Most often, babies with a similar disease are born full-term, but in comparison with other children, they have a bluish skin. This is due to the fact that venous blood does not have access to the lungs and is saturated with carbon dioxide instead of oxygen.
Meanwhile, the pulmonary artery, on the contrary, has an excess of oxygen. In other words, there is a complete imbalance between the two circles of blood circulation.
In children born with such a pathology, health does not immediately deteriorate. This is due to a special opening through which venous blood has access to the lungs. But this interaction is extremely short-lived and after a certain period of time, the newborns experience deterioration in health, requiring immediate surgical intervention.
It should be noted that transposition of the great arteries is treatable. In modern perinatal centers, this defect is quickly detected and cured by surgery. During the operation, the cardiac vessels are dissected, the arteries that have been cut off from the aorta are docked to the pulmonary artery, thereby making the anatomical correction of this malformation.
In Russia, an operation to eliminate a congenital malformation has been successfully carried out for over 20 years. After the surgical intervention, the child should be regularly examined by a cardiologist, thereby excluding further complications.
Ductus-dependent heart defects with systemic blood flow through the PDA
Today in medical practice there are several of the most complex congenital heart defects, which are characterized by an open arterial duct, which is necessary for stable pulmonary and systemic circulation. With development without deviations, the pulmonary duct should close for the first time after the birth of the baby.
The pulmonary atresia system may not develop properly in the following cases:
- pulmonary atresia valve stenosis;
- tricuspid valve atresia;
- transposition of great vessels.
Ductus-dependent heart defects in newborns can present with severe shortness of breath during feeding. Auscultation may reveal a heart murmur. Also, this pathology provides for a characteristic enlargement of the liver. After a certain period of time, the channel must gradually close, which will lead to death.
Also, ductus-dependent heart defects in newborns are characterized by increased fatigue, bluish skin and impaired peripheral microcirculation. During the diagnosis, heart failure is detected. The main symptom of this defect is the weakening of the pulsation in the peripheral arteries.
Break of the aortic arch
With this type of defect, communication between the ascending and descending aorta is completely absent. A break in the aortic arch refers to a ductus-dependent pathology and, based on this, the first signs of deterioration in health appear after the closure of the PDA. After a short period of time, the child's condition may approach critical. This is facilitated by tachycardia, shortness of breath, weak pulsation. During the process, the liver, kidneys and stomach are damaged.
The break of the aortic arch can have a different anatomical structure and, depending on this, the pulse may differ in location. In type A, the location of the pulse on the arms is higher than on the legs; Type B is characterized by a significant slowdown in the pulse on the left arm.
During treatment, special inotropic drugs are used to support cardiac output. Most often, a drug such as dopamine is used, which, in addition to its direct purpose, has a positive effect on the renal system. Overdose should be avoided, as in this case a significant amount of blood can be displaced into the lungs.
In the most severe cases in medicine, they resort to artificial ventilation. It should be noted that this procedure should be carried out in a mode that excludes the addition of oxygen. Artificial ventilation lungs allows you to prevent complete closure of the patent ductus arteriosus and control the volume of blood flow to the lungs.
Sharp coarctation of the aorta
Coarctation of the aorta does not belong to congenital heart defects, it directly affects the aorta itself. But from the point of view of medicine, such a pathology still belongs to the group of heart defects, since it negatively affects the entire circulatory system as a whole.
Coarctation, or in other words, the narrowing is located next to the ductus arteriosus, where there is a transition of the aortic arch to another section. If the narrowing is rather sharp, then the left ventricle begins to intensively distill blood into the aorta, as a result of which the upper arterial pressure is much higher than the lower one. In this case, the heart can work normally, but due to the thickening of the walls of the left ventricle. This can lead to negative consequences.
In newborns, with a sharp coarctation of the aorta, the blood supply to the lower section occurs exclusively through the patent ductus arteriosus. In this case, there is a direct threat to the head section and requires urgent surgical intervention.
Surgical operation to eliminate this pathology is carried out in two ways:
But today, thanks to modern X-ray surgery, it is possible to avoid re-narrowing. This is achieved by inserting a special balloon catheter into the aorta. The pressure in the balloon expands the constriction.
In older children, a tubular structure is placed at the coarctation site, which allows you to hold the walls of the aorta, such a procedure completely excludes the occurrence of relapse again.
Critical aortic stenosis
Most often, diseases of the heart system are detected with a significant narrowing of the aorta, which is located in the valve region and requires immediate surgical intervention. The main signs of aortic stenosis are shortness of breath, respiratory failure, dizziness and nausea.
This disease can be diagnosed at all stages of human development. But unlike other cardiac malformations, it requires a completely different method of treatment.
In adults, heart disease is diagnosed when following symptoms: short-term loss of consciousness, shortness of breath, increased physical fatigue with a passive lifestyle. In children with such violations, increased fatigue, pale skin is revealed. It should be noted that the disease can be inherited.
At birth, babies often aortic stenosis may not be detected immediately, but there are several symptoms by which it is possible to determine the presence of pathology: arrhythmia, poor heartbeat, blue skin.
Nowadays, such a heart defect is treated by surgery. During the operation, the narrowing site of the cardiac aorta expands. This can be done through valve replacement or balloon repair.
The operation can be performed in the case when the patient was not identified during the diagnosis special contraindications to its implementation.
Left heart hypoplasia syndrome
Left heart hypoplasia syndrome refers to an underdevelopment of the left ventricle. This syndrome begins to develop actively after the complete closure of the arterial blood duct after the birth of a child.
First of all, it is characterized by such features as:
- shortness of breath;
- mild pulsation;
- pallor of the skin.
Syndrome of hypoplasia of the left heart can be attributed to congenital malformations of the heart. When diagnosing, the main signs are: poor development of the left chambers and aortic stenosis.
In most cases, diagnose this pathology became possible even during the intrauterine development of the fetus. After the birth of a child, he has a weak pulse, which is present on the arms and legs, and severe shortness of breath.
A newborn with such a diagnosis is urgently transferred to the intensive care unit and further surgery is performed:
If the hypoplasia syndrome was detected in utero, then pregnancy should be managed strictly in specialized perinatal centers. After birth, the newborn should be supervised around the clock by specialists such as a cardiologist, neonatologist and cardiac surgeon.
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