Symptoms of congenital heart disease in a child. Heart defect in a child. Treatment of heart disease using conservative methods

According to various sources, about 1% of babies are born with congenital heart defects, while doctors are only able to identify the factors that provoked the development of such fetal pathologies in the prenatal period in only 10% of cases. Thanks to early diagnosis and modern methods of surgical treatment, most of these children manage not only to overcome death, but also to live, keeping up with their peers.

Heart disease: what is it?

Heart disease is a change in the anatomical structures of the heart (chambers, valves, septa) and the vessels extending from it, which lead to hemodynamic disturbances. All heart defects are divided into two groups: congenital and acquired. In childhood, congenital heart defects (CHD) are usually detected. They come in two types:

“Blue”, in which venous blood enters the arteries, so the skin acquires a bluish tint. This group of congenital heart diseases is the most dangerous, since the child’s organs and tissues do not receive enough oxygen due to the mixing of arterial and venous blood saturated with carbon dioxide. The most common “blue” congenital heart defects are pulmonary atresia, tetralogy of Falo, and transposition of the vessels.
“White”, characterized by the discharge of blood to the right side of the heart and pale skin. Defects of this type are easier for patients to tolerate, but over time they lead to the development of heart failure and lung problems. Examples are atrial septal defect, patent ductus arteriosus, etc.

Causes

Congenital heart disease in children develops in the womb, and this happens when the heart is formed - during the first 2 months of pregnancy. If negative factors influence the female body during this period, the risk of congenital heart disease in the child increases significantly. Factors leading to the development of heart defects in the fetus include:

Alcohol, nicotine, drugs.
Radiation.
Certain medications (including sulfonamides, aspirin, antibiotics).
Rubella virus.
Unfavorable ecology.

In addition, genetics plays a large role in the formation of heart defects. Mutation of certain genes causes a disruption in the synthesis of proteins that form the septum of the heart. Genetic mutations can be inherited, or they can appear due to a woman’s use of drugs, alcohol, exposure to radiation, etc.

How to determine a heart defect?

An experienced ultrasound doctor can diagnose heart defects even in utero. Therefore, gynecologists strongly recommend that all expectant mothers undergo routine ultrasound examinations. Prenatal detection of serious congenital heart disease in the fetus gives a woman the right to choose: to give birth or not to give birth to a seriously ill child. If a woman wants to carry the pregnancy to term, organize the birth in such a way that the newborn is immediately provided with the necessary medical care (as a rule, these are resuscitation measures) and the operation is performed as soon as possible.

It often happens that heart defects are not detected in utero, the child is born, at first glance, completely healthy, and problems arise later. Therefore, in order not to miss congenital heart disease, to prevent the progression of pathology and the development of complications, each newborn is carefully examined in the maternity hospital. The first thing that indicates a possible defect is a murmur detected by listening to the heart. If this is detected, the child is immediately sent to a specialized clinic for further examination (echocardiography, ECG and other studies).

However, it is not always possible to detect a heart defect in a newborn in the first days of life (murmurs may simply not be heard), so it is important for parents to know what symptoms indicate that something is wrong with the child’s heart in order to consult a doctor in a timely manner. These signs include the following:

Pale or bluish skin (especially around the lips, on the arms, on the heels).
Poor weight gain.
Sluggish sucking, frequent breaks during feeding.
Rapid heartbeat (the norm in newborns is 150 – 160 beats per minute).

With some congenital heart disease, pronounced symptoms of the pathology appear not in the first year of life, but later. In such cases, the presence of heart pathology can be suspected based on the following signs:

In addition, parents should regularly take the child to a pediatrician or family doctor (every month in the first year of life, annually thereafter), since only a doctor can hear heart murmurs and notice what fathers and mothers do not pay attention to.

If someone in the family has congenital heart disease or the pregnancy occurred against the background of aggravating factors (endocrine and autoimmune diseases of the woman, severe toxicosis, threat of miscarriage, infectious diseases, taking medications, smoking and alcohol abuse, etc.), the child It is advisable to examine the heart using echocardiography even in the absence of any pathological symptoms.

Treatment and prognosis

The approach to treatment of congenital heart disease is always individual. For some patients, surgery is performed immediately after birth, for others – after six months, and for others, doctors treat them conservatively, without any surgical interventions. Congenital defects that are well tolerated by patients and do not always require surgical correction (since they often close spontaneously) include the following:

Small defects in the septa between the ventricles and atria.
Patent ductus arteriosus.
Minor deformations of the heart valves.

The prognosis for these congenital heart defects is usually favorable, even if surgical treatment is required.
The situation is much worse with most “blue” vices. These vices are more complex and more dangerous. The most severe congenital heart diseases include:

Transposition (change of places) of the aorta and pulmonary artery.
The origin of both the aorta and pulmonary artery is from the right ventricle.
Tetralogy of Falo (includes 4 anomalies of the development of the heart and great vessels).
Severe valve defects.
Hypoplasia (underdevelopment) of the heart. A particularly dangerous defect is the underdevelopment of the left sections. The question of how long people live with it can be answered with statistical data - with this defect there is almost 100% mortality.
Atresia (fusion) of the pulmonary artery.

With severe congenital heart disease, heart failure rapidly increases; children immediately after birth go into a very serious condition, requiring immediate surgical intervention. The success of such treatment directly depends on how quickly the newborn is delivered to a specialized cardiac surgery clinic and how the correct treatment tactics are chosen. Compliance with these two conditions is possible only in one case - if the defect is identified before the birth of the child. Intrauterine diagnosis of congenital heart disease allows doctors of all levels (both obstetricians-gynecologists and cardiac surgeons) to prepare for the upcoming birth and plan surgical intervention on the newborn’s heart.

Pediatric congenital heart defects

Heart disease is a change in the functioning of the muscular and valvular apparatus of the heart and its partitions.

In medicine they stand out congenital and acquired heart defects.

Acquired defects change the functioning of the heart valve. Most often they appear in patients with rheumatism, syphilis and atherosclerosis.

The clinical picture of all defects often consists of general characteristics. But there are also peculiar manifestations of the disease that are specific to a certain symptom.

In our article we will focus on childhood congenital heart muscle defects.

The occurrence of the disease.

Childhood congenital heart disease occurs in a child due to improper development of blood circulation while the child is still in the womb. The baby's heart begins to form from the 3rd to the 8th week of pregnancy. Its normal development can be affected by negative influences.

Of these, the first place is occupied by infectious diseases that a woman could suffer during the first half of pregnancy - rubella, influenza, herpes, tonsillitis and others. Chronic illnesses of parents, drug abuse during pregnancy, smoking and alcoholism of future parents also have a negative impact.

Diagnosis of congenital heart defects.

The definition of a child's congenital defect as a disease is based on the external manifestation of certain signs, on data from clinical studies and other methods. Based on all these signs, the doctor can determine the presence of the disease and identify not only the type of defect, but also the group to which it belongs.

The study of the heart includes an electrocardiogram, x-rays of the heart and lungs, and an echocardiogram.

Symptoms of the disease.

Children with heart defects often lag behind their peers in physical development and are more likely to suffer from viral diseases. The most common complaints in these cases are complaints of shortness of breath during physical activity, rapid fatigue, even when the child is not doing anything. In such children, the skin becomes paler than usual.

Types of childhood congenital heart defects.

Congenital heart disease in children is very diverse in nature of the disorders. The most common defects occur when there is an obstruction in the septum between the ventricle and the atrium, due to which some of the blood from the left half of the heart immediately enters the right half, but should go directly into the pulmonary trunk.

With all congenital defects, less arterial blood enters the systemic circulation than is needed. Therefore, an overload occurs in the pulmonary circulation. The greater this overload, the more difficult the disease progresses.

Treatment of heart disease.

Treatment of each type of congenital defect is strictly individual. Those defects that do not directly cause any disruption to the functioning of the child’s body do not require medical intervention at all. People with such diseases most often do not complain about their health.

But when problems do arise, the child requires surgical intervention. It should normalize the functioning of the heart. Heart valve replacement is possible. In more severe cases, surgery may not be possible at all. Then the patient is prescribed a certain regimen that allows him to simply delay the time of final wear and tear of the heart muscle.

Heart disease in children: how to treat?

Pathology of the heart, in which there are defects in the valve apparatus, as well as its walls, is called heart disease. In the future, this pathology causes the development of cardiovascular failure. Vice children's hearts may be congenital or acquired. Congenital heart disease is a pathology when the cause of cardiac defects and the vessels adjacent to it are disturbances in the processes of embryogenesis.

The following types of congenital heart defects are distinguished: a defect with overload of the pulmonary circulation, atrial septal defect and interventricular septal defect; open ductus arteriosus, a defect with the union of the pulmonary circulation; isolated pulmonary artery stenosis; tetralogy of Fallot; transposition of the great vessels; defect with normal pulmonary blood flow; aortic stenosis; coarctation of the aorta. Congenital defects in children arise in the womb. The presence of the disease can be detected in the early stages using cardiac ultrasound, Doppler or electrocardiography.

The main causes of heart disease are as follows:

hereditary disease, that is, parents or close relatives suffered from heart defects;
smoking and alcohol during pregnancy;
living of a pregnant woman in an unfavorable zone, an environmental disaster zone;
cases of miscarriages or stillbirths;
transmission during pregnancy of infectious diseases such as rubella.

With acquired heart defects, defects occur in the area of the valve apparatus, expressed by stenosis or valvular insufficiency of the heart. In this case, surgical intervention is necessary.

Acquired heart defects in children, as a rule, arise as a consequence of previous diseases, such as rheumatism, mitral valve prolapse, and infective endocarditis.

The following help determine the presence of the disease: signs of heart disease in children. Firstly, these are heart murmurs. The doctor can determine them by listening to the child’s heart. The presence of organic noise indicates the threat of defect. After the discharge of children whose risk of illness remains in question, doctors give some advice, how to determine heart defect. Parents should be concerned if the child's monthly weight gain is less than 400 grams, the child has shortness of breath and increased fatigue. This manifests itself mainly during feeding: the baby eats little and gets tired of sucking very quickly. Also, heart disease in children is accompanied by the presence of tachycardia - rapid heartbeat, cyanosis - cyanosis of the skin.

There is no clear answer to the question: “How to treat heart disease.” The choice of treatment method depends on many factors, such as the type of defect, the nature of the current disease, the condition and age of the patient. One should also take into account the fact that heart disease in children can be age-related, and upon reaching 15-16 years old it goes away on its own. This applies to birth defects. Often, the disease that caused the defect or contributed to its progression is initially treated. In these cases, drug and preventive treatment is used. In cases with acquired defects, the matter sometimes ends with surgical intervention. The surgical treatment method is commissurotomy. It is used for patients suffering from isolated mitral stenosis.

For mitral insufficiency, surgical intervention is used, but as the disease becomes more complicated and the patient’s well-being worsens. During the operation, the valve is replaced with its artificial counterpart. Also, therapeutic therapy for heart defects includes diets, general hygiene measures and physical therapy exercises. Nutritionists recommend eating more protein foods, limiting water and salt intake, and not eating before bed. In addition, physical activity is necessary to train the heart muscle. Doctors follow a set of exercises for heart defects. Firstly, walking, it increases blood circulation, breathing, and tones the muscles, preparing them for further exercise.

It is recommended to start and finish a set of exercises by walking. Secondly, these are exercises for the shoulder girdle and arms. They help straighten the spine and chest and are also good for breathing. Thirdly, breathing exercises are an integral part of the classes. In general, a set of training should begin with morning exercises; during the day you can jog or just take a walk.

Training will be effective if carried out 2-3 times a week for 40-50 minutes. Walking or running programs are developed for each patient individually, depending on his state of health. After completing the program under the supervision of a cardiologist, you can move on to independent studies.

Congenital heart defects

Congenital heart defects (CHD) are anatomical defects of the heart, its valve apparatus or its vessels that occurred in utero (at 2-8 weeks of pregnancy). These defects can occur alone or in combination with each other.

Etiology. Viral infections (rubella, measles, mumps, chickenpox, polio, etc.), maternal heart defects, alcoholism, drug addiction, the use of certain medications, ionizing radiation, hypovitaminosis, pregnancy over 35 years of age, often have a negative impact on the process of heart formation. diseases of the genital area. One of the important factors is also the health of the father.

The prevalence of congenital heart disease is 30% of all congenital malformations. They rank first in mortality of newborns and children of the first year of life. Congenital heart disease can appear immediately after the birth of a child or occur hidden.

Clinic. The most accepted division of congenital heart disease into “blue” (with cyanosis) and “white” (without cyanosis). In addition, all congenital heart diseases are divided depending on the state of hemodynamics in the pulmonary and systemic circulation.

Classification of congenital heart disease according to hemodynamic status

3 Varieties

3.1 Stages of the disease

4 Symptoms of pulmonary hypertension in children

5 Features of the disease in newborns

6 Which doctor and diagnostic procedures are needed?

7 Treatment of pulmonary hypertension in children

8 Possible complications

9 Prognosis and prevention

Sometimes doctors diagnose such a serious disease as primary pulmonary hypertension in children. Often doctors fail to find out the root cause that provoked high blood pressure in the lungs. With this pathology, children experience constant bluish skin (cyanosis) and rapid breathing. The disease is serious and can be fatal if help is not provided in a timely manner.

What do the statistics say?

If a child is diagnosed with pulmonary hypertension, then there is a sharp increase in pressure in the vascular beds of the lungs, which negatively affects the heart. To prevent heart failure, the child's body reduces blood pressure in the lungs by dumping blood into the open ductus arteriosus. Thus, the circulation of blood fluid in the lungs is reduced.

According to statistics, no more than 2 out of 1000 newborns suffer from pulmonary hypertension.

About 10% of babies in intensive care experience signs of pulmonary hypertension. The pathology affects not only premature babies. It is often recorded in post-term or full-term infants. Pulmonary hypertension is predominantly observed in newborns who were born by cesarean section (80% of children). Doctors manage to diagnose the disease in 95% of newborns within the first day and begin therapy on time.

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Causes of the disease

Fetal growth retardation can cause pulmonary hypertension.

If it is impossible to find out the cause, doctors make a diagnosis of “primary or idiopathic pulmonary hypertension.” The following reasons can often provoke a pathological condition in the internal organ of a child:

Stress during labor, which is manifested by hypoxia, hypoglycemia, hypocalcemia. After the child is born, spasm of the arterioles located in the lungs is possible, which will lead to sclerotic type changes.
Delayed development in the womb. With this development, the vascular walls retain their embryonic structure even after birth. Spasms in underdeveloped vessels are often observed.
Signs of a congenital diaphragmatic hernia, which does not allow the internal organ to develop and fully perform its functions.

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Risk group

Children with intrauterine hypoxia.
The presence of intrauterine infectious lesions or blood poisoning.
Uncontrolled use of medications by pregnant women (antibiotics, non-steroidal anti-inflammatory drugs).
The presence of congenital heart defects (CHD) and lungs.
Children with signs of polycythemia, as a result of which the number of red blood cells in the newborn’s blood fluid rapidly increases.

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Varieties

Classification

Types of pulmonary hypertension

By origin	Primary or idiopathic disease, in which there are no pathological symptoms on the side of the respiratory organs and blood flow. A secondary disease in which the child has pathologies of the respiratory organs that provoke the development of pulmonary hypertension.
Appearance mechanism	Severe spastic vascular reaction. Hypertrophy of the vascular wall, in which the cross-sectional area does not decrease. Hypertrophy of the vascular wall, in which the cross-sectional area decreases. Embryonic structure of blood vessels.
Intensity and duration of flow	Transient or transient lung disease, in which severe symptoms are noted. This type of pulmonary hypertension is caused by changes in blood circulation in the newborn. Normal operation stabilizes after 7-14 days. A persistent disease resulting in a permanent deviation in blood circulation in an internal organ.

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Stages of the disease

Pulmonary hypertension in children is classified according to severity.

In children, pulmonary hypertension occurs in 4 stages. The first stage is the easiest; at this stage it is possible to cure the child completely if the therapy is chosen correctly. If not detected in a timely manner, pulmonary hypertension progresses to stage 2. If treatment is not started within 3 years, then stages 3 and 4 occur, during which irreversible changes in the structure of the lungs and heart develop.

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Symptoms of pulmonary hypertension in children

Heavy breathing, frequent shortness of breath, which was not preceded by physical activity.
Drawing the chest inward while inhaling.
Blue discoloration of the skin and mucous membranes, development of persistent cyanosis.
The child begins to gradually lose weight.
There are unpleasant, bursting sensations in the stomach.
Feeling of weakness and fatigue.
Frequent heartbeat.

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Features of the disease in newborns

A newly born baby often has difficulties with the functioning of the heart and respiratory system. If persistent placental blood circulation is observed in a child in the first hours of life, this indicates that the blood circulation in the lungs has not yet been fully adapted for independent work. In such newborns, breathing does not start on their own and they require emergency assistance. Persistent pulmonary hypertension in newborns is manifested by the following symptoms:

hard breath;
poor response to oxygen therapy;
blue skin.

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Which doctor and diagnostic procedures are needed?

A pediatric neonatologist will help make the correct diagnosis for a newborn baby.

If breathing problems are detected in a newborn, you should contact a neonatologist or pediatrician as soon as possible. If possible, the child should be shown to a pediatric pulmonologist. To find out the diagnosis and root causes of the pathology, diagnostic procedures are necessary:

examination and listening of the heart;
donating blood for laboratory tests to determine how oxygenated the blood is (oxygenation);
instrumental examinations, including electrocardiogram, radiography and ultrasound using Doppler;
checking the newborn's response to oxygen supply.

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Treatment of pulmonary hypertension in children

Treatment of the disease is carried out strictly under the supervision of a doctor; in newborns, treatment is carried out in intensive care. First of all, you should stabilize blood pressure in the pulmonary vessels as quickly as possible and relieve spasms of the latter. Treatment for pulmonary hypertension includes:

The use of medications that relax vascular walls and eliminate spasms. Tolazoline and sodium nitroprusside are prescribed.
IV administration of drugs that prevent the development of heart failure (“Dopamine”, “Adrenaline”).
During the first hours of life, a child is given a surfactant so that the lungs can open fully.
Antibacterial drugs are prescribed if the problem is associated with an infectious lesion in the child’s body.
The prescription of diuretic and anticoagulant drugs for pulmonary hypertension in children is rarely observed, only according to special indications from a doctor.

In case of severe respiratory failure, the method of extracorporeal membrane oxygenation is used to saturate the blood with oxygen.

If there is a high probability of death of the child, extracorporeal membrane oxygenation is used. With this therapeutic method, the child’s blood is saturated with oxygen through a device. Using catheters, the device is connected to the child and thus purifies the blood and saturates it with oxygen.

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Possible complications

If you do not provide timely help to a child with pulmonary hypertension, then death is possible within 3 days. It is extremely rare that children with pulmonary hypertension who do not receive medical care manage to live to 5 years of age. Death occurs as a result of the rapid development of heart failure and due to oxygen starvation (persistent hypoxemia).

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Prognosis and prevention

If the disease is detected in time and proper therapy is started, the prognosis is favorable. With proper treatment, a newborn's health will return to normal by the age of one year. In 30% of patients, negative consequences are observed, in which the child lags behind in psychophysical development, and disruption of the visual and auditory systems occurs.

To prevent such a disease in a child, a woman should think about prevention even during pregnancy. Drinking alcohol and smoking is not allowed. Infections that can be transmitted to the fetus should be avoided. If illness occurs, you must consult a doctor and not self-medicate by taking self-prescribed medications.

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Symptoms of congenital and acquired heart defects

Heart defects are progressive chronic diseases characterized by pathological changes in the heart valves, walls, septa, and blood vessels. As a result, blood flow in the organ itself, as well as in the pulmonary and systemic circulation, is disrupted. Heart defects in adults and children are a large group of diseases that can be congenital or acquired.

What are congenital heart defects?

These are anatomical defects of the heart muscle, its valves or blood vessels. They are formed during intrauterine development and occur in 5-10 newborns out of a thousand. The exact cause of their development is not known, but they are believed to be related to genetic and environmental factors. Congenital heart defects can be the consequences of infections suffered by the mother in the first trimester of pregnancy. Among all congenital anomalies, this type ranks second, second only to defects of the nervous system. There are about 100 congenital heart diseases, and their classification is quite complex. Defects in newborns are characterized mainly by damage to the walls of the myocardium and large vessels adjacent to them.

What are the signs?

The set of signs of congenital heart anomalies depends on the type and severity of the defect. In some cases, symptoms of a heart attack are observed immediately. Sometimes the disease is not detected in newborns and subsequently proceeds without visible manifestations for a long time. Symptoms of heart abnormalities often appear in adults. The main signs of congenital heart disease that may be present in children are:

dyspnea;
heart murmurs;
fainting;
frequent ARVI,
poor appetite;
developmental delay, short stature;
underdevelopment of muscles and limbs;
blue discoloration of the area around the mouth, as well as the nose, ears, and limbs;
Older children experience lethargy and a reluctance to move and play.

All symptoms of congenital heart disease are divided into four groups:

Cardiac syndrome is manifested by shortness of breath, pain in the chest, heart failure, rapid heartbeat, pallor of the skin, cyanosis or cyanosis of the skin and mucous membranes.
Heart failure syndrome is expressed in tachycardia, cyanosis, and attacks of shortness of breath.
With chronic hypoxia syndrome, there is a lag in development and growth, thickening of the terminal phalanges of the fingers, and deformation of the nails.
Respiratory disorders: delayed and rapid breathing, retraction of the lower chest, protrusion of the abdomen, cyanosis of the mucous membrane and skin, dullness of tones, slow or rapid pulse.

There are several classifications of congenital heart disease. A conditional division into two groups is accepted: white and blue. In the first case, a left-right discharge occurs without mixing venous and arterial blood. In the second, there is a right-left discharge, arterial blood mixes with venous blood.

Symptoms of blue defect are detected at an early age. A cardiac abnormality can manifest itself as a sudden attack, during which shortness of breath, nervous agitation, cyanosis and even loss of consciousness are observed.

The signs of white defect are the same, but appear at a later age - in children after 8 years of age. In addition, with this pathology, the lower part of the body usually lags behind in development.

Acquired vices

Acquired heart defects can develop in adults and children. These are defects of one or more valves, which is why they are called valve defects. This may be stenosis (narrowing) or valve insufficiency, or a combination of both. Existing defects prevent normal blood flow. Acquired heart abnormalities develop as a result of disease, overload or expansion of the heart chambers. This defect can be caused by inflammatory processes, infectious diseases and autoimmune reactions.

Symptoms

Clinical manifestations depend on the type of defect and its severity. Symptoms are determined by the location (mitral, aortic or tricuspid valve) and the number of valves affected. In addition, the signs also depend on the functional form: stenosis, insufficiency, the presence of stenosis or insufficiency on several heart valves, the presence of both stenosis and insufficiency on one valve.

Mitral stenosis

It is characterized by shortness of breath, which at first occurs only during exertion, and then in a calm state. There is a dry or wet cough, hoarseness, and hemoptysis. The heartbeat quickens, interruptions occur in the functioning of the heart, and the limbs swell. Patients complain of pain in the chest and under the ribs on the right. The patient experiences weakness and fatigue. In severe cases, pulmonary edema and asthma attacks are possible.

Mitral regurgitation

At first, shortness of breath is present only during physical activity, but after a while it appears at rest. The patient complains of heart pain, weakness and palpitations. A dry or slightly wet cough occurs. During the examination, a murmur is detected in the upper part of the heart, and myocardial enlargement upward and to the left.

Aortic insufficiency

Subjective signs of such a defect may not appear for a long time due to compensation due to the work of the left ventricle. Heart pain due to aortic insufficiency is usually poorly relieved or does not go away at all after taking nitroglycerin. Patients complain of headaches, dizziness, shortness of breath and chest pain during exercise, and then at rest, palpitations, a feeling of heaviness and pain in the hypochondrium on the right. There is pallor of the skin, pulsation of the arteries of the neck and head, swelling of the legs, and possible fainting.

Aortic stenosis

Signs of such a defect may not appear for a long time. Typical symptoms are headache, dizziness, fainting, shortness of breath on exertion, and chest pain, usually constricting. Subsequently, pain appears in the right hypochondrium, high fatigue, swelling of the extremities, shortness of breath at rest, and asthma attacks. There is pallor of the skin, a rare pulse, increased or normal diastolic pressure and decreased systolic pressure. Signs of aortic stenosis are more pronounced during physical and emotional stress.

Tricuspid insufficiency

This type of heart defect rarely develops in its pure form; it is usually combined with other valve defects. With the development of tricuspid insufficiency, swelling and heaviness in the right hypochondrium occur, and ascites is possible. The skin becomes bluish, there may be a yellowish tint, swelling and pulsation of the veins of the liver and neck are observed. Blood pressure is increased, pulse is rapid. The functioning of the liver, kidneys, and gastrointestinal tract may be disrupted.

Combined defects

Combined heart defects are more common than isolated ones. In this case, one valve, two or three may be affected.

Combined defects are possible, in which two defects are found in one valve: both stenosis and insufficiency. Symptoms of combined heart disease depend on the predominance of one lesion over the other. In some cases, the signs of both defects are expressed equally.

The most common condition is simultaneous stenosis and mitral valve insufficiency. Usually the symptoms of one or the other predominate. Signs of this defect are primarily shortness of breath and cyanosis of the skin. If stenosis of the mitral valve of the heart predominates, then a small pulse, increased diastolic and decreased systolic pressure are noted. If insufficiency is more pronounced rather than stenosis, then blood pressure and pulse may remain normal.

Also, in the case of mitral disease, where stenosis predominates, there will be signs of stenosis of the left atrioventricular orifice. These are shortness of breath, hemoptysis, palpitations, and heart failure. If mitral regurgitation is more pronounced, then symptoms will include pain in the heart, a dry cough or with the release of a small amount of sputum.

Tetralogy of Fallot: symptoms, diagnosis, correction, prognosis

About 100 years ago, the diagnosis of “tetralogy of Fallot” sounded like a death sentence. The complexity of this defect, of course, allowed for the possibility of surgical treatment, but the operation was carried out for a long time only to alleviate the patient’s suffering, since it could not eliminate the cause of the disease. Medical science moved forward, the best minds, developing new methods, never ceased to hope that the disease could be dealt with. And they were not mistaken - thanks to the efforts of people who dedicated their lives to the fight against heart defects, it became possible to treat, prolong life and improve its quality even with such ailments as tetralogy of Fallot. Now new technologies in cardiac surgery make it possible to successfully correct the course of this pathology with the only condition that the operation will be performed in infancy or early childhood.

The very name of the disease says that its appearance is due not to one, but to four defects that determine a person’s condition: tetralogy of Fallot is a congenital heart defect that combines 4 anomalies:

A defect in the septum between the ventricles of the heart, usually the membranous part of the septum is missing. The length of this defect is quite large.
Increased volume of the right ventricle.
Narrowing of the lumen of the pulmonary trunk.
Displacement of the aorta to the right (dextroposition), to the point where it partially or even completely moves away from the right ventricle.

Basically, tetralogy of Fallot is associated with childhood, this is understandable: the disease is congenital, and life expectancy depends on the degree of heart failure, which is formed as a result of pathological changes. It is not a fact that a person can expect to live happily ever after - such “blue” people do not live to an old age, and, moreover, they often die during the infancy period if surgical intervention is postponed for some reason. In addition, the tetralogy of Fallot may be accompanied by a fifth anomaly of cardiac development, which turns it into a pentade of Fallot - atrial septal defect.

Circulatory disorders with tetralogy of Fallot

Tetralogy of Fallot belongs to the so-called “blue” or cyanotic defects. A defect in the septum between the ventricles of the heart leads to a change in blood flow, resulting in blood entering the systemic circulation that does not bring enough oxygen to the tissues and they, in turn, begin to experience starvation.

Due to increasing hypoxia, the patient’s skin acquires a cyanotic (bluish) tint, which is why this defect is called “blue”. The situation with tetralogy of Fallot is aggravated by the presence of narrowing in the area of the pulmonary trunk. This leads to the fact that a sufficient volume of venous blood cannot escape through the narrowed opening of the pulmonary artery into the lungs, so a significant amount of it remains in the right ventricle and in the venous part of the systemic circulation (this is why patients turn blue). This mechanism of venous stagnation, in addition to reducing blood oxygenation in the lungs, contributes to the fairly rapid progression of CHF (chronic heart failure), which manifests itself:

Worsening cyanosis;
Violation of metabolism in tissues;
Accumulation of fluid in cavities;
Presence of edema.

In order to prevent such a development of events, the patient is indicated for cardiac surgery (radical or palliative surgery).

Symptoms of the disease

Due to the fact that the disease manifests itself quite early, in the article we will focus on childhood, starting from birth. The main manifestations of tetralogy of Fallot are caused by an increase in CHF, although in such babies the development of acute heart failure (arrhythmia, shortness of breath, anxiety, breast refusal) cannot be excluded. The appearance of the child largely depends on the severity of the narrowing of the pulmonary trunk, as well as on the extent of the defect in the septum. The greater these disturbances, the faster the clinical picture develops. The appearance of the child largely depends on the severity of the narrowing of the pulmonary trunk, as well as on the extent of the defect in the septum. The greater these disturbances, the faster the clinical picture develops.

On average, the first manifestations begin at 4 weeks of a child’s life. Main symptoms:

A bluish coloration of the skin of a child first appears when crying or sucking, then cyanosis can persist even at rest. At first, only the nasolabial triangle, fingertips, and ears appear blue (acrocyanosis), then, as hypoxia progresses, total cyanosis may develop.
The child is lagging behind in physical development (later he begins to hold his head up, sit up, and crawl).
Thickening of the terminal phalanges of the fingers in the form of “drumsticks”.
Nails become flattened and round.
The chest is flattened, and in rare cases, a “heart hump” forms.
Decreased muscle mass.
Irregular growth of teeth (wide gaps between teeth), caries develops quickly.
Spinal deformity (scoliosis).
Flat feet develops.
A characteristic feature is the appearance of cyanotic attacks, during which the child experiences:
- breathing becomes more frequent (up to 80 breaths per minute) and deeper;
- the skin becomes bluish-purple;
- pupils dilate sharply;
- shortness of breath appears;
- characterized by weakness, up to loss of consciousness as a result of the development of hypoxic coma;
- Muscle cramps may occur.

Older children tend to squat during attacks, as this position makes their condition a little easier. On average, such an attack lasts from 20 seconds to 5 minutes. However, after it, children complain of severe weakness. In severe cases, such an attack can lead to a stroke or even death.

Algorithm of actions when an attack occurs

You need to help the child squat down or take a “knee-elbow” position. This position helps reduce venous blood flow from the lower body to the heart, and therefore reduces the load on the heart muscle.
Oxygen supply through an oxygen mask at a rate of 6-7 l/min.
Intravenous administration of beta blockers (for example, Propranolol at 0.01 mg/kg body weight) eliminates tachycardia.
The administration of opioid analgesics (Morphine) helps to reduce the sensitivity of the respiratory center to hypoxia and reduce the frequency of respiratory movements.
If the attack does not stop within 30 minutes, emergency surgery may be required.

Important! During an attack, drugs that increase heart contractions (cardiotonics, cardiac glycosides) should not be used! The action of these drugs leads to an increase in the contractility of the right ventricle, which entails additional blood discharge through the defect in the septum. This means that venous blood, which contains practically no oxygen, enters the systemic circulation, which leads to an increase in hypoxia. This is how a “vicious circle” arises.

What tests are used to diagnose Tetralogy of Fallot?

When listening to the heart, the following is revealed: a weakening of the second tone; a rough, “scraping” noise is detected in the second intercostal space on the left.
Electrocardiography data can reveal ECG signs of enlargement of the right chambers of the heart, as well as a shift of the heart axis to the right.
The most informative is an ultrasound of the heart, which can reveal a defect in the interventricular septum and displacement of the aorta. Thanks to Doppler ultrasound, it is possible to study in detail the blood flow in the heart: the discharge of blood from the right ventricle to the left, as well as the difficulty of blood flow into the pulmonary trunk.
X-rays reveal the outline of the heart in the shape of a “Dutch boot”, in which the apex of the heart is slightly elevated.
In a blood test, red blood cells can be almost twice the permissible limit. This reaction of the body to hypoxia is compensatory. However, this may cause increased thrombosis.

Treatment

If a patient has tetralogy of Fallot, it is important to remember one simple rule: surgery is indicated for all (without exception!) patients with this heart defect.

The main treatment method for this heart defect is surgery. The most optimal age for surgery is considered to be 3-5 months. It is best to perform surgery as planned.

There may be situations where emergency surgery may be required at an earlier age:

Frequent attacks.
The appearance of bluish skin, shortness of breath, increased heart rate at rest.
Marked retardation of physical development.

Usually, a so-called palliative operation is performed as an emergency. During this time, an artificial shunt (connection) is not created between the aorta and the pulmonary trunk. This intervention allows the patient to temporarily gain strength before undergoing a complex, multicomponent and lengthy operation aimed at eliminating all defects in tetralogy of Fallot.

How is the operation performed?

Considering the combination of four anomalies in this heart defect, surgical intervention for this pathology is particularly difficult in cardiac surgery.

Progress of the operation:

Under general anesthesia, a dissection of the chest along the anterior line is performed.
After providing access to the heart, a heart-lung machine is connected.
An incision is made into the heart muscle from the right ventricle so as not to touch the coronary arteries.
From the cavity of the right ventricle, access to the pulmonary trunk is made, the narrowed opening is dissected, and the valves are repaired.
The next step is to close the ventricular septal defect using synthetic hypoallergenic (Dacron) or biological (from the tissue of the heart sac - pericardium) material. This part of the operation is quite complex, since the anatomical defect of the septum is located close to the heart pacemaker.
After successful completion of the previous stages, the wall of the right ventricle is sutured and blood circulation is restored.

This operation is performed exclusively in highly specialized cardiac surgery centers, where relevant experience has been accumulated in the management of such patients.

Possible complications and prognosis

The most common complications after surgery are:

Preservation of narrowing of the pulmonary trunk (with insufficient dissection of the valve).
When the fibers that conduct excitation in the heart muscle are injured, various arrhythmias may develop.

On average, postoperative mortality is up to 8-10%. But without surgical treatment, the life expectancy of children does not exceed 12-13 years. In 30% of cases, the death of a child occurs in infancy from heart failure, stroke, or increasing hypoxia.

However, with surgical treatment performed on children under 5 years of age, the vast majority of children (90%) upon re-examination at the age of 14 years do not reveal any signs of developmental lag from their peers.

Moreover, 80% of operated children lead a normal lifestyle, practically no different from their peers, except for restrictions on excessive physical activity. It has been proven that the earlier a radical operation is performed to eliminate this defect, the faster the child recovers and catches up with his peers in development.

Is registration of a disability group indicated for illness?

All patients before undergoing radical heart surgery, as well as 2 years after the operation, are required to register for disability, after which re-examination is carried out.

When determining the disability group, the following indicators are of great importance:

Are there any circulatory problems after surgery?
Does pulmonary artery stenosis persist?
The effectiveness of surgical treatment and whether there are complications after surgery.

Is it possible to diagnose tetralogy of Fallot in utero?

Diagnosis of this heart defect directly depends on the qualifications of the specialist performing ultrasound diagnostics during pregnancy, as well as on the level of the ultrasound machine.

When an expert-class ultrasound is performed by a high-category specialist, tetralogy of Fallot is detected in 95% of cases up to 22 weeks; in the third trimester of pregnancy, this defect is diagnosed in almost 100% of cases.

In addition, an important factor is genetic research, the so-called “genetic doubles and triples”, which are performed as screening on all pregnant women at 15-18 weeks. It has been proven that tetralogy of Fallot in 30% of cases is combined with other anomalies, most often chromosomal diseases (Down syndrome, Edwards syndrome, Patau syndrome, etc.).

What to do if this pathology is detected in the fetus during pregnancy?

If this heart defect is detected in combination with a serious chromosomal abnormality, accompanied by severe mental development disorders, the woman is offered termination of pregnancy for medical reasons.

If only a heart defect is detected, then a consultation gathers: obstetricians-gynecologists, cardiologists, cardiac surgeons, neonatologists, as well as a pregnant woman. At this consultation, the woman is explained in detail: why this pathology is dangerous for the child, what the consequences may be, as well as the possibilities and methods of surgical treatment.

Despite the multicomponent nature of tetralogy of Fallot, this heart defect is classified as operable, that is, it is subject to surgical correction. This disease is not a death sentence for a child. The modern level of medicine allows in 90% of cases to significantly improve the patient’s quality of life through a complex, multi-stage operation.

Currently, cardiac surgeons practically do not use palliative operations, which only temporarily improve the patient’s condition. The priority is radical surgery performed in early childhood (up to one year). This approach allows you to normalize overall physical development and avoid the formation of permanent deformities in the body, which significantly improves the quality of life.

Video: tetralogy of Fallot, blue defects - program “Live Healthy!”

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Heart disease in a child is the most complex nosological entity in medicine. Every year, per 1000 newborns, there are 10-17 children with this problem. Early detection and referral for treatment guarantees a favorable prognosis for later life.

Undoubtedly, all developmental defects must be diagnosed in the fetus in utero. An important role is also played by the pediatrician, who will be able to promptly identify and refer such a child to a pediatric cardiologist.

If you are faced with this pathology, then let’s look at the essence of the problem, and also tell you the details of the treatment of children’s heart defects.

Diseases of the mother during pregnancy.
An infectious disease suffered in the 1st trimester, when the development of cardiac structures occurs at 4-5 weeks.
Smoking, mother's alcoholism.
Ecological situation.
Hereditary pathology.
Genetic mutations caused by chromosomal abnormalities.

There are many reasons for the appearance of congenital heart disease in a fetus. It is impossible to single out just one.

Classification of defects

1. All congenital heart defects in children are divided according to the nature of the blood flow disturbance and the presence or absence of cyanosis of the skin (cyanosis).

Cyanosis is a blue discoloration of the skin. It is caused by a lack of oxygen, which is delivered with the blood to organs and systems.

2. Frequency of occurrence.

Ventricular septal defect occurs in 20% of all heart defects.
Atrial septal defect accounts for 5 - 10%.
Patent ductus arteriosus accounts for 5 - 10%.
Pulmonary stenosis, stenosis and coarctation of the aorta account for up to 7%.
The remaining part is accounted for by other numerous, but rarer defects.

Signs of heart disease in children

one of the signs of defects is the appearance of shortness of breath. First it appears during exercise, then at rest.

Dyspnea is an increased rate of breathing;

a change in skin tone is the second sign. Color may vary from pale to bluish;

swelling of the lower extremities. This is how cardiac edema differs from renal edema. With kidney pathology, the face swells first;

the increase in heart failure is assessed by an increase in the edge of the liver and increased swelling of the lower extremities. This is usually cardiac edema;

with tetralogy of Fallot there may be shortness of breath and cyanotic attacks. During an attack, the child begins to suddenly “turn blue” and rapid breathing appears.

Symptoms of heart defects in newborns

You need to pay attention to:

starting breastfeeding;
Is the baby actively sucking?
duration of one feeding;
does the breast drop during feeding due to shortness of breath;
Does pallor appear when sucking?

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

Symptoms of heart disease in children older than one year

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

Can they climb the stairs to the 4th floor without shortness of breath? Do they sit down to rest during games?
whether respiratory diseases, including pneumonia and bronchitis, are common.

Clinical case! In a woman at 22 weeks, an ultrasound of the fetal heart revealed a ventricular septal defect and hypoplasia of the left atrium. This is a rather complex vice. After the birth of such babies, they are immediately operated on. But the survival rate, unfortunately, is 0%. After all, heart defects associated with underdevelopment of one of the chambers in the fetus are difficult to treat surgically and have a low survival rate.

Violation of the integrity of the interventricular septum

The heart has two ventricles, which are separated by a septum. In turn, the septum has a muscular part and a membranous part.

The muscular part consists of 3 areas - inflow, trabecular and outflow. This knowledge of anatomy helps the doctor make an accurate diagnosis according to the classification and decide on further treatment tactics.

If the defect is small, then there are no special complaints.

If the defect is medium or large, then the following symptoms appear:

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

For large defects and the development of heart failure, surgical measures should be performed.

Atrial septal defect

Very often the defect is an accidental discovery.

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

With large defects (more than 1 cm), the child may experience poor weight gain and the development of heart failure from birth. Children undergo surgery when they reach five years of age. The delay in surgery is due to the likelihood of spontaneous closure of the defect.

Open duct of Botall

This problem accompanies premature babies in 50% of cases.

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

poor weight gain;
shortness of breath, rapid heartbeat;
frequent ARVI, pneumonia.

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

When diagnosed in the maternity hospital, premature babies are given the drug indomethacin, which scleroses (glues) the walls of the vessel. This procedure is not effective for full-term newborns.

Coarctation of the aorta

This congenital pathology is associated with a narrowing of the main artery of the body - the aorta. In this case, a certain obstacle to blood flow is created, which forms a specific clinical picture.

Happening! A 13-year-old girl complained of increased blood pressure. When measuring pressure on the legs with a tonometer, it was significantly lower than on the arms. The pulse in the arteries of the lower extremities was barely palpable. Cardiac ultrasound revealed coarctation of the aorta. For 13 years, the child has never been examined for congenital defects.

Usually, narrowing of the aorta is detected at birth, but may occur later. Such children even have their own peculiarity in appearance. Due to poor blood supply to the lower part of the body, they have a fairly developed shoulder girdle and puny legs.

It occurs more often in boys. As a rule, coarctation of the aorta is accompanied by a defect in the interventricular septum.

Bicuspid aortic valve

Normally, the aortic valve should have three cusps, but it so happens that there are two of them from birth.

Tricuspid and bicuspid aortic valve

Children with a bicuspid aortic valve do not particularly complain. The problem may be that such a valve will wear out faster, which will cause the development of aortic insufficiency.

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

Children with a bicuspid aortic valve should be monitored twice a year and endocarditis should be prevented.

Sports heart

Regular physical activity leads to changes in the cardiovascular system, which are referred to as “athletic heart.”

An athletic heart is characterized by an increase in the cavities of the cardiac chambers and myocardial mass, but cardiac function remains within the age-related norm.

Changes in the heart appear 2 years after regular training 4 hours a day, 5 days a week. Athletic heart is more common among hockey players, sprinters, and dancers.

Changes during intense physical activity occur due to the economical work of the myocardium at rest and the achievement of maximum capabilities during sports activities.

Sports heart does not require treatment. Children should be examined twice a year.

Acquired heart defects in children

The most common acquired heart defect is a valve defect.

rheumatism;
previous bacterial and viral infections;
infective endocarditis;
frequent sore throats, previous scarlet fever.

Of course, children with an unoperated acquired defect must be observed by a cardiologist or therapist throughout their lives. Congenital heart defects in adults are an important problem that should be reported to your physician.

Diagnosis of congenital heart defects

Clinical examination by a neonatologist of the child after birth.
Fetal ultrasound of the heart. Conducted at 22-24 weeks of pregnancy, where the anatomical structures of the fetal heart are assessed
At 1 month after birth, ultrasound heart screening, ECG.

The most important examination in diagnosing the health of the fetus is ultrasound screening in the second trimester of pregnancy.

Assessment of weight gain in infants, feeding patterns.

Assessment of exercise tolerance, physical activity of children.

When listening to a characteristic heart murmur, the pediatrician refers the child to a pediatric cardiologist.

Ultrasound of the abdominal organs.

In modern medicine, if you have the necessary equipment, diagnosing a congenital defect is not difficult.

Treatment of congenital heart defects

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

The determining tactics of treatment will be:

type of defect;
presence or worsening heart failure;
age, weight of the child;
associated developmental defects;
the likelihood of spontaneous elimination of the defect.

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

Prevention of congenital heart defects

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

Elimination of smoking and toxic effects during pregnancy.
Consultation with a geneticist if there are congenital defects in the family.
Proper nutrition for the expectant mother.
Treatment of chronic foci of infection is mandatory.
Physical inactivity worsens the functioning of the heart muscle. Daily gymnastics, massages, and work with a physical therapy doctor are required.
Pregnant women should definitely undergo ultrasound screening. Heart defects in newborns should be monitored by a cardiologist. If necessary, it is necessary to promptly refer to a cardiac surgeon.
Mandatory rehabilitation of operated children, both psychological and physical, in sanatorium-resort conditions. Every year the child must be examined in a cardiology hospital.

Heart defects and vaccinations

It should be remembered that it is better to refuse vaccinations if:

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

Graduated from South State Medical University, internship in pediatrics, residency in pediatric cardiology, since 2012 she has worked at the Lotos MC, Chelyabinsk.

Heart disease: what is it?

“Blue”, in which venous blood enters the arteries, so the skin acquires a bluish tint. This group of congenital heart diseases is the most dangerous, since the child’s organs and tissues do not receive enough oxygen due to the mixing of arterial and venous blood saturated with carbon dioxide. The most common “blue” congenital heart defects are pulmonary atresia, tetralogy of Falo, and transposition of the vessels.
“White”, characterized by the discharge of blood to the right side of the heart and pale skin. Defects of this type are easier for patients to tolerate, but over time they lead to the development of heart failure and lung problems. Examples are atrial septal defect, patent ductus arteriosus, etc.

Alcohol, nicotine, drugs.
Radiation.
Certain medications (including sulfonamides, aspirin, antibiotics).
Rubella virus.
Unfavorable ecology.

How to determine a heart defect?

Pale or bluish skin (especially around the lips, on the arms, on the heels).
Poor weight gain.
Sluggish sucking, frequent breaks during feeding.
Rapid heartbeat (the norm in newborns is 150 – 160 beats per minute).

Lagging behind peers in physical development.

The child complains of headaches and dizziness.

Periodic fainting.

Frequent colds, complicated by prolonged bronchitis and pneumonia.

Treatment and prognosis

Small defects in the septa between the ventricles and atria.
Patent ductus arteriosus.
Minor deformations of the heart valves.

Transposition (change of places) of the aorta and pulmonary artery.
The origin of both the aorta and pulmonary artery is from the right ventricle.
Tetralogy of Falo (includes 4 anomalies of the development of the heart and great vessels).
Severe valve defects.
Hypoplasia (underdevelopment) of the heart. A particularly dangerous defect is the underdevelopment of the left sections. The question of how long people live with it can be answered with statistical data - with this defect there is almost 100% mortality.
Atresia (fusion) of the pulmonary artery.

While still in the mother’s tummy, the baby’s cardiac system is formed. Every parent worries about the health of the little person, but no one is immune from heart defects. Today, every second child born can be diagnosed with this pathology.

Every mother needs to know what heart disease means in newborns, why it is dangerous, its causes, signs of pathology and methods of treatment. Give up bad habits, follow a proper diet - this is important not only for you, but also for your baby.

Description of the pathology

Heart disease in newborns

Congenital heart disease is an anatomical defect that occurs in utero (during pregnancy, in the early stages), a violation of the correct structure of the heart, or the valve apparatus, or the blood vessels of the child’s heart. Among heart diseases in children, congenital defects firmly occupy a leading position.

Every year, out of every 1,000 babies born, 7 to 17 have heart anomalies or malformations. Moreover, without the provision of qualified cardiac, intensive care and cardiac surgery care, up to 75% of babies may die in the first months of life.

There are about two dozen CHDs in total, and the frequency of occurrence varies. The most common defects, according to pediatric cardiologists, are: ventricular septal defect, in second place is atrial septal defect, in third place is patent ductus arteriosus.

Of particular social significance are the high mortality and disability rates of children from a very early age, which undoubtedly has serious implications for the health of the nation as a whole. Children require detailed and highly qualified treatment; we need trained specialists in the regions and specialized clinics.

Sometimes the treatment of a child is long and expensive, and most parents are simply not able to pay for the treatment, which makes it much more difficult to provide assistance. With the current level of progress in cardiac surgery, it is possible to surgically cure 97% of children with defects, and in the future the children will completely get rid of the disease. The main thing is a timely diagnosis!

Congenital heart defects are anomalies in the structure of large vessels and the heart that form between 2 and 8 weeks of pregnancy. According to statistics, 1 child out of a thousand is diagnosed with such a pathology, and in one or two, the diagnosis can be fatal.

Why does heart disease occur in newborns?

A congenital defect occurs if any harmful factor affects the development of the cardiovascular system in the fetus. During these periods, the most severe defects are formed, because the formation of the chambers and partitions of the heart occurs, and the main vessels are formed.

Often the causes of congenital heart disease are viral diseases that a pregnant woman suffers in the first three months; viruses are able to penetrate to the fetus through the developing placenta and have a damaging effect. The harmful effects of ARVI, influenza and herpes simplex have been proven.

The rubella virus poses the greatest danger to a pregnant woman, especially if there are children in the family. Rubella, contracted by the mother up to 8-12 weeks, in 60-80% of cases causes Gregg's triad - a classic symptom complex of rubella: congenital heart disease with congenital cataracts (clouding of the lens) and deafness.

There may also be malformations of the nervous system. An important role in the formation of congenital heart disease is played by occupational hazards, intoxication, and unfavorable environmental conditions of the place of residence - for mothers who drank alcohol in the early stages of pregnancy, the likelihood of the defect increases by 30%, and in combination with nicotine - up to 60%.

In 15% of children with heart defects, there is an indication of the expectant mother’s contact with paint and varnish materials, and in 30% of children, the fathers were drivers of vehicles, often in contact with gasoline and exhaust gases.

There is a connection between the development of the defect and the mother taking medications shortly before pregnancy, in the early stages - papaverine, quinine, barbiturates, narcotic analgesics and antibiotics, hormonal substances that can negatively affect the formation of the heart.

Chromosomal and gene mutations are detected in 10% of children with heart defects, and a connection with toxicosis of pregnancy and many other factors has been noted.

How does the disease develop and how dangerous is it?

By the end of the first trimester of pregnancy, the fetal heart is already well formed, and by the 16-20th week of pregnancy, it is possible to identify many severe defects using ultrasound. With subsequent studies, the diagnosis can be definitively established.

The blood circulation of the fetus is designed in such a way that most defects do not affect intrauterine development - with the exception of extremely severe ones, in which the death of the baby occurs in the first weeks of intrauterine development.

After birth, the baby’s blood circulation is rearranged into two circles of blood circulation, the vessels and openings that worked intrauterinely are closed, and the circulatory system is adjusted to an adult way.

The clinical picture of congenital heart disease is varied and is determined by three characteristic factors:

depends on the type of defect;
from the capabilities of the baby’s body to compensating for violations, using adaptive reserve capabilities;
complications arising from the defect.

Taken together, the signs give a different picture of the defect in different babies; in some it is recognized immediately, or it can be asymptomatic for a long time. Babies often experience cyanosis (blue color), while others may have a blue appearance in both their limbs and body. The second dangerous sign is shortness of breath and heavy breathing of the baby, he cannot suckle, gets tired quickly, and is lethargic.

It is possible that the baby is not gaining weight well, despite all efforts to feed, there may be delays in psychomotor development, frequent respiratory illnesses, recurring pneumonia in early childhood, disturbances in the structure of the chest with the formation of a protrusion (heart hump) in the area of the projection of the heart.

We will talk about the manifestations, specific complaints and clinical picture of each type of congenital heart disease in the future, the main thing that is worth noting for parents is that if the baby has the slightest alarming symptoms, seek advice from a pediatrician or cardiologist.

Classification

There are a large number of classifications of heart defects in newborns, and among them there are about 100 types. Most researchers divide them into white and blue:

white: baby's skin becomes pale;
blue: the baby’s skin takes on a bluish tint.

White heart defects include:

ventricular septal defect: part of the septum is lost between the ventricles, venous and arterial blood mixes (observed in 10-40% of cases);
atrial septal defect: formed when the closure of the oval window is disrupted, as a result, a “gap” is formed between the atria (observed in 5-15% of cases);
coarctation of the aorta: in the area where the aorta exits the left ventricle, narrowing of the aortic trunk occurs (observed in 7-16% of cases);
stenosis of the aortic mouth: often combined with other heart defects, a narrowing or deformation is formed in the area of the valve ring (observed in 2-11% of cases, more often in girls);
patent ductus arteriosus: normally, closure of the aortic duct occurs 15-20 hours after birth; if this process does not occur, then blood is discharged from the aorta into the vessels of the lungs (observed in 6-18% of cases, more often in boys);
pulmonary artery stenosis: the pulmonary artery narrows (this can be observed in different parts of it) and this hemodynamic disturbance leads to heart failure (observed in 9-12% of cases).

Blue heart defects include:

tetralogy of Fallot: accompanied by a combination of pulmonary artery stenosis, displacement of the aorta to the right and ventricular septal defect, leading to insufficient blood flow into the pulmonary artery from the right ventricle (observed in 11-15% of cases);
atresia of the tricuspid valve: accompanied by a lack of communication between the right ventricle and the atrium (observed in 2.5-5% of cases);
anomalous drainage (ie drainage) of the pulmonary veins: the pulmonary veins drain into the vessels leading to the right atrium (observed in 1.5-4% of cases);
transposition of large vessels: the aorta and pulmonary artery change places (observed in 2.5-6.2% of cases);
common arterial trunk: instead of the aorta and pulmonary artery, only one vascular trunk (truncus) branches off from the heart, this leads to mixing of venous and arterial blood (observed in 1.7-4% of cases);
MARS syndrome: manifested by mitral valve prolapse, false chordae in the left ventricle, patent foramen ovale, etc.

Congenital valvular heart defects include anomalies associated with stenosis or insufficiency of the mitral, aortic or tricuspid valve.

Although congenital defects are detected in the womb, in most cases they do not pose a threat to the fetus, since its circulatory system is slightly different from that of an adult. Below are the main heart defects.

Ventricular septal defect.

The most common pathology. Arterial blood enters through the opening from the left ventricle to the right. This increases the load on the small circle and on the left side of the heart.

When the hole is microscopic and causes minimal changes in blood circulation, surgery is not performed. For large holes, suturing is done. Patients live to old age.

A condition where the interventricular septum is severely damaged or absent altogether. In the ventricles, a mixture of arterial and venous blood occurs, the oxygen level drops, and cyanosis of the skin is pronounced.

Children of preschool and school age are typically forced to squat (this reduces shortness of breath). An ultrasound scan reveals an enlarged spherical heart and a noticeable cardiac hump (protrusion).

The operation must be done without delaying for long, since without appropriate treatment, patients, at best, live up to 30 years.

Patent ductus arteriosus

It occurs when, for some reason, the connection between the pulmonary artery and the aorta remains open during the postpartum period.

A small diameter of the cleft does not pose a danger, while a large defect requires urgent surgical intervention.

The most severe defect, which includes four anomalies at once:

stenosis (narrowing) of the pulmonary artery;
ventricular septal defect;
dextraposition of the aorta;
enlargement of the right ventricle.

Modern techniques make it possible to treat such defects, but a child with such a diagnosis is registered with a cardiorheumatologist for life.

Aortic stenosis

Stenosis is a narrowing of a vessel that interferes with blood flow. It is accompanied by a tense pulse in the arteries of the arms, and a weakened pulse in the legs, a large difference between the pressure in the arms and legs, a burning sensation and heat in the face, numbness of the lower extremities.

The operation involves installing a graft on the damaged area. After the measures taken, the functioning of the heart and blood vessels is restored and the patient lives a long time.

General symptoms of the disease in newborns

Within the group of diseases called Congenital Heart Disease, symptoms are divided into specific and general. Specific ones, as a rule, are not assessed immediately at the time the child is born, because the first goal is to stabilize the functioning of the cardiovascular system.

Specific symptoms are often identified during functional tests and instrumental research methods. The general symptoms include the first characteristic signs. This is tachypnea, tachycardia or bradycardia, skin coloring characteristic of two groups of defects (white and blue defects).

These violations are fundamental. At the same time, the task of the circulatory and respiratory system is to supply the remaining tissues with oxygen and a substrate for oxidation, from which energy is synthesized.

Under conditions of blood mixing in the cavity of the atria or ventricles, this function is disrupted, and therefore peripheral tissues suffer from hypoxia, which also applies to nervous tissue. These features also characterize heart valve defects, vascular malformations in the heart, dysplasia of the aorta and pulmonary veins, transposition of the aorta and pulmonary trunk, coarctation of the aorta.

As a result, muscle tone decreases and the intensity of the manifestation of basic and specific reflexes decreases. These signs are included in the Apgar scale, which allows you to determine the degree of full term of the child.

At the same time, congenital heart disease in newborns can often be accompanied by early or premature birth. This can be explained by many reasons, although often, when congenital heart disease is not detected in newborns, this indicates prematurity due to:

Metabolic;
Hormonal;
Physiological and other reasons.

Some birth defects are accompanied by changes in skin color. There are blue defects and white defects, accompanied by cyanosis and pallor of the skin, respectively. White defects include pathologies accompanied by the discharge of arterial blood or the presence of an obstacle to its release into the aorta.

These vices include:

Coarctation of the aorta.
Aortic stenosis.
Atrial or ventricular septal defect.

For blue defects, the development mechanism is associated with other reasons. Here the main component is stagnation of blood in a large circle due to poor outflow into the pulmonary aorta, lungs or left parts of the heart. These are disorders such as mitral, aortic, tricuspid congenital heart disease.

The causes of this disorder also lie in genetic factors, as well as in diseases of the mother before and during pregnancy. Mitral valve prolapse in children: symptoms and diagnosis Mitral valve prolapse (MVP) in children is one of the types of congenital heart defects, which became known only half a century ago.

Let us remember the anatomical structure of the heart to understand the essence of this disease. It is known that the heart has two atria and two ventricles, between which there are valves, a kind of gate that allows blood to flow in one direction and prevents blood from flowing back into the atria during contraction of the ventricles.

Between the right atrium and the ventricle, the locking function is performed by the tricuspid valve, and between the left ones - by the bicuspid, or mitral, valve. Mitral valve prolapse is manifested by the bowing of one or both valve leaflets into the atrium during contraction of the left ventricle.

Mitral valve prolapse in a child is usually diagnosed in older preschool or school age, when, unexpectedly for the mother, the doctor discovers a heart murmur in a practically healthy child and suggests being examined by a cardiologist. An ultrasound examination of the heart will confirm the doctor’s suspicions and allow us to speak with confidence about mitral valve prolapse.

Regular monitoring by a cardiologist is the only indispensable condition that a child will have to comply with before starting activities associated with physical overexertion. Most people with mitral valve prolapse lead normal lives without knowing they have the disease.

Severe complications of mitral valve prolapse are rare. This is mainly divergence of the leaflets, leading to mitral valve insufficiency, or infective endocarditis.

Heart disease in newborns - causes

In 90% of cases, congenital heart disease in a newborn develops due to exposure to unfavorable environmental factors. The reasons for the development of this pathology include:

genetic factor;
intrauterine infection;
age of parents (mother over 35 years old, father over 50 years old);
environmental factor (radiation, mutagenic substances, soil and water pollution);
toxic effects (heavy metals, alcohol, acids and alcohols, contact with paints and varnishes);
taking certain medications (antibiotics, barbiturates, narcotic analgesics, hormonal contraceptives, lithium preparations, quinine, papaverine, etc.);
maternal diseases (severe toxicosis during pregnancy, diabetes mellitus, metabolic disorders, rubella, etc.)

Children at risk for developing congenital heart defects include:

with genetic diseases and Down syndrome;
premature;
with other developmental defects (i.e., with disturbances in the functioning and structure of other organs).

Symptoms and signs of congenital heart disease in children can vary. The degree of their manifestation largely depends on the type of pathology and its impact on the general condition of the newborn. If a baby has a compensated heart defect, it is almost impossible to notice any signs of the disease externally.

If the newborn has a decompensated heart defect, then the main signs of the disease will be noted after birth. Congenital heart defects in children are manifested by the following symptoms:

Blue skin. This is the first sign that the child has congenital heart disease.

It occurs against the background of a deficiency of oxygen in the body. Limbs, the nasolabial triangle, or the entire body may turn blue. However, blue discoloration of the skin can also occur with the development of other diseases, for example, the central nervous system.

Breathing problems and cough.

In the first case we are talking about shortness of breath.

Moreover, it occurs not only during the period when the baby is awake, but also in a state of sleep. Normally, a newborn baby takes no more than 60 breaths per minute. With congenital heart disease, this amount increases by almost one and a half times.

Increased heart rate. A characteristic sign for congenital heart disease. But it should be noted that not all types of defect are accompanied by such a symptom. In some cases, on the contrary, a decreased pulse is observed.

General deterioration in health: poor appetite, irritability, restless sleep, lethargy, etc. In severe forms of congenital heart disease, children may experience attacks of suffocation and even loss of consciousness.

A doctor can assume that a newborn child has this pathology based on the following signs:

Bluishness of the limbs.
Pallor of the skin.
On cold hands, feet and nose (to the touch).
Heart murmurs during auscultation (listening).
Presence of symptoms of heart failure.

If the baby exhibits all these signs, the doctor gives a referral for a full examination of the child to clarify the diagnosis.

As a rule, the following diagnostic methods are used to confirm or refute the diagnosis:

Ultrasound of all internal organs and assessment of their functioning.
Phonocardiogram.
X-ray of the heart.
Cardiac catheterization (to clarify the type of defect).
MRI of the heart.
Blood tests.

It should be noted that external signs of congenital heart disease may initially be completely absent, and appear only as the baby grows older. Therefore, it is very important that every parent thoroughly examines their child in the first few months.

This will allow timely identification of the development of congenital heart disease and take all necessary measures. It’s just that if this pathology is not detected in a timely manner and its treatment is not started, this can lead to dire consequences.

Signs of the disease

A newborn baby with a heart defect is restless and does not gain weight well. The main signs of congenital heart disease may include the following symptoms:

cyanosis or pallor of the outer skin (usually in the area of the nasolabial triangle, on the fingers and toes), which is especially pronounced during breastfeeding, crying and straining;
lethargy or restlessness when attaching to the breast;
slow weight gain;
frequent regurgitation during breastfeeding;
causeless screaming;
attacks of shortness of breath (sometimes combined with cyanosis) or constantly rapid and difficult breathing;
causeless tachycardia or bradycardia;
sweating;
swelling of the limbs;
bulging in the area of the heart.

If such signs are detected, the child’s parents should immediately consult a doctor to have the child examined. During the examination, the pediatrician can detect heart murmurs and recommend further treatment by a cardiologist.

Diagnostics

If congenital heart disease is suspected, the child is urgently sent for consultation to a cardiologist, and in case of emergency measures, to a cardiac surgery hospital.

There they will pay attention to the presence of cyanosis that changes when breathing under an oxygen mask, shortness of breath involving the ribs and intercostal muscles, assess the nature of the pulse and pressure, conduct blood tests, assess the condition of organs and systems, especially the brain, listen to the heart, noting the presence of various noises, and will conduct additional research.

An ultrasound of the heart and blood vessels will be performed. Diagnostics, goals:

clarify whether there really is a vice;
determine the main circulatory disorders caused by congenital heart disease, recognize the anatomy of the defect;
to clarify the phase of the defect, the possibility of surgical and conservative treatment at this stage;
determine the presence or absence of complications, the feasibility of their treatment;
choose the tactics of surgical correction and timing of the operation.

At the present stage, with the introduction into practice of almost universal ultrasound examination of the fetus during pregnancy, there is actually a possibility of making a diagnosis of congenital heart disease at a period of pregnancy up to 18-20 weeks, when the question of the advisability of continuing pregnancy can be decided.

Unfortunately, there are few such highly specialized hospitals in the country, and most mothers are forced to go to large centers in advance for hospitalization and childbirth. If an ultrasound reveals abnormalities in the baby’s heart, do not become despondent.

The defect is not always detected in utero, but from the moment of birth the clinical picture of the defect begins to increase - then emergency assistance may be required, the baby will be transferred to a cardiac surgery hospital in an intensive care unit and everything possible will be done to save his life, including open-heart surgery.

To diagnose children with suspected congenital heart disease, a complex of the following research methods is used:

Echo-CG;
radiography;
general blood analysis.

If necessary, additional diagnostic methods such as cardiac catheterization and angiography are prescribed.

All newborns with congenital heart defects are subject to mandatory monitoring by a local pediatrician and cardiologist. A child in the first year of life should be examined every 3 months. For severe heart defects, examination is carried out every month.

Parents must be made aware of the mandatory conditions that must be created for such children:

preference for natural feeding with mother's or donor milk;
increasing the number of feedings by 2-3 doses with a decrease in the amount of food per meal;
frequent walks in the fresh air;
feasible physical activity;
contraindications for being in severe frost or open sun;
timely prevention of infectious diseases;
rational nutrition with a reduction in the amount of liquid drunk, table salt and the inclusion of foods rich in potassium in the diet (baked potatoes, dried apricots, prunes, raisins).

Surgical and therapeutic techniques are used to treat a child with congenital heart disease. As a rule, medications are used to prepare a child for surgery and treatment after it.

For severe congenital heart defects, surgical treatment is recommended, which, depending on the type of heart defect, can be performed using a minimally invasive technique or using an open heart with the child connected to a heart-lung machine.

After the operation, the child is under the supervision of a cardiologist. In some cases, surgical treatment is carried out in several stages, i.e. the first operation is performed to alleviate the patient’s condition, and subsequent operations are performed to completely eliminate the heart defect.

The prognosis for timely surgery to eliminate congenital heart disease in newborns is favorable in most cases.

Medications

Taking medications during pregnancy is of particular importance. Currently, they have completely stopped taking thalidomide - this drug caused numerous congenital deformities during pregnancy (including congenital heart defects).

In addition, the following have a teratogenic effect:

alcohol (causes ventricular and atrial septal defects, patent ductus arteriosus),

amphetamines (VSDs and transposition of large vessels are more often formed),

anticonvulsants - hydantoin (pulmonary stenosis, coarctation of the aorta, patent ductus arteriosus),

trimethadione (transposition of the great vessels, tetralogy of Fallot, left ventricular hypoplasia),

lithium (Ebstein's anomaly, tricuspid valve atresia),

progestogens (tetralogy of Fallot, complex congenital heart disease).

There is a general consensus that the most dangerous period for the development of congenital heart disease is the first 6-8 weeks of pregnancy. When a teratogenic factor enters this interval, the development of severe or combined congenital heart disease is most likely.

However, the possibility of less complex damage to the heart or some of its structures at any stage of pregnancy cannot be ruled out.

Correction methods

Emergency, or primary adaptation, begins from the moment the baby is born. At this stage, in order to compensate for congenital heart disease and dysfunction of the heart, all the body’s reserves are used, the vessels, heart muscles, lung tissues and other organs that experience oxygen deficiency adapt to the extreme load.

If the capabilities of the baby’s body are too small, such a defect can lead to the death of the baby if cardiac surgery is not provided to him quickly.

If there are enough compensatory capabilities, the body enters the stage of relative compensation, and all the child’s organs and systems enter a certain stable rhythm of work, adjusting to increased demands, and they work this way whenever possible and the baby’s reserves will not be exhausted.

Then decompensation naturally occurs - the terminal stage, when, having become exhausted, all the structures of the heart and blood vessels, as well as lung tissue, can no longer perform their functions and heart failure develops.

The operation is usually carried out in the compensation stage - then it is easiest for the child to endure it: the body has already learned to cope with increased demands. Less often, surgery is required urgently - at the very beginning of the emergency phase, when the child cannot survive without help.

Surgical correction of congenital defects in Russia dates back to 1948, when the first correction of congenital defects was performed - ligation of the patent ductus arteriosus. And in the 21st century, the possibilities of cardiac surgery have expanded significantly.

Now assistance is being provided to eliminate defects in low birth weight and premature babies, operations are being carried out in cases that even two decades ago were still considered incorrigible. All efforts of surgeons are aimed at correcting congenital heart disease as early as possible, which will allow the child to lead a normal life in the future, no different from his peers.

Unfortunately, not all defects can be eliminated with one operation. This is due to the characteristics of the baby’s growth and development, and in addition to this, the adaptive abilities of the vessels of the heart and lungs to the load.

In Russia, about 30 institutions provide care to children, and more than half of them can perform major open-heart and cardiopulmonary bypass operations. The operations are quite serious, and after them a long stay in the clinic for rehabilitation is required.

Minimally invasive techniques are gentle and less traumatic - operations using ultrasound and endoscopic techniques that do not require large incisions or connecting the baby to a heart-lung machine.

Through large vessels, using special catheters under X-ray or ultrasound control, manipulations are carried out inside the heart, making it possible to correct many defects of the heart and its valves. They can be performed under both general and local anesthesia, which reduces the risk of complications. After the interventions, you can go home after a few days.

If surgery is not indicated for the baby or the stage of the process does not allow it to be performed right now, various medications are prescribed to support heart function at the proper level.

For a child with congenital heart disease, it is vital to strengthen the immune system in order to prevent the formation of foci of infection in the nose, throat or other places. They need to often be in the fresh air and monitor the loads, which must strictly correspond to the type of defect.

Consequences of the disease

Any congenital heart defect leads to serious hemodynamic disturbances associated with the progression of the disease, as well as decompensation of the body’s cardiac system. The only way to prevent the development of cardiovascular failure is early surgery, performed within 6 months to 2 years.

Its importance lies in the need to normalize blood flow in the heart and great vessels. Children with congenital heart disease need to be protected from infective endocarditis, an infection and inflammation of the inner layer of heart tissue.

Infection can occur in children with congenital heart disease after most dental procedures, including teeth cleanings, fillings, and root canal treatment.

Surgery of the throat, oral cavity, and procedures or examinations of the gastrointestinal tract (esophagus, stomach and intestines) or urinary tract can cause infective endocarditis. Infective endocarditis can develop after open heart surgery.

Once in the bloodstream, bacteria or fungi usually migrate towards the heart, where they infect abnormal cardiac tissue exposed to turbulent turbulence of the blood flow, the valves. While many microorganisms can cause infective endocarditis, infective endocarditis is most often caused by staphylococcal and streptococcal bacteria.

Many teenagers with heart defects suffer from spinal curvature (scoliosis). In children with difficulty breathing, scoliosis can complicate respiratory problems.

Helping a weak heart

To help your core recover faster, follow these recommendations. Nutrition. Food should be low in calories and low in salt. The core needs to consume:

more protein foods (boiled lean meat, fish, dairy products),
vegetables (beets, carrots, tomatoes, potatoes),
fruits (persimmons, bananas, apples),
greens (dill, parsley, lettuce, green onions).

Avoid foods that cause bloating (legumes, cabbage, soda). The child should not eat baked goods and semi-finished products. Do not offer your baby:

Let's instead:

rosehip decoction,
fresh juice,
slightly sweetened compote.

Exercises. CHD is not a reason to stop playing sports. Enroll your little one in exercise therapy or conduct classes at home.

Start your warm-up with two to three deep breaths. Perform sideways and forward bends of your torso, stretching exercises, walking on your toes, then bending your legs at the knee.

After getting rid of a vice, the baby needs time to readjust to living without it. Therefore, the baby is registered with a cardiologist and visits him regularly. Strengthening the immune system plays an important role, since any cold can have a detrimental effect on the cardiovascular system and health in general.

As for physical exercises in school and kindergarten, the degree of load is determined by a cardio-rheumatologist. If an exemption from physical education classes is necessary, this does not mean that the child is contraindicated to move. In such cases, he engages in physical therapy according to a special program at the clinic.

Children with congenital heart disease are advised to spend a long time in the fresh air, but in the absence of extreme temperatures: both heat and cold have a bad effect on blood vessels that are working hard. Salt intake is limited. The diet must include foods rich in potassium: dried apricots, raisins, baked potatoes.

Vices are different. Some require immediate surgical treatment, others are under constant medical supervision until a certain age.

In any case, today medicine, including cardiac surgery, has stepped forward, and defects that were considered incurable and incompatible with life 60 years ago are now successfully operated on and children live long lives.

Therefore, when you hear a terrible diagnosis, you should not panic. You need to tune in to fight the disease and do everything on your part to defeat it.

In this case, it is also necessary to take into account other potentially unfavorable factors, for example, the adverse effect of high temperature on certain heart defects. For these reasons, when choosing a profession in these patients, it is necessary to take into account the opinion of the cardiologist.

And the last nuance that I would like to touch upon is pregnancy in women with congenital heart disease. This problem is now quite acute, due to its complexity and not so low prevalence, especially after mitral valve prolapses began to be classified as “minor heart defects” and they began to be subject to orders and regulations of the Ministry of Health regarding the tactics of managing pregnant women with UPS.

In general, with the exception of anatomically and hemodynamically compensated defects, pregnancy in all congenital heart diseases is associated with a risk of complications. True, it all depends on the specific defect and the degree of compensation.

In some congenital heart diseases (for example, ventricular septal defect and aortic stenosis), increased workload during pregnancy can lead to the development of heart failure.

During pregnancy, there is an increased tendency to form vascular aneurysms, including ruptures of the vascular wall. Women with high pulmonary hypertension are more likely to experience miscarriages, vein thrombosis, and even sudden death. Therefore, the issue is resolved individually in each case, and it is better to resolve it in advance.
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“A child has a heart defect”—sometimes these words sound like a sentence. What is this disease? Is such a diagnosis really so scary and what methods are used to treat it?

Diagnosis of heart disease in a child

There are cases when people live with one kidney, half a stomach, and no gall bladder. But it is impossible to imagine a person who lives without a heart: after this organ stops working, within a few minutes life in the body fades away completely and irrevocably. This is why a diagnosis of heart disease in a child is so frightening for parents.

Without going into medical details, the disease described is associated with the malfunction of the heart valves, along with which the organ itself gradually fails. This problem is the most common cause of heart disease, but it is far from the only one. In addition, there are cases when the disease develops as a result of an abnormal structure:

organ walls;
heart septum;
large heart vessels.

Such changes can be congenital defects, or they can be acquired during life.

Congenital heart defect

If a child is born with a heart defect, then this disease is called congenital.

Statistics show that approximately 1% of newly born babies suffer from this disease. Why is heart disease so common in newborns? It all depends on the lifestyle the mother leads during pregnancy.

The question of whether the baby will be healthy or not is decided in the first months of pregnancy. The risk of giving birth to a child with a heart defect increases significantly if the expectant mother during this period:

drank alcohol;
smoked;
was exposed to radiation;
suffered from a viral illness or vitamin deficiency;
took illegal medications.

If you notice the symptoms of heart disease in children early and start treatment on time, then there is a chance to completely restore the normal functioning of the organ. On the contrary, if the problem is detected too late, then irreversible changes will occur in the structure of the heart muscle, and urgent surgery will be required.

Acquired heart defect

Acquired heart defects in children usually occur due to improper functioning of the valve system. This problem can be solved surgically: valve replacement helps to return to your previous active life.

Causes of the disease

Acquired heart disease in a child occurs due to many reasons.

Rheumatic endocarditis. This disease affects the heart valves, in the stroma of which granulomas form. In 75% of cases, it is rheumatic endocarditis that causes the development of the disease.
Diffuse connective tissue diseases. Pathologies such as lupus erythematosus, scleroderma, dermatomyositis and others often lead to complications on the kidneys and heart.
Chest injury. Any powerful blows to the chest area are highly likely to cause the development of a defect.
Unsuccessful heart surgery. After operations on the heart, such as valvotomy, have already been performed, complications occur that provoke the development of the defect.
Atherosclerosis. This is a chronic disease of the arteries and vessels, on the walls of which atherosclerotic plaques begin to form. Quite rare, but atherosclerosis also causes changes in the work and structure of the heart.

From this list it is clear that if a heart defect has developed in a child, the reasons for this can be very diverse. But it is important to find them, at least so that the prescribed treatment is competent and most effective.

Heart defects in children are accompanied by specific symptoms that you need to be aware of and sound the alarm if they appear in your baby.

During an on-duty examination, a pediatrician may hear a heart murmur in a sick child. After their detection, the attending physician must prescribe an ultrasound. But the diagnosis of “heart disease” may not be confirmed, since functional heart murmurs are the norm in growing children.

In the first months of life, the physical development of babies is very intensive; every month they should gain at least 400 g in weight. If this does not happen, then you need to immediately contact a cardiologist, since the lack of weight gain is one of the main signs of heart problems.

Lethargy and rapid fatigue of a child are also an obvious signal of health problems. If shortness of breath is added to all this, then the risk of hearing an unpleasant diagnosis increases.

Research methods

Heart defects in children, unfortunately, are rarely detected on time. There are several reasons for this.

Firstly, during pregnancy it is almost impossible to determine the development of the disease in the child. During a transvaginal ultrasound, an experienced specialist may notice certain changes in the functioning of the baby’s heart, but many pathologies do not yet appear at this stage. The categories of women who are at risk were identified above - it is better for such mothers to take the initiative and undergo a transabdominal ultrasound at the 20th week of pregnancy.
Secondly, after the birth of children, tests for heart defects are not included in the list of mandatory tests and examinations. And parents do not take the initiative on their own and do not carry out additional diagnostic procedures.
Thirdly, from the very beginning the symptoms of the disease do not make themselves felt. And even if a child feels that something wrong is happening to him, he cannot explain it. Parents are too busy with everyday worries to regularly take their baby for certain examinations.

Newborns usually only undergo an ECG and a few more tests, and this, as a rule, ends the diagnosis. However, an electrocardiogram at such a young age is not able to detect congenital heart disease. If you conduct an ultrasound examination, it is possible to detect the disease at an early stage. Here, a lot depends on the experience of the specialist who performs the ultrasound. It is better to repeat the procedure in several clinics at once, especially if there is a suspicion of heart disease.

Course of the disease

If symptoms of heart disease in children brought you to the doctor’s office, and the diagnosis was confirmed, there is no reason to despair.

The course of the disease does not always lead to sad consequences. For example, left atrioventricular valve insufficiency of degrees I and II allows people to live from 20 to 40 years without surgery, maintaining a certain degree of activity.

But the same diagnosis, but already grade III and IV, accompanied by shortness of breath during exercise, swelling of the lower extremities, liver problems, requires an immediate course of treatment and urgent surgical intervention.

Signs of heart disease in children noticed by parents and pediatricians do not yet constitute a basis for making a diagnosis. As mentioned above, systolic murmur is also observed in healthy children, so ultrasound cannot be avoided.

An echocardiogram may show signs of left ventricular overload. You may also need an additional chest x-ray, which will show changes not only in the heart, but also signs of deviation of the esophagus. After this, we can finally say whether the child is sick or healthy.

Unfortunately, an ECG cannot help in diagnosing heart disease in the early stages: changes in the cardiogram are noticeable when the disease is already actively progressing.

Treatment of heart disease using conservative methods

Confirmed signs of heart disease in children are a reason to begin immediate treatment to prevent irreversible changes in the organ.

Doctors do not always turn to surgical methods - some patients do not require surgery, at least until a certain time. What is really needed is the prevention of the disease that provoked the illness we are considering.

If a heart defect is detected in children, treatment involves a competent daily routine. Such children definitely need to lead an active and active lifestyle, accompanied by moderate physical activity. But overwork - physical or mental - is strictly contraindicated. Aggressive and strenuous sports should be avoided, but race walking, roller skating or cycling, and so on will be useful.

It is possible that drug therapy will be required to help eliminate heart failure. Diet also plays a key role in treating the disease.

Treatment of the disease with surgical methods

When a heart defect is detected in children, operations are mandatory if we are talking about the last stages of the disease, which cannot be treated with medications and diet.

With the development of new technologies, surgical treatment has become available not only for children from one year old, but even for infants. When an acquired heart defect is diagnosed, the main goal of surgery is to preserve the functionality of a person's own heart valves. In the case of congenital defects or disorders that cannot be corrected, valve replacement is required. Prosthetics can be made from mechanical or biological materials. Actually, the cost of the operation depends on this.

The operation is performed on an open heart under artificial circulation. Rehabilitation after such a surgical intervention is long, requires patience, and most importantly, attention to the little patient.

Bloodless operation

It is no secret that due to health conditions, not everyone undergoes such heart operations. And this fact depressing medical scientists, so for many years they have been looking for ways to increase the survival rate of patients. Eventually, such a surgical technology as “bloodless surgery” appeared.

The first operation without chest incisions, without a scalpel and virtually without blood was successfully performed in Russia in 2009 by a Russian professor and his French colleague. The patient was considered hopelessly ill because he was diagnosed with aortic valve stenosis. This valve should have been replaced, but due to various reasons the likelihood that the patient would survive was not very high.

The prosthesis was inserted into the patient's aorta without incisions in the chest (through a puncture in the thigh). Then, using a catheter, the valve was directed in the right direction - to the heart. A special technology for manufacturing the prosthesis allows it to be rolled into a tube when inserted, but as soon as it enters the aorta, it opens to normal size. These surgeries are recommended for older people and some children who are unable to undergo full-scale surgery.

Rehabilitation

Cardiac rehabilitation is divided into several stages.

The first lasts from three to six months. During this period, a person is taught special rehabilitation exercises, a nutritionist explains new principles of nutrition, a cardiologist monitors positive changes in the functioning of the organ, and a psychologist helps to adapt to new living conditions.

The central place in the program is given to proper physical activity, since it is necessary to keep not only the heart muscle, but also the heart vessels in good shape. Physical activity helps control blood cholesterol levels, blood pressure levels, and also helps to lose excess weight.

Constantly lying down and resting after surgery is harmful. The heart must get used to the normal rhythm of life, and dosed physical activity helps it do this: race walking, running, exercise bikes, swimming, walking. Basketball, volleyball, and weight training equipment are contraindicated.

In contact with

Intrauterine development of the fetus sometimes goes wrong, which leads to pathological changes in the structure of some organs. About 1% of babies are born with a congenital heart defect. This is a group of very dangerous diseases that require timely intensive treatment.

Why are children born with heart defects?

The main factor provoking the problem under consideration is heredity (point gene or chromosomal changes). In most cases, the trigger for mutations is unfavorable external conditions. Congenital heart disease in children - causes:

exposure to ionizing radiation;
consumption of alcohol or toxic chemical compounds by the expectant mother;
smoking;
living in an area with poor ecology;
use of certain medications during pregnancy;
the age of the father and mother is over 45 years;
severe toxicosis during pregnancy;
professional activity that negatively affects the health of parents.

Children whose mothers have the following diseases are more likely to have congenital heart defects:

diabetes;
adenoviruses;
chicken pox;
serum hepatitis;
herpes simplex;
listeriosis;
syphilis;
tuberculosis;
cytomegaly;
toxo- and mycoplasmosis;
endocrine disorders;
systemic lupus erythematosus;
phenylketonuria.

Heart defects in children - classification

Cardiologists divide the described pathologies into 3 groups. The first includes any heart defect in children, characterized by the presence of an obstacle to the drainage of blood from the ventricles. The most common options are narrowing of the pulmonary artery, congenital stenosis and coarctation of the aorta. The remaining 2 groups include a large number of diseases; they need to be considered in more detail.

Pale heart defect

This type of disease is also called white. With such congenital pathologies, venous blood does not mix with arterial blood, it is discharged from the left half of the heart to the right. These include:

defects of the interatrial and interventricular septa;
patent ductus arteriosus;
congenital AV communication;
dispositions;
isolated pulmonary stenosis;
septal defects;

Children born with a heart defect of this type are retarded in physical development, especially in the lower part of the body. Closer to adolescence (10-12 years), they begin to feel severe pain syndromes in the limbs and abdomen, suffer from dizziness and shortness of breath. The disease progresses rapidly and requires effective systemic treatment.

The name of this group of congenital pathologies is associated with the characteristic skin tone during the development of the disease. If a child was born with a heart defect of the form in question, he will have cyanosis of the lips and face, and a slightly purple tint to the nail plates. This type of disease includes the following disorders:

Eisenmenger complex;
triad, tetralogy of Fallot;
complete transposition of the great vessels;
Ebstein's anomaly;
common arterial trunk;
atresia of the tricuspid valve.

Heart disease in a child - symptoms

Clinical manifestations of the presented group of pathologies depend on their type, timing of progression with the development of circulatory decompensation and the nature of hemodynamic disorders. Congenital heart defects in young children have the following symptoms:

bluishness or pallor of the skin and mucous membranes;
anxiety;
breast refusal;
rapid fatigue after the start of sucking;
deterioration in sleep quality;
frequent crying;

Signs of heart disease in children increase as they grow older. The older the baby gets, the more pronounced the manifestations of the disease:

retardation in physical development;
pain in the chest, head;
swelling;
heart rate fluctuations;
dyspnea;
sweating;
tachycardia;
arrhythmias;
swelling of the cervical vessels;
chest deformation;
instability of blood pressure;
dizziness;
apathy and lethargy;
muscle weakness.

Diagnosis of congenital heart defects in children

Modern instrumental research helps to identify the problem under consideration. Depending on the suspected type of disease, diagnosis of heart disease in children includes:

electrocardiogram;
plain radiography;
echocardiography (sometimes with Doppler ultrasound);
magnetic resonance and computed tomography;
phonocardiography;
angiography;
probing.

All methods of therapy for the described group of diseases are divided into radical and conservative. Surgical treatment of congenital heart defects in children is often the only way to save the baby’s life, so operations are carried out even during fetal development and immediately after birth. In complex and mixed types of pathology, a healthy organ transplant is required.

Drug treatment of heart disease in children is symptomatic or auxiliary therapy on the eve of surgery. A conservative approach is used mainly for pale forms of the disease; sometimes special medications have to be taken constantly. Only a qualified cardiologist can draw up a correct treatment plan and select effective medications.

Life of children with heart defects

The prognosis in this situation depends on the timeliness of detection of the disease and initiation of therapy. According to mortality statistics among infants in the first year of life, congenital heart defects in children occupy the top position; about 75% of babies die from this pathology. If the disease was diagnosed at an early stage of progression and the cardiologist prescribed effective treatment, the prognosis is favorable.

Care for children with heart defects is organized in a medical institution. The child is placed in a resuscitation system with the possibility of light and sound insulation. To maintain a normal state, the following is carried out:

tube feeding;
oxygen supply (if necessary);
change body position every 2 hours;
constant monitoring of body temperature, pressure, heart rate and respiratory movements.

At home, parents should monitor the baby's calmness to prevent attacks of shortness of breath and cyanosis. Such children need to be fed little by little, often, by feeding them to the breast or offering them a bottle at the first sign of hunger. It is important to use special soft nipples designed for premature babies. It is necessary to help the baby burp more often, especially in the case of artificial feeding.

Prevention of congenital heart defects in children

The main way to prevent the development of this disease in the fetus is to exclude all of the above risk factors. The expectant mother should:

Lead the healthiest lifestyle possible.
Get vaccinated against viral pathologies.
Thoroughly .
Attend all prenatal diagnostic sessions.
Avoid (if possible) taking medications.

If one of the family members on the female or male side has a similar pathology, the risk of conceiving a child with the disease in question is very high. Often such babies are born prematurely, and congenital heart disease in premature babies is extremely rarely treatable. Sometimes doctors advise you to weigh in advance and think carefully about the advisability of procreation.