Congenital heart disease (CHD) is an anatomical change in the heart, its vessels and valves that develop in utero. According to statistics, such a pathology occurs in 0.8-1.2% of all newborns. CHD in a child is one of the most common causes of death under the age of 1 year.
Causes of CHD in children
At the moment, there are no unambiguous explanations for the occurrence of certain heart defects. We only know that the most vulnerable organ of the fetus for a period of 2 to 7 weeks of pregnancy. It is at this time that the laying of all the main parts of the heart, the formation of its valves and large vessels takes place. Any impact that occurred during this period can lead to the formation of pathology. As a rule, it is not possible to find out the exact cause. Most often, the following factors lead to the development of CHD:
- genetic mutations;
- viral infections suffered by a woman during pregnancy (in particular, rubella);
- severe extragenital diseases of the mother (diabetes mellitus, systemic lupus erythematosus and others);
- alcohol abuse during pregnancy;
- mother's ageover 35.
The formation of CHD in a child can also be affected by unfavorable environmental conditions, radiation exposure and taking certain medications during pregnancy. The risk of having a baby with a similar pathology increases if the woman has already had regressive pregnancies in the past, stillbirth or death of the baby in the first days of life. It is possible that undiagnosed heart defects were the cause of these problems.
Do not forget that congenital heart disease may not be an independent pathology, but part of some no less formidable condition. For example, in Down syndrome, heart disease occurs in 40% of cases. At the birth of a child with multiple malformations, the most important organ will most often also be involved in the pathological process.
Types of CHD in children
Medicine knows more than 100 types of various heart defects. Each scientific school offers its own classification, but most often the UPUs are divided into "blue" and "white". Such a selection of defects is based on the external signs that accompany them, or rather, on the intensity of the color of the skin. With "blue" the child has cyanosis, and with "white" the skin becomes very pale. The first variant occurs in tetralogy of Fallot, pulmonary atresia and other diseases. The second type is more typical for atrial and ventricular septal defects.
There is another way of dividing CHD in children. Classification in this case involves the grouping of vices into groupsaccording to the state of the pulmonary circulation. There are three options here:
1. CHD with pulmonary congestion:
- open ductus arteriosus;
- atrial septal defect (ASD);
- ventricular septal defect (VSD);
2. VPS with small circle depletion:
- Tetralogy of Fallot;
- pulmonary stenosis;
- transposition of the great vessels.
3. CHD with unchanged blood flow in the pulmonary circulation:
- coarctation of the aorta;
- aortic stenosis.
Signs of congenital heart defects in children
CHD is diagnosed in a child based on a range of symptoms. In severe cases, changes will be noticeable immediately after birth. It will not be difficult for an experienced doctor to make a preliminary diagnosis already in the delivery room and coordinate his actions in accordance with the current situation. In other cases, parents do not suspect the presence of heart disease for many more years, until the disease passes into the stage of decompensation. Many pathologies are detected only in adolescence at one of the regular medical examinations. In young people, congenital heart disease is often diagnosed when passing through a commission at the military registration and enlistment office.
What gives the doctor reason to assume congenital heart disease in a child in the delivery room? First of all, the atypical coloring of the skin of a newborn attracts attention. Unlike rosy-cheeked babies, a child with heart disease will be pale or blue (depending on the type of lesion of the pulmonary circulation). Skin is cool and drytouch. Cyanosis can spread to the whole body or be limited to the nasolabial triangle, depending on the severity of the defect.
When you first listen to the heart sounds, the doctor will notice pathological noises at significant auscultation points. The reason for the appearance of such changes is the wrong flow of blood through the vessels. In this case, using a phonendoscope, the doctor will hear an increase or decrease in heart tones or detect atypical noises that a he althy child should not have. All this together makes it possible for the neonatologist to suspect the presence of a congenital heart disease and send the baby for targeted diagnostics.
A newborn with one or another CHD, as a rule, behaves restlessly, cries often and for no reason. Some children, on the contrary, are too lethargic. They don't breastfeed, refuse a bottle, and don't sleep well. Possible shortness of breath and tachycardia (rapid heartbeat)
In the event that the diagnosis of CHD in a child was made at a later age, development of deviations in mental and physical development is possible. Such children grow slowly, gain weight poorly, lag behind in school, not keeping up with he althy and active peers. They do not cope with the stress at school, do not shine in physical education classes, and often get sick. In some cases, a heart defect becomes an accidental finding at the next medical examination.
In severe situations, chronic heart failure develops. There is shortness of breath at the slightest exertion. Swelling of the legs, enlargement of the liver andspleen, there are changes in the pulmonary circulation. In the absence of qualified assistance, this condition ends in disability or even death of the child.
All these signs allow to a greater or lesser extent to confirm the presence of CHD in children. Symptoms may vary in different cases. The use of modern diagnostic methods allows us to confirm the disease and prescribe the necessary treatment in time.
UPU development stages
Regardless of the type and severity, all vices go through several stages. The first stage is called adaptation. At this time, the child's body adapts to the new conditions of existence, adjusting the work of all organs to a slightly altered heart. Due to the fact that all systems have to work at this time for wear and tear, the development of acute heart failure and failure of the whole organism cannot be ruled out.
The second stage is the phase of relative compensation. The changed structures of the heart provide the child with a more or less normal existence, performing all their functions at the proper level. This stage can last for years until it leads to the failure of all body systems and the development of decompensation. The third phase of CHD in a child is called terminal and is characterized by serious changes throughout the body. The heart can no longer cope with its function. Degenerative changes in the myocardium develop, sooner or later ending in death.
Atrial septal defect
Let's consider one of the types of UPU. ASD in children is one of the most common malformationsheart, found in babies over the age of three years. With this pathology, the child has a small hole between the right and left atria. As a result, there is a constant reflux of blood from left to right, which naturally leads to overflow of the pulmonary circulation. All the symptoms that develop in this pathology are associated with a violation of the normal functioning of the heart in altered conditions.
Normally, the opening between the atria exists in the fetus until birth. It is called the foramen ovale and usually closes with a newborn's first breath. In some cases, the hole remains open for life, but this defect is so small that the person does not even know about it. Violations of hemodynamics in this variant is not observed. An open foramen ovale that does not cause any discomfort to the child can become an accidental finding during an ultrasound examination of the heart.
In contrast, a true atrial septal defect is a more serious problem. Such holes are large and can be located both in the central part of the atria and along the edges. The type of congenital heart disease (ASD in children, as we have already said, is the most common) will determine the method of treatment chosen by the specialist based on ultrasound data and other examination methods.
ASD symptoms
Distinguish between primary and secondary atrial septal defects. They differ among themselves in the peculiarities of the location of the hole in the wall of the heart. In primary ASD, a defect is detectedat the bottom of the barrier. The diagnosis of CHD, secondary ASD in children is made when the hole is located closer to the central part. Such a defect is much easier to correct, because in the lower part of the septum there is a little heart tissue that allows you to close the defect completely.
In most cases, young children with ASD are no different from their peers. They grow and develop with age. There is a tendency to frequent colds without any particular reason. Due to the constant reflux of blood from left to right and the overflow of the pulmonary circulation, babies are prone to bronchopulmonary diseases, including severe pneumonia.
For many years of life, children with ASD may have only a slight cyanosis in the area of the nasolabial triangle. Over time, pallor of the skin develops, shortness of breath with minor physical exertion, and a wet cough. In the absence of treatment, the child begins to lag behind in physical development, ceases to cope with the usual school curriculum.
The heart of little patients can withstand the increased load for a long time. Complaints of tachycardia and heart rhythm irregularities usually appear at the age of 12-15 years. If the child has not been under the supervision of doctors and has never had an echocardiogram, the diagnosis of CHD, ASD in a child can only be made in adolescence.
Diagnosis and treatment of ASD
On examination, the cardiologist notes an increase in heart murmurs at significant auscultation points. This is due to the fact that when blood passes through the narrowed valves, turbulence develops, which the doctor hears through a stethoscope. Blood flow through a defect in the septum does not cause any noise.
While listening to the lungs, you can detect moist rales associated with stagnation of blood in the pulmonary circulation. Percussion (thumping of the chest) reveals an increase in the boundaries of the heart due to its hypertrophy.
When examining an electrocardiogram, signs of overload of the right heart are clearly visible. An echocardiogram revealed a defect in the area of the interatrial septum. An x-ray of the lungs allows you to see the symptoms of blood stasis in the pulmonary veins.
Unlike a ventricular septal defect, an ASD never closes on its own. The only treatment for this defect is surgery. The operation is performed at the age of 3-6 years, until cardiac decompensation has developed. Surgery is planned. The operation is performed on an open heart under cardiopulmonary bypass. The doctor sutures the defect or, if the hole is too large, closes it with a patch cut from the pericardium (heart shirt). It is worth noting that the operation for ASD was one of the first surgical interventions on the heart more than 50 years ago.
In some cases, instead of traditional suturing, an endovascular method is used. In this case, a puncture is made in the femoral vein, and an occluder (a specialdevice that closes the defect). This option is considered less traumatic and safer, since it is performed without opening the chest. After such an operation, children recover much faster. Unfortunately, not in all cases it is possible to apply the endovascular method. Sometimes the location of the hole, the age of the child, as well as other related factors do not allow such an intervention.
Ventricular septal defect
Let's talk about another type of UPU. VSD in children is the second most common heart disease in children over the age of three. In this case, a hole is found in the septum separating the right and left ventricles. There is a constant reflux of blood from left to right, and, as in the case of an ASD, an overload of the pulmonary circulation develops.
The condition of little patients can vary greatly depending on the size of the defect. With a small hole, the child may not make any complaints, and the noise during auscultation is the only thing that will bother parents. In 70% of cases, minor ventricular septal defects close by themselves before the age of 5 years.
A completely different picture emerges with a more severe variant of CHD. VSD in children sometimes reaches large sizes. In this case, there is a high probability of developing pulmonary hypertension - a formidable complication of this defect. At first, all body systems adapt to new conditions, moving blood from one ventricle to another and creating an increasedpressure in the vessels of the small circle. Sooner or later, decompensation develops, in which the heart can no longer cope with its function. There is no discharge of venous blood, it accumulates in the ventricle and enters the systemic circulation. High pressure in the lungs prevents heart surgery, and such patients often die from complications. That is why it is so important to identify this defect in time and refer the child for surgical treatment.
In the event that the VSD did not close on its own before 3-5 years or is too large, an operation is performed to restore the integrity of the interventricular septum. As in the case of an ASD, the opening is sutured or closed with a patch cut from the pericardium. It is also possible to close the defect by endovascular means, if the conditions allow it.
Treatment of congenital heart defects
The surgical method is the only one to eliminate such a pathology at any age. Depending on the severity, CHD treatment in children can be performed both in the neonatal period and at an older age. There are cases of heart surgery performed on the fetus in the womb. At the same time, women were able not only to safely carry the pregnancy to the due date, but also to give birth to a relatively he althy child who does not require resuscitation in the very first hours of life.
Types and terms of treatment in each case are determined individually. The cardiac surgeon, based on the examination data and instrumental methods of examination, chooses the method of operation andsets deadlines. All this time the child is under the supervision of specialists who control his condition. In preparation for the operation, the baby receives the necessary drug therapy to eliminate unpleasant symptoms as much as possible.
Disability with CHD in a child, subject to timely treatment, develops quite rarely. In most cases, surgery allows not only to avoid death, but also to create normal living conditions without significant restrictions.
Prevention of congenital heart defects
Unfortunately, the level of development of medicine does not provide an opportunity to intervene in the intrauterine development of the fetus and somehow affect the laying of the heart. Prevention of CHD in children involves a thorough examination of parents before a planned pregnancy. Before conceiving a child, the expectant mother should also give up bad habits, change jobs in hazardous industries to other activities. Such measures will reduce the risk of having a child with a pathology of the development of the cardiovascular system.
Roubly vaccinated against rubella, which is given to all girls, helps to avoid CHD due to this dangerous infection. In addition, expectant mothers should definitely undergo ultrasound screening at the scheduled gestational age. This method allows you to identify malformations in the baby in time and take the necessary measures. The birth of such a child will be supervised by experienced cardiologists and surgeons. If necessary, immediately from the delivery room, the newborn will be taken to a specializeddepartment to operate immediately and give him the opportunity to live on.
Prognosis for the development of congenital heart defects depends on many factors. The sooner the disease is detected, the more likely it is to prevent the state of decompensation. Timely surgical treatment not only saves the lives of young patients, but also allows them to live without any significant he alth restrictions.
