Congenital Heart Disease - Causes, Symptoms and Treatment .MF .
Causes of congenital heart defects
Symptoms Diagnosis Treatment
Lifestyle with heart disease
As you know, the heart - it is an important organ in the human body, right from his work depends on the welfare of the whole organism.The heart is made up of muscle (myocardium) and connective tissue (heart valves, major blood vessels walls).The activity of the heart is caused by the rhythmic and consistent reduction of its constituent bodies (atria and ventricles), causing the blood flowing through the lungs is saturated with oxygen (called pulmonary circulation), and carries oxygen to all organs and tissues (systemic circulation).
When the fetal heart develops during pregnancy, his work is different from that of a newborn child and an adult heart.In particular, the pulmonary circulation begins to function fully only during labor, when there disclosure of the lungs of the newborn, and at the time of the first cry, they are filled with blood.Therefore, there are special holes and channels in the
sometimes under the influence of adverse factors during fetal development occur gross violations of the formation of the anatomical structures of the heart that affects its activity and are not always consistent with the child's life.Then either by ultrasound of the fetus during pregnancy or in the first days after birth the newborn is set diagnosis of congenital heart malformation .What is it, what is the prognosis for life and what methods of preserving the life and health of these kids offers modern medicine, we try to find out in this article.
So these disease states represent a large group of diseases of the heart, united by the following features:
- occur during fetal development;
- characterized by gross violations of architectonic heart and major vessels (aorta, and the lower hollow Vienna, pulmonary artery and veins);
- anatomical changes cause significant disturbances in hemodynamics (blood circulation throughout the body);
- due to underdevelopment of the anatomical structures, or change their normal location in the heart.
prevalence rate varies from 6 to 9 per 1,000 live births.According to different authors, the options of congenital malformations of the heart, there are from 50 to 100.
Schematic representation of certain heart defects
Causes of congenital heart
Due to the fact that during fetal development is an active formation of allorgans of the human body, especially the heart, the fetus and a pregnant woman vulnerable to the effects of various negative factors.Thus, the impact on wrong during organogenesis may have an increased background radiation, ionizing radiation, infectious diseases of mother, especially viruses - rubella, measles, chicken pox, herpes;taking certain drugs and toxic substances (drugs, alcohol) during pregnancy, especially during the first trimester (8 th -12 weeks - a period of the most intense form all the organs of the fetus).The 4 - 10% of birth defects are genetically determined, that is inherited.
Symptoms of congenital heart defects
Clinical symptoms depend on the defects of their kind.There are flaws, "blue" and "white" types, as well as defects that create obstruction to blood flow.
main manifestation «blue» defects (transposition (change of location) of the great arteries, tetralogy of Fallot, atresia - imperforate - tricuspid valve) is cyanosis - a blue coloration of the skin of fingers, hands, feet, nasolabial triangle, ears, nose or,extreme cases, the entire body.It is also a manifestation of arterial hypoxemia (low oxygen) are shortness of breath, loss of consciousness with convulsions or without, tachycardia (rapid heartbeat), retarded growth and development, frequent colds, neurological symptoms in the absence of normal cerebral blood flow.As a rule, this type of defects manifest themselves in the first hours and days of a newborn baby's life.Transposition of the great arteries (vena cava are included in the left, not the right atrium and the aorta extends from the right rather than the left ventricle) is a severe defect incompatible with life, and the child usually dies soon after birth.There is also incompatible with the life of vices include a three-chamber heart (two atria and one ventricle and one atrium and two ventricles).The lethality of defects of this type is very high, if children with such defects survive the first few days of life, without treatment die by the end of the first - the second year.
By vices white type include ventricular septal defect, an outdoor Botallo (blood) flow, atrial septal defect.Clinically, these defects can not begin to manifest itself in the early, childhood, and to the 16 - 20 years.Symptoms of white type defects are: pale skin, developmental delays, frequent SARS, emerging signs of right heart failure - shortness of breath and tachycardia during exertion or at rest.
Flaws an obstacle to blood flow: stenosis (luminal narrowing) of the aorta, coarctation (segmental narrowing) of the aorta, pulmonary stenosis is clinically manifested by shortness of breath, palpitations, chest pain, decreased endurance, swelling, developmental delays and circulatory disorders of the lower half of the body.If aortic coarctation children live to a maximum of 2 years old.
diagnosis of congenital heart malformations
Usually, to diagnose fetal malformations, including heart, perhaps even at the stage of the ultrasound scan of a pregnant woman.Then, depending on the type of defect, the woman may be advised to either abortion (with the evils that are not compatible with life, with multiple deformities and so on. D.), A continuation of the pregnancy with a more detailed examination of pregnant women and addressing the question of surgical treatment of the child immediatelyor shortly after birth.But sometimes due to some reasons (not pregnant prenatal visit and ultrasound study, insufficient equipping of FAPs ultrasound equipment, and so on. D.) Malformations can be diagnosed only after birth.
Despite the fact that congenital symptoms bright enough during the clinical examination of the newborn child's diagnosis can only assume, as many symptoms are not strictly specific and can be caused by other serious conditions of newborns (respiratory distress syndrome, intracranial hemorrhage, etc.. d.).Also, not all defects can produce a characteristic pattern auscultation (listening in the chest), and vice versa, noise, clicks or other auscultatory manifestations may occur in minor deviations from the norm in the structure of the heart (small anomalies).Therefore, if heart disease has not been diagnosed by fetal ultrasound, all the kiddies with symptoms of circulatory disorders (diffuse or akrotsianoz, shortness of breath when feeding or resting, loss of consciousness, convulsions), must be made of the heart Ultrasound during their stay in hospital.
Echocardiography (ultrasound of the heart) is one of the most informative imaging techniques heart defects.Also they can be assigned an electrocardiogram (show arrhythmias, hypertrophy of the atria and / or ventricles, if any), chest X-ray (show the stagnation of blood in the lungs, if there is an increase in the shadow of the heart due to the expansion of its chambers).In particularly difficult cases, or before the surgical treatment can be assigned ventriculography (introduction of radiopaque substance into the cavity of the heart ventricles), angiography (introduction of contrast through the vessels of the heart cavity), sensing of the heart chambers with the measurement of the pressure in them.
now dwell on ultrasound common heart defects.
A. Congenital heart whipping with volume overload blood vessels in the lungs (pulmonary circulation).
1. Atrial septal defect - with the help of a one-dimensional echocardiography revealed signs of volume overload and dilation (expansion) of the right ventricle, with two-dimensional echocardiography echo visible break between the atria, while Doppler study estimated the turbulent (with the "twists") of blood flow through the atrial septumand the degree of impairment of pulmonary blood flow.
2. Ventricular septal defect - during ultrasound of the heart visualized hole in the septum between the ventricles, dilatation of the left and right ventricles, turbulent blood flow from the left to the right ventricle, assessed the degree of pulmonary hypertension severity, measured by a pressure difference in the ventricles.
It appears septal defect between the ventricles during echocardiography with Doppler.Left - normal interventricular septum, the right - its defect (VSD).
3. Open arterial canal - is shown on echocardiography continuous blood flow through the posts in the aorta and pulmonary artery, changes in blood flow in the pulmonary trunk mouth.
4. coarctation of the aorta - see section segmental narrowing of the aortic lumen, accelerated blood flow below the segment.
5. Transposition of the great arteries - rendered improper discharge of vessels from the heart.
B. Heart defects with a decrease in blood volume in the pulmonary circulation.
1. Tetralogy of Fallot - echocardiography in addition to stenosis (narrowing) of the pulmonary artery and the septum between the ventricles of the defect is determined by right ventricular hypertrophy and the passage of the aorta from the right ventricle, and estimated the degree of violation of intracardiac hemodynamics.
2. pulmonary artery stenosis - narrowing of the pulmonary artery revealed the lumen, and the acceleration of blood flow at the mouth of the pulmonary artery and right ventricular hypertrophy.
3. Epstein anomaly - a pathology of the tricuspid valve of the heart, when the flap valve is not attached to the fibrous ring between the atrium and ventricle on the right and to the walls of the right ventricle, causing a reduction in its volume.When ECHO - CG determined valve pathology, estimated the expansion of the heart cavities and violation of intracardiac blood flow.
4. tricuspid valve atresia - with ECHO - CG no reflection echo from the tricuspid valve, recorded hypertrophy of the right atrium and the left ventricle.
B. Heart defects with a decrease in blood volume in the systemic circulation (in the vessels of vital organs).
1. coarctation of the aorta (see. Above).
2. Isolated aortic stenosis - narrowing of the estimated degree visualized rapid blood flow through the aortic valve and misshapen valve leaflets.
G. heart defect without hemodynamic instability.
- dextrocardia (mirroring the location of the heart on the right) - is a rare anomaly, in cardiac ultrasound hemodynamic usually not recorded.
Treatment of congenital heart malformations
Complete cure the vast majority of heart disease is only possible by means of surgical correction.Cardiac surgery can be performed in the first hours or days of life of the newborn, or the first year of a child's life.In patent ductus arteriosus is allowed expectant management (no symptoms of life-threatening conditions), as this duct can be closed independently of the first two years of life.
operations may be performed as an open-heart (with incision of the chest wall) and cardiovascular method (where access to the heart is performed by introducing the probe into the blood vessels, reaching the heart chambers).The latter method, for example, is used for the correction of defects between the atria or ventricles, which is supplied with a probe occluder closing holes.
But some heart defects that are not compatible with life, for example, three-chambered heart (one atrium and two ventricles, or two atria and one ventricle) surgical repair, unfortunately, is not possible.
Besides cardiac surgery, the patient is assigned to drug therapy to improve the contractile function of the heart and "unloading" of the pulmonary circulation.Used ACE inhibitors (enalapril, perindopril, lisinopril, ramipril, and others), diuretics (furosemide, indapamide etc.), B-blockers (carvedilol, bisoprolol, etc.).
Lifestyle with congenital heart disease patient
following recommendations must be observed concerning his lifestyle:
- rational balanced diet;
- dieting with restriction of salt and fluid intake (to reduce volume overload of the heart and blood vessels);
- sufficient exposure to fresh air;
- exclusion of any sport and strong limitation of physical activity;
- sufficient for the duration of sleep;
- regular monitoring by a cardiologist and cardiac surgeon with necessary medical and diagnostic activities;
- pregnant women with disabilities "blue" type is strictly contraindicated, but if it was carried out surgical treatment, the possibility of continuing the pregnancy is determined in each case individually to the joint management of pregnancy a heart surgeon, cardiologist and an obstetrician-gynecologist in a specialized hospital.Delivery is usually carried out by Caesarean section.
forecast for congenital heart defects
forecast for the lives of most heart defects unfavorable.As mentioned above, the cardiac surgery treatment so kiddies need in the first days and months after birth, otherwise they will die within the first two years due to the progression of heart failure and associated complications (bacterial endocarditis, fatal rhythm disturbances, increased risk of thrombosis and thromboembolic complications., frequent diseases of respiratory system (protracted bronchitis, severe pneumonia) exception is the white type defects in which, in the absence of surgical treatment due to any reason the children are able to live up to 16 -. 18
after surgical correction of the forecast favorable for life,but still the child's condition is severe enough, so for these children should be strengthened supervision of parents and doctors.
In conclusion, it should be noted that the diagnosis of the child at the present stage of development of medicine is not a sentence, since the possibility of domestic and foreign cardiologychildhood allow bear, give birth and raise a child, able to lead a full life, despite such a serious illness.
therapists Sazykina OJ