Congenital heart disease (CHD) is anatomical changes in the heart, its vessels and valves, developing in utero. According to statistics, a similar pathology occurs in 0.8-1.2% of all newborns. CHD in a child is one of the most common causes of death before the age of 1 year.
Causes of CHD in children
At the moment, there is no unambiguous explanation for the occurrence of certain heart defects. It is only known that the most important organ of the fetus is the most vulnerable at 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 takes place, the formation of its valves and large vessels. 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 transmitted by a woman during pregnancy (in particular, rubella);
- severe extragenital diseases of the mother (diabetes, systemic lupus erythematosus, and others);
- alcohol abuse during pregnancy;
- mother's age is over 35 years.
The formation of CHD in a child can also be affected by adverse environmental conditions, radiation exposure, and the use of certain medications during pregnancy. The risk of giving birth to a baby with a similar pathology increases if the woman has already experienced regressive pregnancies in the past, stillbirth, or death of the baby in the first days of life. It is possible that the cause of these problems was undiagnosed heart defects.
Do not forget that CHD may not be an independent pathology, but part of some no less formidable condition. For example, with Down syndrome, heart diseases occur 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 IPUs are divided into “blue” and “white”. This selection of defects is based on external signs that accompany them, and more precisely, on the intensity of color of the skin. With “blue” the child has cyanosis, and with “white” the skin becomes very pale. The first option occurs with tetralogy of Fallot, atresia of the pulmonary artery and other diseases. The second type is more characteristic of defects in the atrial and interventricular septa.
There is another way to separate CHD in children. Classification in this case involves the union of defects in groups according to the state of pulmonary circulation. Three options are distinguished here:
1. CHD with congestion of the pulmonary circulation:
- open ductus arteriosus;
- atrial septal defect (ASD);
- ventricular septal defect (DMS);
2. UPU with depletion of a small circle:
- tetralogy of Fallot;
- pulmonary stenosis;
- transposition of the great vessels.
3. CHD with unchanged blood flow in a small circle:
- coarctation of the aorta;
- aortic stenosis.
Signs of congenital heart defects in children
The diagnosis of CHD in a child is made on the basis of a number of symptoms. In severe cases, changes will be noticeable immediately after birth. It is not difficult for an experienced doctor to make a preliminary diagnosis already in the delivery room and coordinate their actions in accordance with the current situation. In other cases, parents do not suspect the presence of heart disease for many 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, CHD is often diagnosed when passing a commission in the military enlistment office.
What gives the doctor reason to assume CHD in a child still in the delivery room? First of all, the atypical coloration of the skin of the newborn is noteworthy. Unlike pink-cheeked babies, a child with a heart defect will be pale or blue (depending on the type of lesion of the pulmonary circulation). The skin is cool and dry to the touch. Cyanosis can spread to the whole body or be limited to a nasolabial triangle, depending on the severity of the defect.
At the first hearing of heart sounds, the doctor will notice pathological noises at significant points of auscultation. The reason for the appearance of such changes is an incorrect blood flow through the vessels. In this case, with the help of a phonendoscope, the doctor will hear an amplification or weakening of heart sounds, or he will find atypical noises that a healthy child should not have. All this in a complex makes it possible for a neonatologist to suspect the presence of a congenital heart defect and direct the baby for targeted diagnosis.
A newborn with one or another CHD, as a rule, behaves uneasily, often and without reason crying. Some children, by contrast, are too lethargic. They do not take breasts, refuse a bottle and sleep poorly. The onset of shortness of breath and tachycardia (heart palpitations) is not ruled out
In the event that the child was diagnosed with CHD at a later age, deviations in mental and physical development are possible. Such children grow slowly, gain weight poorly, lag behind in school, not keeping up with healthy and active peers. They do not cope with the stresses at school, do not shine at physical education classes, and often get sick. In some cases, heart disease becomes an accidental find at the next medical examination.
In severe situations, chronic heart failure develops. Shortness of breath appears at the slightest exertion. The legs swell, the liver and spleen increase, changes occur in the pulmonary circulation. In the absence of qualified assistance, this condition results in disability or even death of the child.
All these signs make it possible to more or less confirm the presence of CHD in children. Symptoms may vary in different cases. The use of modern diagnostic methods allows you to confirm the disease and prescribe the necessary treatment in time.
UPU development stages
Regardless of the type and severity, all defects go through several stages. The first stage is called adaptation. At this time, the child’s body adapts to 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, the development of acute heart failure and a malfunction in the work of the whole organism are not excluded.
The second stage is the phase of relative compensation. Changed heart structures provide the child with a more or less normal existence, performing all its 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
Consider one of the types of CHD. ASD in children is one of the most common heart defects found in babies over the age of three. 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 circle of blood circulation. All the symptoms that develop with 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 an oval window and, as a rule, closes with the first breath of the newborn. In some cases, the hole remains open for life, but this defect is so small that a person does not even know about it. Hemodynamic disturbances with this option are not noted. An open oval window that does not cause any discomfort to the child may become an accidental finding during an ultrasound scan 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 CHD (ASD in children, as we have said, is most common) will determine the treatment method chosen by a specialist based on ultrasound and other examination methods.
Symptoms of ASD
Primary and secondary atrial septal defects are distinguished. They differ among themselves by the features of the location of the hole in the wall of the heart. With primary ASD, a defect is found in the lower part of the septum. The diagnosis of "CHD, secondary ASD" in children is made when the hole is 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 cardiac tissue that allows you to completely close the defect.
In most cases, young children with ASD are no different from their peers. They grow and develop in accordance with age. There is a tendency to frequent colds without much reason. Due to the constant casting of blood from left to right and overflow of the pulmonary circulation, babies are susceptible to bronchopulmonary diseases, including severe pneumonia.
Over the years of life in children with ASD, only slight cyanosis in the region of the nasolabial triangle can be noted. Over time, pallor of the skin develops, shortness of breath with minor physical exertion, a wet cough. In the absence of treatment, the child begins to lag behind in physical development, ceases to cope with the usual school program.
The heart of young patients withstands an increased load for a long time. Complaints of tachycardia and interruptions in heart rate usually appear between the ages of 12-15. If the child has not been under the supervision of doctors and has never undergone Echocardiography, 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 murmur at significant points of auscultation. This is due to the fact that with the passage of blood through the narrowed valves, vortices develop, 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 wet wheezing associated with stagnation of blood in the pulmonary circulation. With percussion (tapping the chest), an increase in the boundaries of the heart is detected in connection with its hypertrophy.
When examined on an electrocardiogram, signs of an overload of the right heart are clearly visible. Echocardiography reveals a defect in the atrial 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, DMPP never closes on its own. The only treatment for this defect is surgical. The operation is performed at the age of 3-6 years, until decompensation of cardiac activity has developed. Surgical intervention is planned. The operation is performed on an open heart in cardiopulmonary bypass. The doctor does the closure of the defect or, if the hole is too large, closes it with a patch cut out of the pericardium (heart shirt). It is worth noting that the operation with ASD was one of the first heart surgeries more than 50 years ago.
In some cases, the endovascular method is used instead of traditional suturing. In this case, a puncture is made in the femoral vein, and an occluder is inserted through it into the heart cavity (a special device by which the defect is closed). This option is considered less traumatic and safer, because it is performed without opening the chest. After such an operation, children recover much faster. Unfortunately, not in all cases the endovascular method can be used. 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 IPN. CHD in children is the second of the most common heart defects older than three years. In this case, an opening 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 ASD, congestion in the pulmonary circulation develops.
The condition of small patients can vary greatly depending on the size of the defect. With a small opening, the child may not make any complaints, and noise during auscultation is the only moment that will disturb parents. In 70% of cases, minor defects of the interventricular septum close by themselves under the age of 5 years.
A completely different picture emerges with a more severe version of CHD. BC in children sometimes reaches large sizes. In this case, the likelihood of developing pulmonary hypertension is a terrible complication of this defect. At first, all body systems adapt to new conditions, distilling blood from one ventricle to another and creating increased pressure in the vessels of the small circle. Sooner or later, decompensation develops, in which the heart can no longer cope with its function. Discharge of venous blood does not occur, it accumulates in the ventricle and enters the large circle of blood circulation. High pressure in the lungs does not allow 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 to surgical treatment.
In the event that the LCI did not close on its own until 3-5 years or is too large, an operation is performed to restore the integrity of the interventricular septum. As in the case of DMP, the hole is sutured or closed with a patch cut from the pericardium. It is possible to close the defect by the endovascular route, if the conditions allow it to be done.
Treatment of Congenital Heart Diseases
The surgical method is the only one to eliminate such a pathology at any age. Depending on the severity, treatment of CHD in children can be performed both during the neonatal period and at an older age. There are known cases of heart surgery in the fetus in the womb. At the same time, women were able not only to safely bring the pregnancy to the due date, but also to give birth to a relatively healthy child who does not need resuscitation in the very first hours of life.
The types and terms of treatment in each case are determined individually. The cardiac surgeon, based on the examination data and instrumental examination methods, selects the method of operation and sets the dates. All this time, the child is under the supervision of specialists who monitor his condition. In preparation for the operation, the baby receives the necessary drug therapy, which helps to eliminate unpleasant symptoms as much as possible.
Disability with CHD in a child, subject to timely treatment, develops rather rarely. In most cases, a surgical operation allows not only avoiding a fatal outcome, but also creating normal living conditions without significant restrictions.
Prevention of congenital heart defects
Unfortunately, the level of development of medicine does not represent 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 the parents before the planned pregnancy. The expectant mother before conceiving a child should also abandon bad habits, change work in hazardous work for other activities. Such measures will reduce the risks of having a baby with a pathology of the development of the cardiovascular system.
Routine rubella vaccination for all girls avoids the occurrence of CHD due to this dangerous infection. In addition, expectant mothers should undergo ultrasound screening on time for gestation. This method allows you to timely identify malformations in the baby and take the necessary measures. The birth of such a child will take place under the supervision of experienced cardiologists and surgeons. If necessary, immediately from the maternity room the newborn will be taken to a specialized department in order to immediately operate and give him the opportunity to live on.
The 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 a state of decompensation. A timely surgical treatment not only saves the lives of young patients, but also allows them to live without any significant health restrictions.