Diagnosis and treatment of heart defects in children (Sergiev Posad)

HomeChildren's clinicCardiologyCongenital heart disease

Congenital heart defect

- a disease of the heart valves, in which the organ begins to malfunction. As a result of a congenital change in the structure of the valve apparatus, cardiac septa, walls, or large vessels extending from the heart, a disturbance in the blood flow of the heart occurs. The disease may progress. In some cases, death is possible.

Congenital heart defects occur with a frequency of 6-8 cases per thousand births, which is 30% of all developmental defects. They rank first in mortality of newborns and children of the first year of life. After the first year of life, mortality decreases sharply, and no more than 5% of children die between the ages of 1 and 15 years.

The earlier a congenital heart defect is detected, the greater the hope for its timely treatment.

General information

Congenital heart disease is the most common congenital anomaly leading to mortality. Occurs in approximately 1% of newborns. Congenital heart defects most often appear in childhood. They can progress and, if not treated correctly, lead to death. Source: JIE Hoffman, S. Kaplan The incidence of congenital heart disease // JACC, 2002, Vol. 39, p.1890—1900

CHD can manifest as single anomalies or a combination of several disorders. It is most dangerous when the disease has no external manifestations and passes hidden. In modern conditions, treatment is usually successful, but timely and accurate diagnosis is vital.

The actions of the mother during pregnancy and of both parents during preparation for it are also important. To assess the risk of having a baby with congenital heart disease, you need to contact a geneticist.

CHD entails a number of complications, including bacterial endocarditis, heart failure, early pneumonia with a prolonged course, short-term fainting, pulmonary hypertension, myocardial infarction, attacks of shortness of breath, and angina syndrome.

Consequences: what will happen if left untreated?

A congenital heart defect is not a situation that can be left to chance. Without treatment, congenital heart disease leads to the development of complications:

• heart failure is a condition in which an organ is unable to do its job;
• rhythm disturbance;
• infective endocarditis - bacterial damage to the heart valves;
• bronchopulmonary diseases (bronchitis, pneumonia).

All these conditions significantly disrupt the normal course of life, prevent full development and can cause disability.

Phases of the disease

CHD occurs in three phases:

• first phase: during it, a compensatory and adaptive reaction to a failure in the dynamics of blood circulation is observed; in case of a serious violation, myocardial hyperfunction occurs.
• second phase: relative compensation occurs. The child’s motor activity and physiological development improves.
• the third phase is terminal. The body has already exhausted the possibilities of compensation; degenerative, dystrophic pathologies of the heart and nearby blood vessels are developing. If a child is sick, especially with complications, then the terminal phase occurs faster. Its outcome is only fatal. Source: E.E. Chepurnykh, E.G. Grigoriev Congenital heart defects // Siberian Medical Journal (Irkutsk), 2014, No. 3, pp. 121-127

Therefore, the earlier the pathology is detected, the more favorable its prognosis.

Heart disease. Treatment without surgery

In some cases this is possible. In these cases, drug therapy is aimed at preventing the development of complications (pulmonary edema, atrial fibrillation, sudden cardiac arrest, etc.), reducing the manifestations of heart and pulmonary failure and improving the quality of life. Diet therapy and physical therapy have a good preventive and supportive effect. Only a specialist can give specific recommendations.

In the pre- and postoperative period, as well as in the absence of indications for surgical intervention, a person can be helped by holistic treatment methods: classical and resonant homeopathy, osteopathy, acupuncture, qigong therapy, herbal medicine.

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Causes of pathology

CHD may develop if:

• parents smoke;
• parents drink alcohol;
• the fetus is affected by external factors during the period of development and formation (high background radiation, lack of vitamins, viruses carried by the mother, polluted air, water, a number of chemicals, including heavy metals). Source: L.N. Falyush, V.V. Florensov Risk factors for congenital heart defects // Clinical medicine. Bulletin of the All-Russian Scientific Center SB RAMS, 2010, No. 6(76), p.67-69

Degrees of heart defects in a child

Depending on the severity of the symptoms of heart disease, there are four degrees of impairment:

• first degree
  - heart function deviates slightly from the norm;
• second degree
  - symptoms of the disease appear, parents can notice them;
• third degree
  - in addition to specific symptoms, disturbances in the functioning of the nervous system appear, as a result of a lack of oxygen to the brain;
• fourth degree
  - respiratory and cardiac activity is inhibited, such changes can lead to the death of the child.

Symptoms of congenital heart disease

They are divided into two large groups according to the color of the child’s skin: “white” and “blue”. A changed skin tone is the first reason for parents and pediatricians to be wary.

"Blue" vices

They usually appear either immediately at birth or a little later. In this case, the ears, lips and body skin are susceptible to cyanosis. Blue discoloration can occur during exertion (screaming, crying of a newborn), during breastfeeding. The “blue” appearance is usually manifested by a mirror arrangement of the great vessels, atresia of the pulmonary artery, and tetralogy of Fallot.

CHD of the “white” variety

Accompanied by pallor and coldness of the extremities. When listening with a stethoscope, noises are heard. They are not direct symptoms, but a heart examination is still required. With “white” pathologies, heart failure is often detected. Changes are detected on x-rays, ECG, ECHO-CG. This type of congenital heart disease is most often a pathology of the interatrial septum and interventricular septum.

Unfortunately, not all types of congenital heart disease occur in newborns. A child can feel well even up to 10 years of age. But sooner or later the vice will appear:

• delay in physiological development;
• pallor or cyanosis;
• shortness of breath during exercise.

Clinical case

A 3-month-old baby was admitted for consultation. From the anamnesis it is known: second pregnancy, delivery by cesarean section at 39-40 weeks. The pregnancy was accompanied by gestosis; in the first trimester, the woman suffered from acute respiratory viral infection (she was treated at home on her own).

A neonatologist at the maternity hospital suspected a congenital heart defect on the third day after the baby was born. The doctor listened to a rough systolic murmur along the left sternal border and referred the child for examination. On the fifth day, echocardiography was performed. A diagnosis was made: open atrioventricular canal, incomplete form. With this pathology, a defect occurs in the lower part of the interatrial septum, and the bicuspid (mitral) valve is split.

Maintenance therapy was prescribed: cardiac glycosides, diuretics. During treatment, the child's condition remained stable.

At the age of 3 months, a repeat examination was carried out. Based on the results, a decision was made to hospitalize and prepare for surgery. The scope of surgical intervention is radical correction of the defect under artificial circulation. A patch was made from the patient's own pericardium (the sac surrounding the heart), and the mitral valve was sutured. The postoperative period was uneventful. Upon further observation, the patient's condition remained stable.

Treatment methods

Treatment of congenital heart disease is carried out only by surgery . Cardiac surgeons perform complex reconstructive interventions, successfully curing those forms of congenital heart disease that were previously considered inoperable. If the diagnosis is made early and treatment is carried out promptly, heart function can be restored to 100%.

Non-invasive therapy (medication, physiotherapy, etc.) may be prescribed as an auxiliary measure. Such treatment is also carried out in cases where it is possible to postpone the operation to a later time or there is a “white” congenital heart disease that has little impact on the child’s well-being during growth and development.

Heart disease. Symptoms

Heart disease. Symptoms in a newborn

Small defects in the structure of the heart may not be detected in the first days and months of life. More significant damage is manifested by the following clinical signs:

• increased or decreased heart rate;
• cyanosis (blue discoloration) of the nasolabial triangle and limbs;
• pallor, sweating and decreased temperature of the feet, palms, and tip of the nose;
• dyspnea;
• frequent regurgitation and difficulty sucking;
• poor weight gain;
• swelling;
• fainting states
• heart murmurs.

Heart disease. Symptoms in a child

An asymptomatic course is typical for minor defects and defects with late manifestation. In other situations, the “set” of clinical signs varies somewhat depending on the type of damage, but some of the most common symptoms can be identified:

• developmental delay (physical);
• shortness of breath during exercise (significant or minor - depends on the severity of the condition);
• cyanosis of the extremities and nasolabial triangle (appearing or worsening during exercise);
• symptom of “drum sticks” and “watch glasses” - characteristic of a number of cardiac, pulmonary, and liver pathologies, thickening of the terminal phalanges of the fingers (sometimes of the toes) and a change in the shape of the nail bed;
• tendency to lung infections;
• arrhythmias;
• chest pain;
• orthopnea (difficulty breathing when lying down);
• swelling of the lower extremities;
• loss of consciousness, etc.

Heart disease. Symptoms in adults

In adults, the congenital defect manifests itself with the signs described above. Especially if the first symptoms appeared after 15–20 years. If the defect was operated on in a timely manner, clinical manifestations may be minor or absent altogether.

Acquired defects behave differently. There are heart defects (for example, mitral stenosis) with very slow progression (the first symptoms that cause concern appear 10 years after diagnosis).

In general, it all depends on the degree of damage to the valve.

The leading symptoms of heart disease in adults are:

• tachycardia and arrhythmias (up to atrial fibrillation);
• chest pain;
• weakness, shortness of breath on exertion and at rest;
• cyanosis of the face and limbs;
• orthopnea;
• attacks of cardiac asthma;
• angina pectoris;
• fainting;
• swelling;
• lung diseases; (up to swelling);
• with right ventricular failure - pain in the right hypochondrium, nausea.

First, characteristic signs of left or right ventricular failure appear (depending on the location of the defect). But over time, doctors are faced with symptoms of both types.

We invite you to “SM-Clinic”

Our clinic’s staff includes some of the best specialists in the Northern capital. We employ experienced pediatricians and pediatric cardiologists who will promptly identify the presence of alarming symptoms and prescribe all the necessary examinations. “SM-Clinic” is well equipped; we can conduct all tests for the presence of congenital heart disease.

Make an appointment with us as soon as possible if you notice signs of congenital heart disease in your child. Time plays a huge role in this disease.

Sources:

1. HER. Chepurnykh, E.G. Grigoriev. Congenital heart defects // Siberian Medical Journal (Irkutsk), 2014, No. 3, pp. 121-127.
2. L.N. Falyush, V.V. Florensov. Risk factors for congenital heart defects // Clinical medicine. Bulletin of the All-Russian Scientific Center SB RAMS, 2010, No. 6(76), p.67-69.
3. J. I. Hoffman, S. Kaplan. The incidence of congenital heart disease // JACC, 2002, Vol. 39, p.1890—1900.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Diagnosis of heart defects in children

During the initial examination, a pediatrician, neonatologist or pediatric cardiologist conducts an examination and auscultation of possible heart murmurs. The presence of swelling, shortness of breath, heart rhythm disturbances, and problems with physical or intellectual development are checked. Based on the results of the inspection, the question of the necessary examination is decided.

Cardiac echocardiography (EchoCG) – combines cardiac ultrasound and cardiogram. The method determines the rhythmogram and structural changes in the heart. EchoCG is an informative method.

Radiology shows the actual size of the heart, its chambers and the relationship of the organ to the size of the chest.

Coronary angiography – a catheter is inserted through the veins or arteries in the arm, groin, or neck (vein only) and reaches the heart. Then a contrast agent is passed through it. This method determines the contractile function of the heart.

Medical equipment uses expert-class equipment from world-famous manufacturers.

The task of the Children's Medical Department is to provide a full range of medical care from prevention to treatment, when symptoms of a defect appear from birth to 18 years.

In our children's department, appointments are conducted by doctors who have undergone special training to identify health problems in children and infants, taking into account all age-related characteristics.

Pediatric doctors at the Paracelsus Clinic work according to the principles of evidence-based medicine (international protocols drawn up on the basis of clinical trials). This minimizes the likelihood of a false diagnosis.

Parents play a big role in the early diagnosis of heart defects in children. The direction in which the preliminary examination will be carried out depends on how closely the parents monitor the health of their child and how correctly they can describe his condition to the doctor.

Prices

Name of service (price list incomplete)	Price
Appointment (examination, consultation) with a cardiologist, primary, therapeutic and diagnostic, outpatient	1750 rub.
Prescription of treatment regimen (for up to 1 month)	1800 rub.
Consultation (interpretation) with analyzes from third parties	2250 rub.
Consultation with a candidate of medical sciences	2500 rub.
Electrocardiography (ECG)	1400 rub.
Echocardiography (ultrasound of the heart)	3500 rub.