Atrial septal defect in a newborn

Conservative therapy is used as a symptomatic treatment. The main therapy includes only surgery. The operation is performed both on an open heart using cardiopulmonary bypass, and using endoscopic equipment.

If the defect is small, it is simply sutured. If the hole diameter exceeds 1 cm, a patch is applied.

The only way to treat this defect is surgery. During the surgery, the defect is closed. In severe cases, this may be thoracotomy interventions (with a dissection of the chest). Now much less traumatic endovascular methods are preferred. This is also indicated by clinical recommendations.

An operation with a duodenal insufficiency is mandatory, the method of its implementation is determined individually.

In the case of the choice of endovascular intervention, a special device is introduced through a large vessel, which reaches the atrial septal defect and closes it.

Atrial septal defect in newborns is an extremely rare disease that is referred to as congenital heart disease (CHD).

It entails a huge amount of consequences.

How to recognize a problem on time and how to deal with it? We will tell in this article.

Description

Atrial septal defect – congenital heart anomaly (congenital malformation). With an incomplete defect, there is an opening between the partitions, and with a complete defect, there is no partition at all. The disease is characterized by the presence of a message between the right and left atria.

Atrial septal defect is a genetic disease. If the child has close relatives suffering from heart disease, it is necessary to pay more attention to his health.

Also, this disease can develop due to external causes. During pregnancy, you should give up smoking and alcohol, take medications only under the supervision of a doctor. Congenital malformation can occur in cases where the mother of the child during pregnancy was sick with diabetes mellitus, phenylketonuria or rubella.

It is usually characterized by a large size (from three to five centimeters), localization in the lower part of the septum and the absence of a lower edge. The underdevelopment of the primary interatrial septum and the preservation of the primary message relate to this form of defect. Most often, patients have an open antrioventricular canal and splitting of tricuspid and bicuspid valves.

It is characterized by an underdeveloped secondary septum. Usually this is damage of a small size (from one to two centimeters), which is located in the mouth of the vena cava or in the center of the septum. The complete absence of the septum.

Such a defect is called a three-chambered heart. This is due to the fact that due to the complete absence of the septum, a single common atrium is formed, which can be associated with anomalies of the anrioventricular valves or with asplenia.

Small defects are quite difficult to detect – some people learn about their disease only in old age. With a large defect, life expectancy can be reduced to 35-40 years.

This problem over time leads to the depletion of the heart’s restorative resources, which can cause the development of pulmonary diseases, heart failure, pulmonary hypertension, and also lead to private fainting or even a stroke.

Symptoms

In childhood and adolescence, it is often quite difficult to recognize a small and medium defect, since it does not bring any obvious inconvenience. A large defect is much easier to recognize, since with it a rather pronounced symptomatology appears:

  • shortness of breath that occurs during physical exertion;
  • susceptibility to respiratory tract infections;
  • pallor or even blueness of the skin;
  • weakness, fatigue;
  • heart rhythm disorder.

If the patient observes one of the above symptoms, or parents pay attention to the child’s moodiness, tearfulness, lack of desire to play with other children for a long time, then you should consult a pediatrician or therapist. Next, the doctor will conduct an initial examination and, if necessary, give a direction for further examination.

What is the difference between a ventricular septal defect in a fetus and an atrial defect? Learn from this article.

Diagnostics

Various methods are used to identify the disease. For further guidance, you should contact your pediatrician or therapist, who, based on an analysis of the complaints of the patient or his parents, can refer you to a cardiologist.

First, a medical history of the patient’s life is collected (whether his relatives have congenital heart defects, how the mother was pregnant), and then they are given the direction for the following tests: a general urinalysis, a biochemical and a general blood test. Based on the results obtained, it is possible to find out how other internal organs function, and whether this is associated with the work of the heart.

A general examination, auscultation (listening to the heart), percussion (heart beating) are also carried out. The last two methods make it possible to find out whether there are changes in the shape of the heart and whether noises characteristic of this defect are audible. After the studies, the pediatrician or therapist decides whether there is reason for further diagnosis.

In the event that the doctor suspects that the patient has a congenital heart disease, more complex research methods are used:

  • An X-ray examination of the chest organs allows you to see changes in the shape of the heart.
  • Electrocardiography (ECG) makes it possible to observe the patient’s abnormalities in conduction and heart rate, as well as an increase in the right departments.
  • Echocardiography (echocardiography), or ultrasound. When using the two-dimensional (Doppler) method, you can see in what place the septal defect and its size are localized. In addition, this method allows you to see the direction of blood discharge through the hole.
  • Probing (insertion of a catheter) helps determine the pressure in the cavities of the heart and blood vessels.
  • Angiography, ventriculography and magnetic resonance imaging (MRI) are prescribed in cases where other methods of research were not indicative.

Therapies

One of the methods for treating small defects that do not impede the patient’s life is a conservative treatment method. In addition, this type of treatment is also used in cases where an operation not performed on time was the result of the development of diseases such as myocardial ischemia and heart failure.

Surgery is recommended for patients aged 1 year to 12 years. This is due to the fact that at this age the body has already adapted to the changes that have occurred in the body due to the atrial septal defect, and there is no longer the possibility of an independent closure of the defect. There are currently two ways to close a defect.

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Open operation

If the size of the hole does not exceed four centimeters, then an open heart operation can be performed. During the operation, a cardiopulmonary bypass, most often with cardiac arrest, is used.

Depending on the size of the defect, the method for its elimination is also determined: suturing the defect (not more than 120 millimeters) or installing a patch from your own pericardium.

The recovery period lasts about a month. At this time, it is necessary to monitor nutrition and refrain from physical exertion.

Этот способ оперативного вмешательства заключается в том, что через бедренную вену вводят катетер с окклюдером (пластиной), который далее направляется в правое предсердие. Далее окклюдер закрывает отверстие, «пломбирует» его.

Этот способ проведения операции имеет ряд преимуществ перед открытой операцией: нет необходимости в общем наркозе, мало травм, быстрый восстановительный период – всего несколько дней.

Что такое декстрокардия сердца, и могут ли правосердцечные люди нормально жить? Подробности тут.

Для того чтобы предотвратить развитие дефекта межпредсердной перегородки у детей, матери необходимо вовремя встать на учет в женской консультации во время беременности.

Следует исключить курение, употребление алкоголя, придерживаться правильного питания и принимать лекарственные препараты только по назначению врача. Также стоит сказать гинекологу, который ведет вашу беременность, о наличии родственников, страдающих врожденным пороком сердца.

Сегодня выявить дефект межпредсердной перегородки у детей довольно просто, порок сердца у новорожденных в большинстве случаев выявляется при проведении ультразвукового исследования. Если же болезнь не была обнаружена сразу после рождения, но у вас появились подозрения – необходимо проконсультироваться с врачом.

Прогноз

При своевременном выявлении наличия дефекта межпредсердной перегородки и его актуальном лечении прогноз благоприятный.

Если порок сердца был выявлен во взрослом возрасте, и его наличие никак не сказывается на качестве жизни больного, прогноз также остается благоприятным. В этом случае рекомендуется проходить ежегодное профилактическое обследование.

Если человек был прооперирован без осложнений в детском возрасте, то он считается практически здоровым. В этом случае прогноз жизни благоприятный. Сохранение на протяжении длительного времени ДМПП может приводить к частым пневмониям. Реже – к задержке физического развития, сердечной недостаточности и летальному исходу. Чем раньше было проведено устранение дефекта, тем благоприятнее прогноз.

Дефект межпредсердной перегородки у детей при отсутствии лечения может привести к серьезным нарушениям работы сердца. Устранить его можно только хирургическим способом. Современная педиатрия и кардиохирургия говорят, что чем раньше была проведена операция, тем меньше последствий ребенок ощутит в будущем.

Смотрите далее: импетиго у детей

Профилактика развития патологии

In cardiological practice, the disease is usually characterized depending on the location of the defect:

  • epigastric disease is diagnosed if the defect is located in the lower part of the septum;
  • most often muscle anomalies are located in the middle part;
  • pyrembranous disease is diagnosed if a defect is found in the upper part of the heart muscle.

Closing in infants naturally is only possible in the first case. If the defect is in the middle part, then the operation will not be required if its size does not exceed several millimeters. In the latter case, there are also high chances of self-overgrowing.

Pathology of this nature in medical practice is usually classified according to size:

  • without special symptoms and a sharp deterioration in health, only diseases with a small defect penetrate;
  • with an average gap, negative manifestations will be noticeable in the first few months of the baby’s life;
  • with a large defect, the risk of death is increased.

A ventricular septal defect can occur against the background of the negative effects of external and internal factors. The fetus also falls into the risk group in case of regular adverse effects of certain causes during pregnancy.

Unfortunately, today there are no measures that would make it possible to nullify the likelihood of developing a heart defect in the fetus. A woman should be careful about her own health. It is important to detect the disease as early as possible and direct all efforts to eliminate it. To do this, adhere to the following recommendation:

  • Mom should be registered for pregnancy before the end of the first trimester.
  • Nutrition is of no small importance, because it is with food that the necessary amount of vitamins and minerals enters the body.
  • A woman should be constantly registered with an obstetrician. It is not recommended to skip scheduled examinations.
  • Minimize alcohol consumption. It is advisable to completely abandon it, as well as smoking and drug use.

The timely operation ensures a normal life for the child in the future

In a newborn, ASD: what is an atrial septal defect and is the operation necessary for children?

In each case, the symptoms of the disease, sometimes with hemodynamic disorders, are very different. The severity of symptoms directly depends on the size and location of the defect, the duration of the disease and the presence of secondary complications.

In newborns, transient cyanosis may occur. Cyanosis of the skin and mucous membranes is manifested during crying and anxiety. As a rule, specialists associate this condition of the child with perinatal encephalopathy.

If the patient has an atrial septal defect expressed in an almost complete absence or rudimentary development of the septum, the first symptoms of the disease begin to appear as early as 3-4 months of age. Characteristic symptoms:

  • pale skin;
  • tachycardia;
  • weak weight gain, moderate growth retardation and physical development.

Due to hypervolemia of the pulmonary circulation, the disease proceeds with prolonged wet cough, shortness of breath and characteristic wheezing. Children under 10 years old suffer from dizziness, they quickly get tired during physical exertion and often lose consciousness.

If the atrial septal defect does not exceed 10-15 mm, then, as a rule, the disease proceeds without any clinical signs of heart disease. With age, the problem worsens, by the age of 20, patients develop pulmonary hypertension, and heart failure occurs. In adult patients, cyanosis, arrhythmia, and sometimes expectoration of blood are observed.

Any operation can lead to certain complications. Sometimes patients’ body temperature rises above 38 degrees, discharge from the wound appears, the rhythm of the heartbeat changes, shortness of breath with tachycardia and heart failure occurs. A child’s lips and skin may turn blue. In this case, you should immediately seek medical help. Such conditions are observed quite rarely, usually children quickly recover after surgery.

Over the past few years, the birth of children with congenital heart disease of varying severity has become more frequent. One of the common pathologies is ASD, an atrial septal defect, characterized by the presence of one or more holes on the septum between the right and left atria. In this regard, the quality of life of the crumbs can greatly decrease. The faster the deviation is discovered, the better its outcome.

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Congenital heart disease (CHD) is diagnosed with abnormal heart development in the prenatal period. This is the pathology of blood vessels and valves. ASD is also a congenital malformation, but it is connected with the septum between the right and left atria. The diagnosis is made in 40% of cases with a full examination of newborns. Doctors often reassure that over time, openings (or windows) in partitions can close themselves. Otherwise, surgery is required.

The septum separating the atria is formed at 7 weeks of fetal development. At the same time, a window remains in the middle through which blood circulation in the crumbs occurs. When the baby is born, the window should close a week after his birth. Often this does not happen. Then we are talking about CHD, atrial septal defect. This case is not considered difficult if there are no signs of a serious combination of CHD and ASD.

Pathology is dangerous because sometimes it is asymptomatic, manifesting itself after several years. In this regard, in many perinatal centers, a list of mandatory examinations of newborns includes ultrasound of the heart and examination by a cardiologist. Just listening to heart rhythms does not bring the proper result: noises can appear much later.

Doctors distinguish two types of ASD:

  • with a primary defect, an unclosed window is located at the bottom of the partition;
  • when the secondary holes are located closer to the center.

Description

Causes of heart disease

In the presence of ASD, the order of the blood flow in the chambers of the heart and the great vessels suffers, that is, hemodynamics. Under pressure, blood is discharged from the left atrium to the right. This causes an increase in the load on the right chambers of the heart. Over time, the right ventricle increases in mass and volume. After – completely out of order. In many ways, pulmonary hypertension contributes to this.

In newborns, this defect does not manifest itself in any way. Symptoms of the disease increase with age. In some cases, its presence is completely recognized after adulthood. Sometimes there is a delay in physical development. Frequent infectious diseases of the lower respiratory tract may occur.

Most often, symptoms appear in adulthood. They are associated with a violation of the right ventricle and atria. Shortness of breath during exercise, fatigue develop. Atrial fibrillation, rhythm disturbance, increased blood pressure in the pulmonary circulation, and heart failure appear later.

  1. In utero, the presence of an opening in the septum between the atria does not affect the function of the heart, since through it there is a discharge of blood into the large circle of blood circulation. This is important for the life of the baby, because its lungs do not function and the blood that is intended for them goes to the organs that work more actively with the fetus.
  2. If the defect remains after childbirth, blood during heart contractions begins to flow into the right side of the heart, which leads to overload of the right chambers and their hypertrophy. Also, a child with ASD eventually has compensatory ventricular hypertrophy, and the walls of the arteries become denser and less elastic.
  3. With very large hole sizes, hemodynamic changes are observed already in the first week of life. Due to blood entering the right atrium and overfilling of the pulmonary vessels, an increase in pulmonary blood flow occurs, which threatens the child with pulmonary hypertension. Consequences of pulmonary congestion are also edema and pneumonia.
  4. Further, the child develops a transitional stage, during which the vessels in the lungs spasm, which is clinically manifested by an improvement in the condition. During this period, it is optimal to perform an operation to prevent vascular sclerosis.

Possible complications

ASD can be complicated by such pathologies:

  • Severe pulmonary hypertension.
  • Infectious endocarditis.
  • A stroke.
  • Arrhythmias.
  • Rheumatism
  • Bacterial pneumonia.
  • Acute heart failure.

Do I need an operation

Surgical treatment is not required for all children with a defect in the septum that delimits the atria. With small sizes of the defect (up to 1 cm), self-overgrowing is often observed by 4 years of age. Children with such ASD are examined annually, observing their condition. The same tactics is chosen with a small septal aneurysm.

The treatment of children diagnosed with medium or large ASD, as well as major heart aneurysm, is surgical. It involves the implementation of either endovascular or open surgery. In the first case, the defect is closed to children by a special occluder, which is delivered directly to the child’s heart through large vessels.

The following video will present you with useful tips for parents who have experienced this disease.

Prevention

To prevent the occurrence of a child with ASD, it is important to carefully plan the pregnancy, pay attention to prenatal diagnosis and try to exclude the influence of negative external factors on the pregnant woman. Expectant mother should:

  • It is fully balanced to eat.
  • Enough to rest.
  • Regularly go to the consultation and take all the tests.
  • Avoid toxic and radioactive effects.
  • Do not use medicine without a doctor’s prescription.
  • Protect yourself from rubella in a timely manner.
  • Avoid communication with people with SARS.
Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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