Congenital heart disease in a fetus ⋆ Heart treatment

Pregnancy itself is an extremely difficult period in a woman’s life. It is even more difficult to bear a baby when the expectant mother knows that he has a congenital heart disease.

Unfortunately, the statistics is inexorable – more than 75% of children born with congenital heart defects die, usually not reaching the age of six months. Doctors add fuel to the fire. Having diagnosed heart disease, they immediately say that the child will not survive, regardless of the severity of the violation!

Our consultant, head of the Perinatal Cardiology Department of the Center for Cardiovascular Surgery. A.N. Bakuleva, MD Elena Dmitrievna BESPALOVA thinks differently: “Timely detection of heart disease, preparation of the future baby for childbirth and the upcoming operation will save his life, and in 90% of cases get rid of this disease forever!”

In our country it is fashionable to play sports, eat right, and lately it has been very honorable to pay special attention to your health. But, unfortunately, pregnancy planning still does not take its place in this peculiar list of popularity. But it is precisely from the “nonrandomness of conception” that the health of future babies depends.

What is the reason for this? First of all, with the fact that the formation of the heart occurs at the 6-8th week of pregnancy, that is, when the woman herself may not even suspect that she will soon become a mother. The most important point is the fifth week of pregnancy, responsible for the processes of separation of various structures and departments of the heart.

A woman who plans her pregnancy a few months before the upcoming event excludes from her diet everything that could harm her unborn baby – some medications, cigarettes, alcohol – she tries to minimize the chance of getting ARVI or ARI – these are commonplace infections most dangerous in the first ten weeks of pregnancy. So, this mother has a chance to give birth to a completely healthy and strong baby.

Unfortunately, none of us is safe from the birth of a baby with a congenital heart disease. But there are women for whom every pregnancy is a kind of lottery: what if you are lucky and the baby is born healthy? What are the risk factors?

– The family has relatives with heart defects. The likelihood of it recurring in a child is rather high. If such violations were observed in the mother, then the probability of transmitting bad genes to the baby is 5-7 times higher than if the father had a heart disease.

– The presence in a woman of children with congenital heart disease. If there are factors that caused this disease that have not been resolved, there is a chance of repetition.

– Chronic diseases of the mother. One of the most dangerous in this case is insulin-dependent diabetes mellitus (type 33 diabetes). Terrible is not only the likelihood of defects, but also the outcome of the pregnancy itself. In the second half of pregnancy, a woman’s condition worsens due to her underlying illness. Most often, this leads to the fact that the pregnant woman must be delivered earlier (sometimes at the rd week).

– Exposure to external factors – contact with chemicals, adverse environmental conditions, x-rays. Thus, it is noted that among female painters, the likelihood of having children with a variety of defects, including the heart, is extremely high. Even if they stop work in advance, this probability remains. And in the case of X-rays – a one-time action is enough, especially if the procedure is carried out before the 8th week of pregnancy.

– Taking certain medications – antibiotics, tranquilizers, antivirals – especially in the first trimester of pregnancy. I would especially like to note women who have been treated for infertility for a long time or have decided on in vitro fertilization. These women take a lot of drugs – antiviral and hormonal. And this can have an adverse effect on the course of pregnancy and the health of the unborn baby, even after the termination of drug therapy.

– The presence of infection in a woman – cytomegalovirus, ureaplasmosis, leukoplasmosis, herpes virus, Coxsackie virus. This is one of the most dangerous factors, since a woman can be a carrier of these infections for a long time and not know about it. As a rule, they either do not manifest themselves in any way, or their symptoms are very general, and they can be detected only with the help of special tests.

Plus, there are hundreds of thousands of viruses. It is simply impossible to exclude the presence of all women in the body of a woman. Such, for example, include the Coxsackie virus, which has many options – women are not examined for it in routine consultations. But sometimes it is because of him that pregnancy ends very poorly.

!  Chord in the heart of a child

Viral infections become the cause of extremely severe malformations. This is due to the fact that they are able to act on one of the critical periods of the formation of the heart – the period of cell differentiation – which leads to serious anatomical disorders in its structure. So, in three out of four pregnant women who did not treat latent infections, hypoplasia (underdevelopment) of the left parts of the fetal heart is observed. This defect reduces the quality of life of the baby, and even a large number of operations only briefly prolong the life of the child.

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Diagnostics

One of the components of the successful treatment of heart defects is the study of the entire background of this disease before the birth of the baby. There are indirect indicators of the possibility of developing heart disease during pregnancy: fetal growth retardation, fetal dropsy, the presence of one artery in the umbilical cord (normally there should be two). All these violations are a good reason to undergo additional examinations.

Exactly the presence or absence of congenital heart disease in the fetus can only be determined using ultrasound. Using modern diagnostic methods, this can be done very early, starting already from the 14-15th week of pregnancy.

If this is not possible, be sure to examine at 18-20 weeks. During this period, you can find absolutely all known cardiac pathologies. It is very important that the ultrasound is thorough and precise, the doctor must be able to look at the heart and know what to pay attention to.

If the baby’s congenital heart disease is confirmed, in no case do not miss an ultrasound at the later stages of pregnancy. This examination allows us to understand whether the myocardium is contracting well or poorly, whether there is fluid in the pericardium – all these functional changes are manifestations of intrauterine infection.

They can be corrected medically before childbirth with the help of the most commonplace drugs – actavigil or chimes – drugs that improve oxygen delivery. This therapy is used for the manifestation of any intrauterine infection, the detection of hypoxia or developmental delay, and treats hypoxic (associated with a lack of oxygen) rhythm disturbances.

At a later stage of pregnancy – 33-34 weeks – echocardiography is prescribed to a pregnant woman. It is necessary in order to understand the state of the anatomy of the defect at the time of birth.

Some heart defects are combined with diseases associated with chromosomal breakdowns – in such cases, the procedure of genetic karyotyping is required. This is an invasive procedure aimed at examining fetal cells, and is resorted to only in exceptional cases. So, the full form of atrio-ven-tricular communications is one of the grossest violations of the anatomy of the heart valves, in 50% of cases it is combined with Down’s disease.

What is the forecast

So, a terrible diagnosis was confirmed – the future baby has a heart defect. What is it worth preparing further? More than 100 different heart defects are known to those skilled in the art. Among them there are favorable defects, that is, those that can be operated on. Such defects include the open ductus arteriosus (normal communication between the aorta and the pulmonary artery should close immediately after the birth of the baby), defects in the atrial and interventricular septa (openings in the septum of the heart), minor changes in heart valves.

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Sometimes they are so insignificant that they do not require any surgical intervention at all – only closer monitoring by a doctor. Such defects do not disrupt the normal functioning of the heart and often spontaneously close in the first year of life. If a cardiologist suggests that these defects can lead to heart failure over time, surgery is needed.

From the point of view of cardiac surgeons, they are not classified as complex, and their technique is well developed. There are more complex and gross heart defects, for example, a violation in the structure and location of the main blood vessels or gross changes in the structure of heart valves. The result of the operation in this case depends on the characteristics of the disease – the same defect can have several anatomical variations – and also on how quickly violations of the anatomy of the heart were detected, whether the baby was promptly delivered to a specialized clinic. Sometimes surgical intervention is required in the first days or even hours after the birth of the baby.

There is a group of so-called adverse defects when surgery is impossible and the probability of a fatal outcome for a baby is high. In such cases, women have the opportunity to be examined and after that make a more balanced choice – to terminate the pregnancy or keep it.

Waiting for a miracle

Interpretation of results: norm and pathology

On an ultrasound scan of the heart, you can see in real time:

  • chambers (right and left ventricle, right and left atrium);
  • interventricular and interatrial septum;
  • heart walls;
  • valves (mitral, tricuspid, aortic and pulmonary arteries);
  • pericardium and pericardial cavity;
  • large vessels, including coronary vessels;
  • speed and rhythm of contractions;
  • blood flow in the heart and blood vessels (using the Doppler effect), etc.

The thickness of the walls and interventricular septum (MJP), the diameter of large vessels, the size of each chamber with systole (CSD) and diastole (CDD) are measured, their volume is calculated. Using dopplerography, blood flow velocity, blood volume in systole and diastole, ejection fraction (RF) are determined.

In conclusion, the doctor describes all the data obtained, indicates the presence of changes:

  • defect of the septum, valve apparatus;
  • blockage of blood vessels, myocardial ischemia, scar tissue;
  • inflammatory tissue lesions (myocarditis, pericarditis);
  • the presence of fluid in the pericardial cavity;
  • valve dysfunction;
  • congestion (decompensation of the heart muscle);
  • arrhythmia;
  • myocardial hypertrophy with hypertension;
  • narrowing of the aorta, etc.

The diagnosis is made by a cardiologist on the basis of the results and the clinical picture of the disease.

The fetal heart has structural features that can be seen on ultrasound. Normally, since the fetal lungs do not work in the interatrial septum, there is an oval window through which blood is partially discharged into the left atrium. It overgrows after the opening of the lungs, that is, the birth of a child, as well as the Batalov duct, which connects the pulmonary trunk to the aorta.

Heart tissue is also examined. For example, an increase in the echogenicity of the endocardium occurs with fibroelastosis, thinning of the myocardium indicates an abnormality of Ulya, and a thickening of cardiomyopathy. In the myocardium, the detection of hyperechoic formations (rhabdomyomas) is possible. Sometimes there is an increase in echogenicity in the interventricular septum, this may be a temporary phenomenon caused by the deposition of calcium salts, but may also indicate Down syndrome.

Prices for heart ultrasound in Moscow range from 1500 to 3000 rubles. This is an informative and, most importantly, safe method for the study of pathologies during pregnancy. According to experts, ultrasound helps to identify pathology, choose treatment tactics and monitor its effectiveness.

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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