Overview of methods for diagnosing congenital heart disease in children

The etiology of congenital kinds is represented by varied chromosomal abnormalities. Environmental elements additionally play a job. In the occasion that the mom was sick with rubella throughout being pregnant, the next three syndromes are detected in the kid:

  1. Cataract.
  2. Deafness.
  3. Congenital malformations of the heart. Most usually, this may be Fallot’s tetrad (a mixed congenital malformation, which incorporates stenosis of the suitable ventricular output tract, interventricular septal defect, aortic displacement, proper ventricular hypertrophy).
  4. In addition to rubella, the next infectious brokers have an effect on the embryonic improvement of the cardiovascular system:
  • Herpes simplex virus.
  • Adenovirus.
  • Cytomegalovirus.
  • Mycoplasma.
  • Toxoplasma.
  • Treponema pallidum.
  • Listeria.

The etiology of congenital malformations is sort of large. It might embody the use by a pregnant girl of alcohol and medicines. Teratogenic results on the fetus of amphetamines have been confirmed.

Despite the truth that defects will not be inherited, the presence of a household historical past of cardiovascular pathologies will increase the danger of valvular heart defects in children. Also, some consultants discuss in regards to the potential improvement of congenital malformation in future generations with shut marriage.

The trigger of acquired heart defects is most frequently acute rheumatic fever. In addition, the etiology consists of the next illnesses:

  • Atherosclerosis.
  • Syphilis.
  • Autoimmune illnesses.
  • Heart accidents.

Based on the signs recognized in the course of the examination, a prognosis of heart disease isn’t potential. For this, the doctor wants a collection of bodily and instrumental methods. Immediately on the primary go to to a specialist, propaedeutics of inner illnesses, in explicit, auscultation and palpation examination, play a big position.

To perceive the way to decide heart disease, it is very important know the primary instrumental methods used in the prognosis of such illnesses. The following research apply:

  1. Electrocardiography An electrocardiogram will assist detect adjustments in the heart. An ECG for heart defects doesn’t play an enormous position and most frequently helps to establish the results of the disease.
  2. Echocardiography. This is an ultrasound prognosis designed to completely examine the practical and morphological options of the heart.
  3. Phonocardiography is a method that means that you can show heart sounds in a graphical type.
  4. X-ray Allows you to establish the configuration of the heart, in addition to detect the transposition of blood vessels.

Modern pediatrics locations a particular place in the dedication of congenital anomalies on prenatal detection. Such a prognosis of heart defects is carried out in a number of levels. The preliminary stage lies on the shoulders of an atypical gynecologist, and after a suspicion of adjustments, the pregnant girl is referred to a specialist in fetal echocardiography.

Heart disease in newborns can present itself in other ways. The scientific image is determined by the kind of defect, the diploma of hemodynamic impairment, the presence of concomitant pathology and different elements. Some CHD stay asymptomatic and will not be detected in the neonatal interval. They are identified later – in infants aged 1-6 months. Less generally, CHD is detected after the primary 12 months of life.

The main signs of congenital heart disease:

  • cyanosis or pallor of the pores and skin and mucous membranes;
  • cardiac murmurs;
  • indicators of heart failure.

During the disease in newborns, two vital durations are distinguished:

  • 3-Fifth day: the oval window closes;
  • 3-6 weeks: decreased vascular pulmonary resistance.

During these durations, hemodynamics are disturbed, and the situation of the kid worsens.

In infants and infants beneath 3 years of age, the next signs might point out the presence of CHD:

  • blueness or pallor of the pores and skin;
  • fatigue throughout feeding;
  • dyspnea;
  • lack of weight;
  • lag in bodily improvement;
  • frequent illnesses of the bronchi and lungs.

Some heart defects stay undiagnosed till adolescence. Pathology might be suspected by the next indicators:

  • lag in bodily improvement (low weight and top);
  • fatigue, weak spot;
  • cardiopalmus;
  • swelling of the extremities;
  • pallor or cyanosis of the pores and skin;
  • elevated sweating;
  • cardiovascular syndrome (hoarseness, stridor – wheezing noisy respiration).

If an adolescent demonstrates these signs, it’s best to seek the advice of a health care provider: discover out the trigger of this situation, rule out congenital heart disease.

Clinical case

A child was admitted for session on the age of 3 months. From the anamnesis it’s identified: second being pregnant, supply by cesarean part for a interval of 39-40 weeks. The bearing of the kid proceeded towards the background of gestosis; in the primary trimester, the girl underwent ARVI (was handled at dwelling on her personal).

Congenital heart disease was suspected by a neonatologist in a maternity hospital on the third day after the beginning of the newborn. The physician listened to a gross systolic murmur alongside the left edge of the sternum and despatched the kid for examination. On the fifth day, echocardiography was carried out. Diagnosed with open atrioventricular canal, incomplete type. With this pathology, a defect happens in the decrease half of the atrial septum, and a bicuspid (mitral) valve additionally splits.

Assigned upkeep remedy: cardiac glycosides, diuretics. During remedy, the kid’s situation remained secure.

At the age of 3 months, a second examination was carried out. According to the outcomes, a call was made about hospitalization and preparation for the operation. The quantity of surgical procedure is a radical correction of the defect in cardiopulmonary bypass. A patch was created from his personal pericardium (bag surrounding the heart), mitral valve suturing was carried out. The postoperative interval was uneventful. Upon additional commentary, the affected person’s situation remained secure.

How to look at a toddler with suspected congenital heart defects? The diagnostic scheme is as follows:

  • Physical examination. The normal situation is assessed, the heart beat and respiratory price are calculated. Of explicit notice is the colour of the pores and skin and mucous membranes (it is very important establish pallor or cyanosis). Auscultation (listening) of the heart and lungs is carried out.
  • Instrumental analysis. If abnormalities are detected throughout a bodily examination, a further examination is indicated. It is important to establish heart disease, set up its sort, to evaluate the diploma of hemodynamic impairment.

Auscultation of the heart is a key level in the first prognosis of congenital malformations. Cardiac tones are evaluated by a neonatologist on the maternity hospital or by a pediatrician on the appointment. It is essential to keep in mind that heart murmurs are detected in 60-70% of newborns in the course of the first week of life, however this doesn’t at all times point out pathology. Often they’re related to the restructuring of blood circulation and are a variant of the norm.

Noises brought on by hemodynamic disturbances in CHD are normally detected on the 4th-Fifth day of life or later. Attention deserves noises that persist for greater than 3 days, in addition to mixed with indicators of heart failure:

  • shortness of breath;
  • heart palpitations and respiration;
  • swelling of the limbs;
  • enlarged liver;
  • extreme sweating;
  • decreased urine output;
  • weak breast sucking (in newborns and children as much as a 12 months).

If pathological noises or different indicators of CHD are detected, the kid falls beneath the supervision of a heart specialist and the examination continues:

  • Electrocardiography (ECG) – an evaluation of the primary indicators of the heart.
  • Echocardiography – an ultrasound examination of the heart. On the display screen, the physician sees a two- or three-dimensional picture, can establish defects in the event of the heart, consider the blood stream.
  • Pulse oximetry – means that you can assess the diploma of blood oxygen saturation and detect hypoxia (oxygen deficiency).
  • Chest x-ray. It is carried out to evaluate the dimensions of the heart. Helps establish some defects. The situation of the pulmonary sample can also be evaluated. Its adjustments point out a violation of blood stream in the pulmonary (pulmonary) circle of blood circulation and assist in the prognosis of many CHD.
  • CT scan. Allows you to get an in depth picture of the chambers of the heart and close by vessels. An different is MRI.
  • Cardiac catheterization. It is carried out solely after a whole ultrasound examination, provides extra detailed details about the work of the physique.

According to the protocol, it is strongly recommended that every one newborns bear pulse oximetry instantly in the maternity hospital (or in the neonatal pathology division if the toddler was hospitalized there). The take a look at is carried out in the primary 24–48 hours of life. It means that you can establish undiagnosed intrauterine malformations, together with vital (CHD, threatening the life of the kid). It is allowed to conduct a take a look at on the primary day after beginning if the newborn worsens.

Pulse oximetry is carried out by a nurse in the neonatal unit. An evaluation of the diploma of oxygen saturation (SaO2) on the suitable arm and leg is carried out. The take a look at outcomes are evaluated by a health care provider:

  • Negative take a look at – SaO2 greater than 95% on each limbs; the distinction between the indications on the arm and leg isn’t greater than 3%. This is an effective consequence, he says that the blood stream isn’t impaired.
  • A constructive take a look at – SaO2 lower than 95% on one limb and 90-95% on the opposite or lower than 90% on the arm and leg; the distinction is greater than 3%. This is an unfavorable consequence – a session with a heart specialist and additional examination are required.

Echocardiography is taken into account the gold customary for the prognosis of CHD. The full scope of the examination is decided by the attending doctor, taking into consideration the particular scientific scenario.

The precept of remedy is decided individually. We take note of present protocols, suggestions and decide the techniques of affected person administration taking into consideration the kind of defect, blood stream situation, and different parameters.

You can’t get rid of the anatomical defect on account of capsules or injections. We prescribe drugs to the kid solely on the stage of preparation for the operation. Used medication from varied teams:

  • glycosidic cardiac brokers;
  • ACE inhibitors;
  • calcium channel blockers;
  • aldosterone receptor antagonists;
  • vasodilators;
  • diuretics.

The targets of this remedy are to compensate for the ensuing heart failure and alleviate the affected person’s situation. In some instances, drug remedy continues after surgical procedure (particularly if the intervention was not radical).

  1. Clinical examination by a neonatologist after beginning.
  2. Fetal ultrasound of the heart. Conducted at 22-24 weeks of being pregnant, the place the anatomical buildings of the fetal heart are evaluated
  3. At 1 month after beginning, ultrasound screening of the heart, ECG.

The most essential examination in diagnosing fetal well being is ultrasound screening of the second trimester of being pregnant.

  • Assessment of weight achieve in infants, the character of feeding.
  • Assessment of tolerance of bodily exercise, motor exercise of infants.
  • When listening to a attribute noise in the heart, the pediatrician sends the kid to a pediatric heart specialist.
  • Ultrasound of the stomach cavity.
    • genetic mutations;
    • viral infections suffered by a lady throughout being pregnant (notably rubella);
    • extreme extragenital illnesses of the mom (diabetes mellitus, systemic lupus erythematosus and others);
    • alcohol abuse throughout being pregnant;
    • The age of the mom is older than 35.

    Classification of defects

    The scientific classification of CHD deserves curiosity:

    • Cyanotic (accompanied by blueness of the pores and skin, mucous membranes). This is tetralogy of Fallot, widespread arterial trunk, transposition of the nice arteries.
    • Accompanied by pallor (narrowing of blood vessels in the pores and skin and mucous membranes is attribute). This occurs with open ductus arteriosus, defects in the septa between the ventricles and atria, valvular stenosis of the pulmonary trunk.
    • Leading to systemic hypoperfusion (weakened blood stream). This is attribute of aortic defects (stenosis or coarctation).

    Another working system includes the division of CHD based on the peculiarities of hemodynamic disturbance – blood stream via the vessels. It is essential to spotlight the next choices:

    • related to fetal communications (options of the bloodstream in the fetus). The motion of blood in a big circle is determined by the patency of a particular construction referred to as the open ductus arteriosus, or OAP.
    • VSP not associated to the preservation of fetal buildings.

    The first case is vital for a new child. His blood circulation is determined by how lengthy the open oval window and the OAP will final. They should be closed throughout beginning. Then a full transition to a brand new routine of blood circulation with two circles is feasible. But with this kind of CHD, the circulatory system can solely operate whereas sustaining fetal buildings – an open oval window or ductus arteriosus. If they shut, a vital scenario develops, and heart failure happens.

    To perceive what heart defects are, you might want to know their classification. To start with, it ought to be stated that there are congenital and purchased defects.

    Depending on the placement of the lesion, there are the next varieties of defects:

    • Pathology of the valves.
    • Pathology of partitions.

    According to the quantity of affected buildings, the next varieties of heart defects are distinguished:

    • Simple. Defeat of one valve.
    • Complicated. Defeat of a number of valves.
    • Combined. The mixture of insufficiency and stenosis in one valve.

    The classification of heart defects additionally takes into consideration the extent of normal hypoxia of the physique. Depending on this issue, the next varieties are distinguished:

    • White. Adequate provide of tissues and organs with oxygen. Cyanosis doesn’t type.
    • Blue. Early manifestation of hypoxia, the formation of central cyanosis.
    Not damagedRight-sided heart, aortic malposition, minor ventricular septal defect (DMS)
    Overfill small circleCSF, atrial septal defect, open ductus arteriosus, irregular pulmonary venous drainageTransposition of main vessels, underdevelopment of the ventricles, widespread arterial trunk
    Impoverishment of the small circlePulmonary stenosisTetralogy of Fallot, false widespread arterial trunk, Ebstein’s disease
    Circulatory issues in a big circleMouth stenosis and coarctation of the aorta

    1. All congenital heart defects in children are divided by the character of blood stream issues and the presence or absence of blueness of the pores and skin (cyanosis).

    Cyanosis is a bluish pores and skin. It is brought on by an absence of oxygen, which is delivered with blood to organs and methods.

    Personal expertise! In my apply, there have been two children with dextracardia (the heart is positioned on the suitable). Such youngsters dwell a traditional wholesome life. Defect is revealed solely when listening to the heart.

    2. Frequency of prevalence.

    1. A ventricular septal defect happens in 20% of all heart defects.
    2. The atrial septal defect takes from 5 – 10%.
    3. The open ductus arteriosus is 5-10%.
    4. Pulmonary stenosis, stenosis and coarctation of the aorta occupy as much as 7%.
    5. The the rest is accounted for by quite a few different, however rarer vices.

    Signs of congenital heart disease in children

    • Symptoms of the disease
    • Symptoms of the disease
    • Diagnostics

    Any suspicion of the gynecologist conducting this examine for the presence of any abnormality in the fetus ought to be duplicated by a further examine by specialists of reproductive facilities.

    When intrauterine heart disease is detected, on the idea of its severity, mixture with the pathology of different organs, the viability of the kid is predicted after beginning. After which, along with my mom, the query of a potential abortion is set.

    If the mom determined to proceed bearing the newborn, then childbirth is deliberate in advance. They are carried out in a specialised establishment in which there’s each alternative for the surgical correction of cardiac pathology instantly or a while after the newborn is born.

    • In these instances, the prognosis after beginning is determined by the extent of compensatory skills of the kid. Some of the defects manifests itself instantly after a couple of hours after giving beginning, half – inside a month after beginning, and a few defects stay unrecognized all through life.
    • And but there are indicators by which one can suspect a congenital pathology of the heart in a new child to extreme manifestations of heart failure. And there are signs that recommend CHD in adults.
    • With the thinning of the compensatory mechanisms (the interval for every defect is totally different), indicators of contractile heart failure regularly seem.

    The subcutaneous tissue of the decrease and higher extremities turns into edematous.

    This is particularly putting when a loosely tied tag with the quantity of beginning and surname of the newborn’s mom abruptly abruptly stops transferring freely and even leaves furrows after itself. In addition, the newborn’s abdomen begins to develop in quantity on account of fluid effusion and a rise in the dimensions of the liver.

    Along with the beforehand described indicators which are decided by auscultation of the heart, which might be expressed in various levels, half of the signs seem in the method of improvement and rising up of the kid.

    The prognosis of CHD in a toddler is made on the idea of a quantity of signs. In extreme instances, adjustments shall be noticeable instantly after beginning. It isn’t tough for an skilled physician to make a preliminary prognosis already in the supply room and coordinate their actions in accordance with the present scenario. In different instances, mother and father don’t suspect the presence of heart disease for a few years till the disease passes into the stage of decompensation.

    What provides the physician motive to recommend CHD in a toddler nonetheless in the supply room? First of all, the atypical coloring of the pores and skin of a new child attracts consideration. In distinction to rosy cheek infants, a toddler with a heart defect shall be pale or blue (relying on the kind of lesion of the pulmonary circulation). The pores and skin is cool and dry to the contact. Cyanosis can unfold to the entire physique or be restricted to a nasolabial triangle relying on the severity of the defect.

    At the primary listening to of the heart tones, the physician will discover irregular noises at important factors of auscultation. The motive for the looks of such adjustments is the improper blood stream via the vessels. In this case, with the assistance of a phonendoscope, the physician will hear the amplification or weakening of the heart tones, or will discover atypical noises that shouldn’t be in a wholesome baby. All this in the advanced permits the neonatologist to suspect the presence of congenital heart disease and ship the newborn to the focused prognosis.

    A new child with this or that CHD, as a rule, behaves restlessly, usually and for no motive weeping. Some children, against this, are too torpid. They don’t take the breast, refuse the bottle and don’t sleep properly. The prevalence of shortness of breath and tachycardia (speedy heartbeat)

    In the occasion that the prognosis of CHD in a toddler was made at a later age, the event of psychological and bodily abnormalities is feasible. Such children develop slowly, gaining weight poorly, lagging behind in college, not holding tempo with wholesome and energetic friends. They don’t address the hundreds in college, don’t shine in bodily schooling courses, they usually get sick. In some instances, heart disease turns into a random discovery on the subsequent medical examination.

    In extreme conditions, continual heart failure develops. Dyspnea seems on the slightest exertion. Legs swell, the liver and spleen enhance, adjustments happen in the pulmonary circulation. In the absence of certified help, this situation ends with incapacity and even the loss of life of a toddler.

    All these indicators make it potential to kind of verify the presence of CHD in children. Symptoms might fluctuate in totally different instances. The use of fashionable diagnostic methods permits to verify the disease and prescribe the mandatory remedy in time.

      one of the signs of vice is the looks of shortness of breath. First, it seems throughout train, then at relaxation.

    Shortness of breath is a speedy respiration price;

  • a change in the shade of the pores and skin is the second signal. Color can fluctuate from pale to cyanotic;
  • swelling of the decrease extremities. This differs from cardiac edema from renal. With kidney pathology, the face first swells;
  • a rise in heart failure is considered a rise in the sting of the liver and a rise in swelling of the decrease extremities. These are, as a rule, cardiac edema;
  • with tetralogy of Fallot, there could also be shortness of breath – cyanotic assaults. During the assault, the kid begins to “flip blue” sharply, and speedy respiration seems.
  • Stages of improvement of CHD

    Regardless of the kind and severity, all defects undergo a number of levels. The first stage is named adaptive. At this time, the kid’s physique adapts to the brand new situations of existence, adjusting the work of all organs to a barely altered heart. Due to the truth that all methods should work at the moment for put on, it’s potential the event of acute heart failure and failure of your entire physique.

    The second stage is the part of relative compensation. Changed heart buildings present the kid with a kind of regular existence, performing all its features on the correct degree. This stage can final for years till it results in the failure of all physique methods and the event of decompensation. The third part of CHD in a toddler is named terminal and is characterised by severe adjustments all through the physique.

    For full improvement, the fetus wants its personal blood circulation, due to this fact, the cardiovascular system develops sooner than others – the formation begins already on the 14th day after conception. After 22 days, the heart begins to pulsate, and some days later the blood begins to flow into. And, though the cardiac system in this era remains to be solely on the preliminary stage of formation, so much is determined by how the processes of improvement of the fetus, the state of the mom and exterior elements proceed.

    Congenital malformations of the cardiovascular system develop from 14 to 60 days from conception. With the conventional course of being pregnant and the proper improvement of the fetus, by the second month the kid’s heart ought to be shaped:

    • partitions develop, the heart turns into four-chambered;
    • there’s a separation of the arterial trunk into the aorta and pulmonary artery;
    • the ventricle is split into two halves;
    • heart valves are shaped.

    But, the affect of destructive elements results in a failure in the event of the cardiac system – that is how congenital malformations type.

    From the twelfth week of being pregnant, you possibly can decide what pathologies can develop in the newborn. This permits mother and father to determine whether or not to terminate or keep a being pregnant. But, it ought to be borne in thoughts that there’s a probability of a medical error and the kid might be born wholesome. In any case, the suspicion of CHD in the kid means that you can put together for potential operations that should be carried out instantly after beginning in order to avoid wasting his life.

    In most instances, congenital heart disease in children happens because of this of a genetic predisposition. If somebody in the household has been identified with congenital illnesses of the heart system, then with a excessive likelihood they are going to be transmitted to the kid.

    The presence of defects in mother and father and the probability of their improvement in a toddler is taken into account as a proportion. So, it happens in 13% of {couples}, if one of the mother and father has a historical past of CHD. Other varieties of pathologies happen with a likelihood of 1-10%.

    The improvement of CHD in a toddler is affected by the life-style of the mom throughout being pregnant planning and gestation. This consists of not solely nicotine and alcoholic drinks, but in addition the use of drugs. What drugs are unsafe:

    • blood thinners with the energetic substance warfarin sodium (Warfarin, Marevan, Warfarex);
    • anticonvulsant and antiepileptic medication;
    • corticosteroids;
    • immunosuppressants;
    • psychostimulants;
    • barbiturates.

    A excessive threat of growing congenital pathologies of the heart and different organs in children whose moms labored in adversarial situations. Lifting weights or inhaling chemical fumes adversely impacts fetal improvement. Infectious illnesses carried by the mom are very harmful for the kid’s heart system.

    Even an simply transferred sickness in the primary trimester can have an effect on the event of the heart and circulatory system.

    An essential position in the formation of defects is performed by continual illnesses of the mom:

    • diabetes;
    • autoimmune illnesses;
    • epilepsy;
    • phenylketonuria;
    • nephrogenic hypertension;
    • extreme kidney disease.

    A excessive threat of growing CHD in a toddler if the mom is youthful than 17 years outdated or older than 40, girls of this age ought to go to the physician extra usually and bear examinations than the remaining. Abnormal improvement of the cardiac system can happen with extreme first trimester toxicosis, extended stress, and the menace of miscarriage in the early levels.

    Despite the truth that the signs of congenital malformations are fairly vivid, in the method of a scientific examination of a new child child, the prognosis can solely be assumed, since many signs will not be strictly particular, however might be brought on by different extreme situations of the new child (respiratory misery syndrome, intracranial hemorrhage, and so forth. .).

    Also, not all defects may give a attribute auscultatory image (in the method of listening to the chest), and vice versa, noises, clicks or different auscultatory manifestations can happen with slight deviations from the norm in the construction of the heart (small anomalies). Therefore, if a heart defect has not been identified by ultrasound of the fetus, all children with signs of circulatory issues (diffuse or acrocyanosis, shortness of breath when feeding or at relaxation, loss of consciousness, convulsions) ought to have an ultrasound scan of the heart whereas in the hospital.

    Echocardiography (ultrasound of the heart) is one of essentially the most informative methods for visualizing heart defects. An ECG can be prescribed (it would present rhythm disturbances, atrial and / or ventricular hypertrophy, if any), chest x-ray (will present blood stasis in the lungs, if any, a rise in heart shadow as a result of growth of its chambers).

    Now we dwell in extra element on the ultrasound prognosis of widespread heart defects.

    A. Congenital heart disease with quantity overload of blood vessels in the lungs (pulmonary circulation).
    1. Atrial septal defect – utilizing one-dimensional echocardiography, indicators of quantity overload and dilatation (growth) of the suitable ventricle are detected, two-dimensional echocardiography reveals a break in the echosignal between the atria, and with a Doppler examine, turbulent (with “vortices”) blood stream via the intercostal area is assessed pulmonary circulation issues. 2.

    So the defect of the septum between the ventricles is manifested throughout echocardiography with Doppler. On the left is the conventional interventricular septum, on the suitable is its defect (VSD).

    3. Open Botallov duct – manifests itself on echocardiography by steady blood stream via communication in the aorta and pulmonary artery, by a change in blood stream on the mouth of the pulmonary trunk. 4. Coarctation of the aorta – a segmental section of narrowing of the aortic lumen is seen, accelerated blood stream beneath the section. 5. Transposition of the primary arteries – the wrong passage of blood vessels from the heart is visualized.

    B. Heart defects with a lower in blood quantity in the pulmonary circulation.
    1. Tetralogy of Fallot – with echocardiography, in addition to stenosis (narrowing) of the pulmonary artery and defect of the septum between the ventricles, hypertrophy of the suitable ventricle and aortic discharge from the suitable ventricle are decided, and the diploma of impaired intracardiac hemodynamics can also be evaluated. 2.

    Pulmonary stenosis – narrowing of the lumen of the pulmonary artery, and acceleration of blood stream on the mouth of the pulmonary artery and hypertrophy of the suitable ventricle. 3. Epstein’s anomaly is a pathology of the event of the tricuspid valve of the heart, when the valve leaflets are hooked up to not the fibrous ring between the atrium and the ventricle on the suitable, however to the partitions of the suitable ventricle, which causes a lower in its quantity.

    With ECHO – CG, the pathology of the valve is decided, the diploma of growth of the cavities of the heart and the violation of intracardiac blood stream are evaluated. Atresia of the tricuspid valve – with ECHO – KG there isn’t any reflection of the echo from the tricuspid valve, hypertrophy of the suitable atrium and left ventricle is recorded.

    B. Heart defects with a lower in the quantity of circulating blood in a big circle of blood circulation (in the vessels of all important organs).
    1. Coarctation of the aorta (see above) .2. Isolated aortic stenosis – the diploma of narrowing is estimated, accelerated blood stream via the aortic valve and deformed valve flaps is visualized.

    G. Heart defects with out impaired hemodynamics.
    – Dextrocardia (a mirror association of the heart on the suitable) is a reasonably uncommon anomaly; as a rule, ultrasound of the heart exhibits no hemodynamic disturbances.

    Operations might be carried out each on an open heart (with a dissection of the chest wall) and by the cardiovascular technique (when entry to the heart is carried out by inserting a probe reaching the heart cavities into the vessels). The latter technique, for instance, is used to right defects between the atria or ventricles, to which the occluder closes the holes with a probe.

    But with some heart defects that aren’t appropriate with life, for instance, a three-chamber heart (one atrium and two ventricles, or two atria and one ventricle), surgical correction, sadly, isn’t potential.

    In addition to cardiac surgical procedure, the affected person is prescribed drug remedy to enhance the contractile operate of the heart and “unload” the pulmonary circulation. ACE inhibitors (enalapril, perindopril, lisinopril, ramipril, and so forth.), diuretics (furosemide, indapamide, and so forth.), B-blockers (carvedilol, bisoprolol, and so forth.) are used.

    The affected person should adjust to the next suggestions relating to his way of life: – a balanced rational weight-reduction plan; – a weight-reduction plan that restricts sodium chloride and the quantity of fluid consumed (to cut back the quantity overload of the heart and blood vessels); – adequate keep in the contemporary air; – the exclusion of any train and restriction robust bodily exertion;

    – adequate sleep for the period; – common monitoring by a heart specialist and cardiac surgeon with the mandatory remedy and diagnostic measures; – being pregnant for girls with defects of the “blue” sort is strictly contraindicated, but when surgical remedy has been carried out, the likelihood of sustaining being pregnant is decided individually in every case with the joint administration of a pregnant cardiac surgeon, heart specialist and obstetrician-gynecologist in a specialised hospital. Delivery, as a rule, is carried out by cesarean part.

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    What is UPU

    Atrial septal defect

    The heart has two ventricles which are separated by a septum. In flip, the septum has a muscular half and a membranous half.

    The muscular half consists of 3 areas – provide, trabecular and outflow. This information in anatomy helps the physician make an correct prognosis based on the classification and decide the additional remedy techniques.


    If the defect is small, then there aren’t any particular complaints.

    If the defect is medium or giant, then the next signs seem:

    • lag in bodily improvement;
    • decreased resistance to bodily exercise;
    • frequent colds;
    • if untreated, the event of circulatory failure.

    Defects in the muscle half as a result of development of the kid are closed independently. But that is topic to small sizes. Also, in such children, it’s crucial to recollect the lifelong prevention of endocarditis.

    With giant defects and with the event of heart failure, surgical measures ought to be taken.

    Very usually, vice is an unintentional discover.

    Children with an atrial septal defect are vulnerable to frequent respiratory infections.

    With giant defects (greater than 1 cm), a toddler might expertise poor weight achieve and the event of heart failure from beginning. Children are operated on after reaching 5 years. The postponement of the operation is as a result of likelihood of an unbiased closure of the defect.

    Consider one of the categories of CHD. ASD in children is one of the most typical heart defects discovered in infants over the age of three. With this pathology, the kid has a small gap between the suitable and left atria. As a consequence, there’s a fixed reflux of blood from left to proper, which naturally results in overflow of the pulmonary circle of blood circulation. All the signs that develop with this pathology are related to a violation of the conventional functioning of the heart in altered situations.

    Normally, the opening between the atria exists in the fetus till beginning. It is named an oval window and, as a rule, closes with the primary breath of the new child. In some instances, the opening stays open for life, however this defect is so small that an individual doesn’t even learn about it. Hemodynamic disturbances with this feature will not be famous. with out inflicting any discomfort to the kid, it could change into an unintentional discovering throughout an ultrasound examination of the heart.

    In distinction, the true atrial septal defect is a extra major problem. Such openings are giant and might be positioned each in the central half of the atria and on the edges. Type of CHD (DMPP in children, as we now have stated, happens most frequently) will decide the remedy technique chosen by a specialist on the idea of ultrasound information and different examination methods.

    Let’s discuss one other sort of IPN. CHD in children is the second of the most typical heart defects older than three years. In this case, a gap is discovered in the septum separating the suitable and left ventricles. There is a continuing reflux of blood from left to proper, and, as in the case of ASD, congestion in the pulmonary circulation develops.

    The situation of small sufferers can fluctuate significantly relying on the dimensions of the defect. With a small opening, the kid might not make any complaints, and noise throughout auscultation is the one second that may disturb mother and father. In 70% of instances, minor ones shut by themselves beneath the age of 5 years.

    A very totally different image emerges with a extra extreme model of CHD. BC in children typically reaches giant sizes. In this case, the probability of growing pulmonary hypertension is a horrible complication of this defect. At first, all physique methods adapt to new situations, distilling blood from one ventricle to a different and creating elevated stress in the vessels of the small circle.

    Sooner or later, decompensation develops, in which the heart can now not address its operate. Discharge of venous blood doesn’t happen, it accumulates in the ventricle and enters the big circle of blood circulation. High stress in the lungs doesn’t enable heart surgical procedure, and such sufferers usually die from problems. That is why it’s so essential to establish this defect in time and refer the kid to surgical remedy.

    In the case when the VSD isn’t closed independently earlier than 3-5 years or is simply too giant, an operation is carried out to revive the integrity of the interventricular septum. As in the case of DMPP, the opening is sutured or closed with a patch lower from the pericardium. It is feasible to shut the defect in an endovascular manner if situations enable it.

    Consider one of the categories of CHD. DMPP in children is one of essentially the most frequent heart defects discovered in children over the age of three years. In this pathology, the kid has a small opening between the suitable and left atria. As a consequence, there’s a fixed reflux of blood from left to proper, which naturally results in an overflow of the pulmonary circulation. All the signs that develop in this pathology are related to impaired regular functioning of the heart in altered situations.

    Normally, a gap between the atria exists in the fetus till beginning. It is named an oval window and, as a rule, closes with the primary inhalation of a new child. In some instances, the opening stays open for life, however this defect is so small that an individual doesn’t even learn about it. Hemodynamic issues in this embodiment isn’t noticed. An open oval window, which doesn’t trigger any discomfort to the kid, might be an unintentional discover throughout an ultrasound examination of the heart.

    Let’s discuss one other type of the UPU. Children with VShP at children – the second of essentially the most usually discovered heart illnesses in age is increased than three years. In this case, a gap is discovered in the septum separating the suitable and left ventricles. There is a continuing surge of blood from left to proper, and, as in the case of DMPP, an overload of the pulmonary circulation develops.

    The situation of younger sufferers can fluctuate significantly relying on the dimensions of the defect. With a small gap, the kid might not make any complaints, and the noise throughout auscultation is the one factor that may trouble the mother and father. In 70% instances, minor ventricular septal defects shut by themselves earlier than the age of 5.

    A very totally different image emerges with a extra extreme model of CHD. BC in children typically reaches giant sizes. In this case, the probability of growing pulmonary hypertension is a horrible complication of this defect. At first, all physique methods adapt to new situations, distilling blood from one ventricle to a different and creating elevated stress in the vessels of the small circle.

    Sooner or later, decompensation develops, in which the heart can now not address its operate. Discharge of venous blood doesn’t happen, it accumulates in the ventricle and enters the big circle of blood circulation. High stress in the lungs doesn’t enable heart surgical procedure, and such sufferers usually die from problems. That is why it’s so essential to establish this defect in time and refer the kid to surgical remedy.

    We will not be identified for sure causes of fetal malformations. We can solely assume the affect of some elements:

    • Chromosomal abnormalities are structural or quantitative adjustments in gene materials. Both maternal and paternal cells might be faulty. Probably a hereditary flaw, and the primary mutation that arose. Even if the mother and father are wholesome, for some motive a defect in a single reproductive cell typically develops. If this explicit cell turns into the idea of the embryo, a violation will happen.
    • The affect of exterior teratogens. Constant contact with toxins is harmful, particularly in the first trimester. Fetal CHD on ultrasound we frequently establish in girls employed in the paint and polish trade. The identical penalties might consequence from taking sure drugs in the primary trimester (antiepileptic medication, Ibuprofen, lithium preparations, and others). An extra of vitamin A, ionizing radiation, dwelling in an ecologically unfavorable space are harmful.
    • Intrauterine infections. This is, first of all, rubella – in the course of the preliminary an infection of the physique, defects in the heart of the fetus, injury to the eyes and listening to organ happen. Danger in the primary trimester of being pregnant is influenza and cytomegalovirus, any viral an infection with fever.
    • Maternal elements. The threat of growing CHD in children is increased with a burdened obstetric historical past. It is at all times alarming if earlier there have been miscarriages, particularly at 13-24 weeks, a possible consequence of an undiagnosed defect. There is a hazard to the unborn baby, alcohol consumption by the mom, smoking. The likelihood of having a child with CHD is increased in girls in labor from 35 years outdated and with diabetes.
    • Family elements. Taking medication (cocaine, marijuana) by the toddler’s father will increase the danger of growing CHD.

    It is essential to know the causes and penalties of heart disease in the new child and the fetus, however usually it’s unimaginable to unequivocally say which issue turned decisive. It is unimaginable to trace what precisely led to the looks of the defect. Did the ibuprofen tablet taken by the mom from headache change into deadly, or was the “caught” virus the trigger of the disease? We can solely speculate and attempt to remove all destructive elements.

    Open oval window

    Of all kinds of CHD, this kind of pathology is far more widespread than others. Normally, every baby in the perinatal interval has a gap between the suitable and left atrium, however after beginning it overgrows inside a couple of months. In some children, the oval window could also be open till the age of two, but when it doesn’t enhance, however, quite the opposite, turns into smaller, then this situation doesn’t require remedy.

    Children with this atrial septal defect have to have an ultrasound of the heart as soon as each 6 months in order to dynamically monitor its situation. For most children, an open oval window doesn’t present itself in any manner, and lots of study their vice solely in maturity.

    The following indicators might accompany an open oval window:

    • Cyanosis;
    • fatigue;
    • dizziness;
    • short-term loss of consciousness.

    Children with such a defect are predisposed to colds, in order that they must be protected, since in the course of the disease the load on the heart and blood vessels will increase.

    The arterial duct is positioned between the aorta and the pulmonary artery, and it’s wanted solely throughout being pregnant to move blood. If the beginning came about in due time with out problems and the newborn was born with regular weight, then this duct closes inside a couple of days. In untimely infants, the closure of the ductus arteriosus can attain three months. If after this time there has not been a closure, then they discuss in regards to the presence of a congenital malformation.

    A small duct doesn’t present itself in any manner, and it will possibly solely be detected utilizing ultrasound. Indirectly, the next signs point out a large duct:

    • lag in top and weight from the norm;
    • problem respiration;
    • pale pores and skin;
    • stressed sleep;
    • poor urge for food.

    All these indicators can accompany different illnesses that aren’t associated to the heart system, so an intensive examination of the kid is required. If well timed remedy isn’t taken, then a small protrusion happens on the kid’s chest. Noises are heard when listening, however solely an skilled specialist can hearken to them. In children with this anomaly, it usually happens, which might result in the loss of life of the kid.

    This drawback accompanies untimely infants in 50% of instances.

    Botallov duct is a vessel that connects the pulmonary artery and the aorta in the fetal life of the newborn. After beginning, it’s delayed.

    If the defect is giant, the next signs are detected:

    • poor weight achieve;
    • shortness of breath, palpitations;
    • frequent SARS, pneumonia.

    Spontaneous closure of the duct, we wait as much as 6 months. If a toddler older than a 12 months he stays unclosed, then the duct should be eliminated surgically.

    When detecting untimely infants, the drug indomethacin, which scleroses (glues) the partitions of the vessel, is run even in the hospital. For full-term newborns, this process is ineffective.

    Bicuspid aortic valve

    This congenital pathology is related to a narrowing of the primary artery of the physique – the aorta. This creates a sure impediment to the blood stream, which kinds a particular scientific image.

    Case! A lady, 13 years outdated, complained of a rise in blood stress. When measuring the stress on the legs with a tonometer, it was considerably decrease than on the palms. The pulse on the arteries of the decrease extremities was barely felt. When identified with ultrasound of the heart, coarctation of the aorta was revealed. A toddler over 13 years has by no means been examined for congenital malformations.

    Usually, aortic narrowing is detected from beginning, however possibly later. Such children, even in look, have their very own peculiarity. Due to poor blood provide to the decrease physique, they’ve a reasonably developed shoulder girdle and sloping legs.

    It happens extra usually in boys. As a rule, coarctation of the aorta is accompanied by a defect in the interventricular septum.

    Normally, the aortic valve ought to have three valves, but it surely so occurs that two of them are laid from beginning.

    Tricuspid and bicuspid aortic valve

    Children with a bicuspid aortic valve don’t notably complain. The drawback could also be that such a valve will put on out sooner, which is able to trigger the event of aortic insufficiency.

    With the event of grade 3 insufficiency, surgical alternative of the valve is required, however this may occur by 40-50 years.

    Children with a bicuspid aortic valve ought to be noticed twice a 12 months and endocarditis ought to be prevented.

    Prediction and prevention of congenital heart defects

    Since it is a congenital drawback, prevention ought to start with the prenatal interval.

    1. Exclusion of smoking, poisonous results throughout being pregnant.
    2. Genetics session in the presence of congenital malformations in the household.
    3. Proper diet of the expectant mom.
    4. Mandatory remedy of continual foci of an infection.
    5. Hypodynamia worsens the functioning of the heart muscle. Daily gymnastics, massages, work with a bodily remedy physician are wanted.
    6. Pregnant girls should bear ultrasound screening. A heart defect in newborns ought to be noticed by a heart specialist. If crucial, be promptly referred to a cardiac surgeon.
    7. Obligatory rehabilitation of operated children, each psychological and bodily, in sanatorium-resort situations. Every 12 months, the kid ought to be examined in a cardiology hospital.

    Unfortunately, the extent of improvement of drugs doesn’t signify a possibility to intervene in fetal improvement and by some means have an effect on the heart tab. Prevention of CHD in children includes an intensive examination of the mother and father earlier than the deliberate being pregnant. Expectant mom earlier than conceiving a toddler must also hand over dangerous habits, change jobs in hazardous manufacturing to a different exercise. Such measures will cut back the danger of having a child with a pathology of the event of the cardiovascular system.

    Routine rubella vaccination for all women avoids the prevalence of CHD on account of this harmful an infection. In addition, expectant moms ought to bear ultrasound screening on time for gestation. This technique means that you can well timed establish malformations in the newborn and take the mandatory measures.

    The prognosis for the event of congenital heart defects is determined by many elements. The sooner the disease is detected, the larger the possibility of stopping the state of decompensation. Timely surgical remedy not solely saves the lives of younger sufferers, but in addition permits them to dwell with none important restrictions on the state of well being.

    Can the disease be prevented? We have no idea for certain why malformations of the heart come up, and we can not totally affect this course of. But it’s in our energy to establish the pathology on the stage of intrauterine improvement, to find out the potential dangers and put together for the beginning of a toddler with a defect. If the defect is incompatible with life, abortion is indicated for as much as 22 weeks.

    How to provide beginning to wholesome children? Specialist recommendation

    Primary prevention is the elimination of all elements that may result in the beginning of a toddler with heart disease. To do that, it is strongly recommended:

    • Have a future mom vaccinated towards rubella earlier than conception. It is proved that this disease results in the looks of extreme CHD in the fetus. Pregnancy might be deliberate 3 months after vaccination.
    • Raise immunity. In the primary trimester, susceptibility to infections will increase. It is important to take care of strengthening immunity in a well timed method. It is essential to watch the weight-reduction plan, take nutritional vitamins in winter and spring.
    • Be cautious. Avoid self-medication and seek the advice of a health care provider. Many medication are prohibited for expectant moms: they’ll trigger fetal abnormalities.
    • To refuse from dangerous habits. When planning being pregnant, you can’t smoke and abuse alcohol.
    • Get remedy. Diabetes mellitus and weight problems in girls enhance the danger of heart defects in the fetus. You have to drop a few pounds and discover ways to management blood sugar earlier than conception.

    During being pregnant, secondary prevention is carried out. It is already unimaginable to forestall the prevalence of CHD, however you possibly can detect them in the primary half of gestation – as much as 20-22 weeks. For this, a lady ought to frequently bear prenatal ultrasound screenings in a well timed method:

    Ultrasound is carried out for all sufferers with out exception, however there’s a particular threat group – those that usually tend to have a toddler with CHD. These are girls who’ve had a viral an infection in the primary trimester, undergo from diabetes and weight problems, take unlawful medication in the early levels, and are over the age of 35 years. They undoubtedly shouldn’t refuse from ultrasound – a fast and secure manner of intrauterine prognosis of heart defects.

    It is essential to keep in mind that fetal CHD is usually mixed with chromosomal abnormalities, due to this fact session with a geneticist and karyotyping are required.

    After detection by ultrasound, it clarifies the prognosis of FEChCG. Fetal echocardiography is taken into account a very secure technique and is carried out at any stage of being pregnant.

    Unfortunately, the extent of improvement of drugs doesn’t signify a possibility to intervene in and by some means have an effect on the laying of the heart. Prevention of CHD in children includes an intensive examination of the mother and father earlier than the deliberate being pregnant. The expectant mom earlier than conceiving a toddler must also abandon dangerous habits, change work in hazardous work for different actions. Such measures will cut back the dangers of having a child with a pathology of the event of the cardiovascular system.

    Congenital heart defects are a number of illnesses related to the presence of anatomical pathology of the heart, its valves and blood vessels, shaped throughout fetal improvement. These defects trigger a change in systemic and intracardiac circulation, heart overload.

    Symptoms of the disease are brought on by the kind of defect, most frequently cyanosis (cyanosis) or pallor of the pores and skin, lag in bodily improvement, heart murmur, manifestation of heart and respiratory failure. If the physician suspected a congenital heart defect, FCG, ECG, echocardiography, radiography are carried out.

    Many varieties of heart issues are mixed with one another or different systemic pathologies in the physique. In adults, CHD is way much less widespread than in childhood. Identification of violations can happen even in maturity.

    To start with, threat elements contributing to the formation of heart abnormalities ought to be highlighted:

    • mom’s age earlier than 17 years or after 40 years;
    • the menace of termination of being pregnant;
    • toxicosis of the primary trimester;
    • endocrine illnesses in a pregnant girl;
    • historical past of stillbirths;
    • burdened by heredity.

    The causes of congenital heart defects might be the next: chromosomal abnormalities, publicity to environmental elements, gene mutations, polygenic-multifactorial predisposition (heredity).

    When laying chromosomes, their structural or quantitative change is feasible. In this case, anomalies are famous in varied organs and methods, and in the cardiovascular one as properly. When trisomy autosomes, as a rule, defects of the septum of the heart develop.

    With mutations of single genes, congenital heart defects are normally related to different defects of different organs. Then cardiac abnormalities are half of autosomal recessive, autosomal dominant or X-linked syndromes.

    During being pregnant (as much as a three-month interval), such destructive elements as ionizing radiation, viral illnesses, taking sure drugs, occupational hazards and addictions of the mom contribute to the improper laying of organs.

    If the fetus in utero infects the rubella virus, then most frequently the kid develops a triad of abnormalities – deafness, glaucoma or cataract, heart disease.

    Also, syphilis, herpes, rooster pox, mycoplasmosis, adenovirus infections, cytomegaly, diabetes, serum hepatitis, toxoplasmosis, tuberculosis, listeriosis, and so forth. have an effect on the formation of the fetus.

    Scientists have discovered that varied drugs act on cardiac intrauterine improvement: progestogens, amphetamines, lithium preparations, and anticonvulsants.

    Due to the above elements, in the fetal improvement, the fetus could also be disturbed by the pure formation of heart buildings, which causes incomplete closure between the ventricles and atria, pathological formation of valves, irregular association of blood vessels, and so forth.

    After beginning, some infants don’t shut the oval window and the ductus arteriosus

    Since the blood circulation contained in the mom differs from the hemodynamics of the new child, then the signs seem nearly instantly after childbirth.

    How rapidly congenital heart disease manifests itself is determined by many elements, together with the person traits of the kid’s physique. In some instances, the formation of gross circulatory issues causes a respiratory an infection or another disease.

    With heart defects of the heart, hypertension of the pulmonary circulation or hypoxemia (low oxygen content material in the blood) might seem.

    About half of the children die with out acceptable help in the primary 12 months of life from manifestations of heart failure. After a 12 months, infants really feel regular, however persistent problems develop. Therefore, in some instances, surgical procedure is important at an early age.

    Classification of congenital heart defects based mostly on the impact on pulmonary blood stream:

    • with elevated blood stream: not inflicting early cyanosis and inflicting cyanosis;
    • with unchanged;
    • depleted: with out cyanosis and with cyanosis;
    • mixed.

    There is one other classification by teams:

    1. White, which, in flip, might be with enrichment or depletion of any circle of blood circulation and with no important violation of blood circulation.
    2. Blue, that are enriched or depleted in a small circle.

    According to the ICD (International Classification of Diseases), congenital anomalies of the circulatory system occupy positions from Q20 to Q28, specifically, heart anomalies are included in Q24.


    Complications of CHD are syncope (fainting), heart failure, pulmonary hypertension, cerebrovascular accident, angina pectoris, bacterial endocarditis, protracted pneumonia, myocardial infarction, relational anemia, and shortness of breath-cyanotic assaults.

    Children refuse to breast, stressed, rapidly get drained in the method of sucking

    Symptoms of congenital heart defects depend upon the kind of issues, the time of formation of hemodynamic decompensation and the character of circulatory issues.

    In infants with a cyanotic sort of disease, cyanosis of the pores and skin and mucous membranes is noticed. It turns into extra pronounced with crying and sucking. White heart abnormalities are detected by cooling of the palms and toes, pallor of the pores and skin.

    Sports heart

    Regular bodily exercise results in adjustments in the cardiovascular system, that are referred to by the time period “sports activities heart.”

    An athletic heart is characterised by a rise in the cavities of the heart chambers and myocardial mass, however on the identical time, cardiac operate stays throughout the age norm.

    Sports heart syndrome was first described in 1899, when an American physician in contrast a bunch of skiers and other people with a sedentary way of life.

    Changes in the heart seem 2 years after common coaching 4 hours a day for 5 days per week. Athletic heart is extra widespread amongst hockey gamers, sprinters, dancers.

    Changes throughout intense bodily exercise happen as a result of economical work of the myocardium at relaxation and the achievement of most capabilities throughout sports activities actions.

    In Italy, in order to watch athletes and provides entry to competitions, a health care provider should bear a 4-year postgraduate course in sports activities drugs.

    An athletic heart doesn’t require remedy. Children ought to be examined 2 occasions a 12 months.

    Due to the immaturity of the nervous system, a preschooler has an unstable regulation of its work, so they’re worse tailored to heavy bodily exertion.

    Acquired heart defects in children

    Most usually, among the many acquired heart defects, valvular defect happens.


    • rheumatism;
    • transferred bacterial, viral infections;
    • infective endocarditis;
    • frequent sore throats, scarlet fever.

    Of course, children with an unoperated acquired defect should be noticed by a heart specialist or therapist for life. Congenital heart defects in adults is a vital challenge that ought to be reported to the therapist.

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    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.