When can you get up after heart defect surgery? Combined aortic disease. Clinical picture of the pathology

Cardiac diseases are numerous and varied. Both adults and children suffer from them. Treatment of severe pathologies requires complex operations on the heart. Many dangerous conditions associated with the development of defects. According to statistics, out of every thousand newly born babies, 8 patients are identified with congenital anomalies of the cardiovascular system. Sometimes even surgery cannot save a person from death. But in a sufficient number of cases, timely treatment (including surgery) helps to cope with the problem and return the patient to health and a normal life.

Heart disease implies all sorts of abnormalities in the structure of the heart muscle, which provoke disruption of blood movement and, as a result, hypoxia of internal organs and systems. Such anomalies include organic damage:

• valve apparatus;
• heart septum;
• heart walls;
• large vessels responsible for the supply and removal of blood.

Defects develop in a person during the period prenatal development or acquired after birth. Factors influencing their formation can be very different: unfavorable pregnancy, infection of the fetus, the influence of alcohol and cigarettes, chronic diseases, taking certain medications, hereditary predisposition.

If heart defects are not treated, coronary disease, heart failure, and myocardial infarction develop. Half of newborns with serious cardiac disorders who were not operated on urgently die within the first month of life. Three quarters of these children do not live to be one year old.

What types of violations are there?

Heart defects can be divided into groups using certain criteria:

1. Depending on the period of formation: congenital and acquired.
2. By location: valve (damage to the cusps of the mitral, tricuspid, pulmonary, aortic valves) and in the area of ​​the septa (between the ventricles or atria).
3. By degree of complexity: isolated (single, simple), complicated (two defects are combined) and combined (there are more than two cardiac disorders).
4. Due to the complications caused: some call them “white”, others “blue”. The former do not cause mixing of blood flows from veins and arteries. Oxygen enters the organs permissible norm. In the second case deoxygenated blood is thrown into the artery, and the heart sends it in this form (with a reduced proportion of oxygen needed by the tissues) throughout the body. Heart failure syndrome develops (lips, fingers, toes, and ears turn blue).
5. Depending on the adaptive ability of the heart muscle: compensated (the heart compensates for existing deviations on its own) and decompensated (provoke the development of insufficient blood supply).

All cardiac pathologies are accompanied to varying degrees hemodynamic disorders. The easiest is the first degree, the fourth is considered very severe.

Congenital heart defects (CHD)

The formation of the circulatory system and its main organ begins in the first weeks of the embryo’s life in the mother’s womb. During this period, any negative impact both external and internal factors can lead to the development of heart defects in the unborn child. Possible causes of congenital abnormalities of the cardiac structure:

• disorders at the gene level;
• radioactive exposure;
• bad heredity;
• infectious lesions of a woman in early pregnancy;
• use medicines in the first trimester;
• a pregnant woman's passion for alcohol, drugs, cigarettes;
• the presence of fetoplacental insufficiency;
• abnormal development of placental vessels;
• relapses chronic diseases during pregnancy.

All congenital defects are divided into three groups:

1. Disorders in which pulmonary circulation is not accompanied by changes.

The aortic inlet or one of the sections of the aorta is narrowed.

1. Conditions characterized by increased pulmonary blood flow.

The botal duct is not closed, there are defects in the barrier between the atria or ventricles.

1. Pathologies that affect the reduction of blood circulating through the lungs.

Presence of tetralogy of Fallot, pulmonary artery with a narrow entrance.

Narrowing (stenosis) of the pulmonary artery

Veins transport blood to the area of ​​the right atrium. From there it enters the right ventricle. The described defect involves improper development of the valve itself, which allows blood to pass from the right ventricle into the pulmonary circulation. In another case, the section of the pulmonary artery directly above the valve or the inlet (ostium) of the vessel under the valve is narrowed. When venous blood passes through the lungs, it gives off carbon dioxide and is saturated with oxygen, and then enters the left side of the heart. From there it will go further to all organs. If the pulmonary trunk is narrowed, the following disorders occur:

• Overstrain of the right ventricle, it is difficult for it to eject blood.
• The volume of blood delivered to the lungs decreases.
• Hypoxia of the whole body.

• Right ventricular failure develops.
• Progression of the pathology without adequate treatment can lead to death.
• On the part of the lungs, tissue necrosis, an inflammatory process with the release of pus, the formation of blood clots, and the development of tuberculosis are possible.

How does the vice manifest itself?

• cyanosis and coldness in the extremities;
• cardiac hump (protrusion of the ribs in the area where the heart is located);
• syndrome drumsticks(the pads of the fingers thicken;
• mental retardation in children.

Tetralogy of Fallot

This defect is quite common in infants. It belongs to severe heart pathologies. Named after the French pathologist Etienne-Louis Fallot, who in 1888 was the first to make a detailed description of this condition. The word “tetrad” (translated from Greek means a grouping of four elements) implies certain 4 characteristics that are combined with each other. In this case, we mean a “blue” heart defect, which combines 4 disorders:

1. Abnormal development of the interventricular septum.
2. Hypertrophy of the right ventricle.
3. Narrow passage of the pulmonary artery.
4. Incorrectly positioned aorta (dextroposition). It is shifted to the right side of the heart. Sometimes partial or complete exit of the vessel from the right ventricular chamber is observed.

The defect is diagnosed in early childhood because, as a rule, such patients rarely survive to adulthood, especially in the absence of proper treatment (mandatory heart surgery). Sometimes the so-called pentade of Fallot occurs - the development of a fifth sign (anomaly of the septum between the atria) in addition to the already existing four.

Cyanotic (blue) defect is characterized by a decrease in the volume of useful (oxygen-enriched) blood in the systemic circulation. Organ hypoxia and venous congestion progress, this is expressed in the following signs of chronic heart failure:

• The skin becomes bluish.
• “Drumstick” syndrome appears. Nails become deformed, thicken, and become rounded.
• Flat chest or “heart hump”.
• Weight loss.
• Physical development is delayed.

• Development of scoliosis, flat feet.
• Large interdental gaps and early caries are observed.
• The presence of attacks of severe cyanosis: rapid breathing, purple skin, shortness of breath, loss of strength, lightheadedness, loss of consciousness, convulsions.
• Swelling appears.

Narrowing (coarctation) of the aorta

The congenital defect manifests itself as an abnormally narrow lumen in one of the sections of the aorta. Usually this is a perforation of the arch of the vessel, sometimes the thoracic or abdominal region.

The aorta is the largest of the arteries in the systemic circulation; it exits from the left ventricle.

Despite the fact that the pathological formation occurs outside the heart, it is still called a heart defect. Because coarctation of such an important vessel directly affects the functioning of the circulatory system and the heart itself.

Hemodynamic disturbances are associated with differences in blood pressure in the vessel. It is elevated up to the narrowed area, which causes hypertrophy of the left ventricle. Below the affected area, the pressure decreases. To restore normal blood flow, additional pathways for blood movement develop in this area.

Symptoms typical for young children:

• pale skin;
• retardation of physical development;
• shortness of breath, pulmonary wheezing;
• frequent pneumonia;
• high pressure in the arteries of the arms and low in the legs, while the legs turn blue.

Signs of the defect in adults:

• the head is heavy and dizzy and hurts;
• chronic fatigue;
• my heart hurts;
• cold and sore legs, cramps and muscle weakness;
• difference in pressure on the upper and lower extremities.

Possible complications:

• pulmonary edema;
• cardiac asthma;
• stroke;
• hypertension;
• sclerosis of renal arterioles.

Patchy ductus arteriosus

In 1564, Leonardo Botallo, a physician from Italy, was the first to describe the duct (named after him) that connects the aortic arch to the pulmonary artery in a child in utero. When a newborn baby begins to breathe through the lungs, this passage becomes overgrown with connective tissue. If this does not happen, a heart defect called patent ductus botellus is diagnosed. The result is hemodynamic disturbances in the pulmonary circulation and cardiac dysfunction. A mixing of venous and arterial blood occurs, and it enters the lungs in a larger volume. The right and then the left ventricles begin to enlarge.

Manifestation of vice:

• pulsating cervical artery;
• cyanosis of the skin in a tense state;
• increased pallor;
• arrhythmia;

• developmental delay in children;
• cough;
• labored breathing.

Such a violation can lead to stroke, aneurysm formation, myocardial infarction, heart failure, and endocarditis of bacterial etiology.

The fetus, while in the womb, does not use the lungs to enrich the blood with oxygen. He has a special blood circulation, it is organized according to a different principle, not like that of adults. During this period, there are elements in the circulatory system that must cease to function after birth. The foramen ovale, as well as the botal duct, are such temporary formations. The window in the heart has a valvular structure and is located in the septum that separates the left atrium from the right. Severe pathology leads to hypertrophy of both atria and ventricles. A minor defect may not affect the health and well-being of a person. Typical symptoms:

• heart hump;
• pale skin;
• severe shortness of breath;
• nose, lips, fingers turn blue at the slightest exertion;
• cough;

• fainting;
• vertigo;
• prostration;
• physical retardation.

Possible consequences: high risk of decompression sickness, septic endocarditis, paradoxical embolism.

Absence of the interventricular septum, or its large defect

Another name for the defect is the Eisenmenger complex (discovered by a German doctor). This is a combination heart disorder, it is characterized by the following features: the absence of a septum between the ventricles or its significant deformation with the formation of a through hole, an enlarged right ventricle, an incorrect location of the aorta. The consequence of such an anomaly is a serious disruption of normal blood circulation, an increase in pulmonary blood flow, the connection of arterial and venous flows, mixed blood leaves the aorta to organs with low oxygen content.

Signs of a defect:

• cardiopalmus;
• dyspnea;
• heartache;
• chronic weakness;
• cyanosis of the skin;

• swollen jugular veins;
• drumstick syndrome;
• heart hump;
• fainting;
• scoliosis;
• coughing up blood.

Possible complications: frequent respiratory diseases, vascular embolism of the brain of the head, endocarditis, heart failure, pulmonary hemorrhage, sudden death.

Ventricular septal defect

A heart defect, called VSD for short, is rare on its own. More often it is combined with other disorders. This is a hole in the septum that separates the ventricles from each other. The defect may be insignificant, then it is not dangerous and is able to eliminate itself with the passage of age. A large passage causes mixing of venous and arterial blood and disruption of blood flow. The heart grows in size, blood stagnates in the lungs, spasms coronary vessels, sclerosis of the pulmonary circulatory system develops.

Symptoms of VSD:

• tachycardia;
• swelling;
• poor appetite;
• constant lethargy;
• mental and physical retardation in the child;

• cyanosis of the skin;
• cough;
• heart hump;
• nosebleeds;
• fainting state.

Consequences of the vice:

• bacterial inflammation of the endocardium;
• development of pulmonary hypertension;
• aortic insufficiency;
• frequent pneumonia;
• heart failure;
• formation of heart block;
• cerebral hemorrhage;
• lung death or abscess;
• coronary or pulmonary embolism
• sudden cardiac arrest.

Patients with severe impairment require surgical correction.

Acquired heart defects

Such defects occur in healthy person, which does not have pathologies in the structure of cardiac tissue. The defect is acquired under the influence of a disease that directly or indirectly affects the heart. Most often it is rheumatism, other causes:

• atherosclerosis;
• syphilis;
• injuries;
• tumor formations;
• sepsis;
• ischemia;
• arterial hypertension;
• development acute heart attack myocardium;
• age-related changes.

Acquired defects concern the valve apparatus. The development of disorders is based on two signs: narrowing of the valve opening and its short leaflets.

Combined aortic disease

Pathology combines several disorders: a narrow aortic orifice and valvular insufficiency. It is usually a combination of defects that is diagnosed; in an isolated form, aortic anomaly is rarely observed. A progressive disease leads to congestion in the pulmonary circle. The main complications are pulmonary edema and cardiac asthma.

A complicated defect manifests itself with all the signs typical of its anomalies. Light form pathology does not cause much discomfort, it requires symptomatic therapy if necessary. The severe form requires surgical intervention.

Aortic stenosis, isolated defect

The narrow entrance to the main artery prevents blood from being completely ejected from the left ventricle. To compensate for this disorder, the heart contracts more strongly, and the myocardial walls on the left side thicken. Severe stenosis leads to significant ventricular hypertrophy. The body suffers from a lack of blood and oxygen.

Characteristic features:

• vertigo;

• frequent fainting;
• pale skin;
• angina pectoris;
• development of the heart hump.

The main complication is heart failure.

Aortic valve insufficiency

Such defects include loose closure of the valves aortic valve or expansion of the valve passage. These pathologies mainly affect men. The disorder is often combined with other defects and causes a reverse flow of blood during the diastole phase from the aorta to the left ventricle. The result is distension of the left ventricular chamber, which over time leads to stretching of the mitral passage and left atrium. And the blood flow of the pulmonary circulation is disrupted, and venous blood stagnation develops.

Typical signs of aortic defects:

• diastolic pressure is reduced to critical levels;
• a sudden change in body position causes severe dizziness;
• suffocation develops at night;
• cervical arteries pulsate and bulge;
• the skin turns white;
• the head shakes;

• small vessels in the eyes and under the nail plate pulsate.

What can happen over time?

1. Heart failure.
2. Dilatation (stretching) of the heart cavities.
3. Venous stagnation, blood retention in the ventricle.

Mitral stenosis (narrowing of the valve between the left atrium and ventricle)

Women are more susceptible to this anomaly. It can be caused by rheumatic carditis with damage to the inner layer of the heart. A combination of the defect with other valvular disorders is more common. Mitral stenosis causes insufficient blood flow from the atrium to the ventricle. Pressure in the pulmonary veins and left atrium increases. Possible pulmonary edema.

Symptoms of a narrowed valve:

• the presence of acrocyanosis and mitral blush;
• reduction of the left side of the chest;
• retardation in mental and physical development.

What does vice lead to:

1. Pulmonary edema (discharge from the mouth of pink foam, blue skin, gurgling breath).
2. Cardiac asthma (difficulty taking a breath).
3. Sclerosis of lung tissue.
4. Decrease in useful lung volume.

Mitral valve insufficiency

The essence of this fairly common defect is a loose connection of the valve leaflets. A disorder occurs due to the inflammatory process in the valve tissues. They lose elasticity and are replaced by connective tissue. Some of the blood flows back into the left atrium. To compensate for the failure of hemodynamics, the entire left half of the heart works in an enhanced mode. The left circulation experiences blood deficiency. Venous blood stagnates in a large circle.

Symptoms:

• the appearance of a special “mitral” blush with a tint of blue;
• syndrome of "cat's purr" - the chest vibrates, it can be felt with a hand;
• the toes, hands, tip of the nose, ears, lips turn blue;
• swelling develops.

Possible consequences:

• congestive failure;
• hypertrophy of the left side of the heart;

A compensated defect does not cause discomfort; people may not know anything about the disease.

Operations and their costs

Surgery is required in the vast majority of cases. It must be carried out as early as possible in order to prevent complications incompatible with life. Sometimes the work of surgeons must be urgent, in the first weeks after the birth of a child. Timely correction of disorders can return a person to normal life, prolong its life and improve well-being.

How much does surgery for heart disease cost? A patient can have heart defects corrected free of charge, based on a special quota allocated by the state. But many people need such help, so the patient has every chance of simply not living to see his turn. There is the possibility of paid surgical treatment. In Moscow, the cost of such an operation varies from 100 to 300 thousand rubles.

cure diseased heart Possibly abroad too. How much does surgery cost for a diagnosis of heart disease outside the CIS?

The most reasonable prices for cardiac surgery services are offered in India.

The quality of treatment varies high level, more than 99% of all operable cases are successful. For example, heart bypass surgery in the United States of America will cost the patient $100,000. Treatment in India will cost 6-9 thousand dollars.

In case of heart disease, the greater cost of the operation will be with open surgery using a heart-lung machine. Minimally invasive procedures are safer and cheaper. They are carried out using catheters - special devices that are inserted into the heart through an artery in the thigh.

Common types of operations for heart defects:

The cost of each of them depends not only on the complexity of the particular case, but also on the prestige of the chosen clinic and the authority of the chief surgeon.

Heart defects, both congenital and acquired, can cause disability, and many people with serious defects die early. Timely detection and surgical treatment is the only chance to prolong life and improve its quality for patients with these types of cardiopathy.

The most complex heart surgeries are performed the best specialists using Newest technologies and high quality equipment. Modern surgeons have sufficient experience and skills in performing such manipulations. The risk of patient death is minimal, and the percentage of successful outcome is very high. But the price of paid cardiac surgery services is not affordable for many, and the state quota, unfortunately, cannot yet satisfy all those in need of treatment. No one knows for sure how long one will have to wait for a planned heart operation, and whether the patient will live to see it.

Grade 1 aortic valve regurgitation What is it? aortic disease hearts?

Heart defects in children are a problem that is often raised in the media. Many children are born with such a pathology, and parents face a difficult choice - to decide on a risky operation or to live in fear that a small heart can stop at any moment. What is fraught with refusal of surgical intervention, and what is heart surgery for a defect?

Clinical picture of the pathology

It's called a vice functional impairment work of the heart associated with pathologies of the valvular apparatus, septum, walls of the heart muscle or large vessels. As a result of any defect in the listed areas, normal blood circulation is disturbed: it can slow down, change direction, or venous and arterial blood is mixed, etc.

In children

Today, congenital heart defects (CHDs) are more common, and some newborns have to undergo surgery almost immediately after birth. The causes of CHD are banal and simple: mother's illness during pregnancy and heredity.

By the way! Modern views diagnostics allow fixing suspicions of heart disease in the fetus, starting from the 11th week of pregnancy.

Symptoms of congenital heart disease may appear immediately after birth. The child is weak, hardly screams, breathes heavily; there is pallor or even blueness on the face. Then the newborn is immediately examined and, if the diagnosis is incompatible with life, they can be operated on the same day. If congenital heart disease is not diagnosed immediately, then similar symptoms will begin to appear during the first two months of a newborn's life.

In adults

Man with healthy heart can also get a defect as a complication after some diseases: tonsillitis, influenza, rubella, atherosclerosis, syphilis, gonorrhea, etc. Heart disease in adults manifests itself in almost the same way as in children: the heart periodically begins to “go in”, shortness of breath, palpitations, anxiety, pathological pallor of the face, and rapid fatigue appear.

Indications for surgery in children and adults

Surgery for congenital heart disease is an intervention that many people wait for and fear at the same time. After all, operating on a major organ is always risky, but if there is no way out, you have to go for it. Absolute indications Not all types of pathology are eligible for surgical intervention, but only some conditions:

• severe symptoms of aortic valve stenosis;
• patent ductus arteriosus;
• nonunion interatrial septum;
• inadequate supply of oxygen to internal organs due to circulatory failure;
• almost all pathologies of the mitral valve;
• enlarged part of the heart (ventricles or atria);
• serious deviations in pressure on the aortic valve.

These are not all possible types of heart defects in children and adults. But it is these conditions that most often cause symptoms that do not allow a person to live fully. If the signs are not obvious, but there is a threat to life, the patient (or the child’s parents) is offered a planned operation.

In some cases, preliminary therapy is carried out. Heart disease can be treated with medications of various modifications: vasodilators, hypotensive, cardiac, diuretic, antithrombotic. The patient is also prescribed B vitamins to strengthen the body’s immune forces.

Prognosis for refusal of surgery

A heart defect is not necessarily a death sentence. Some of its forms allow you to live to an advanced age, but the quality of life is significantly reduced. And if the patient refuses the proposed operation, then a variety of problems may await him:

• periodic exacerbation of heart failure;
• development of various diseases of the heart and blood vessels against the background of defects (ischemia, arrhythmia, endocarditis, myocarditis, pericarditis, etc.);
• increased risk of heart attack and stroke;
• decreased immunity;
• severe course of acute respiratory diseases with complications in the form of bronchitis and pneumonia;
• pulmonary edema;
• hypoxia;
• thromboembolism;
• insufficient blood supply to the brain and, as a result, the risk of developing tumors, reduced mental development.

Even if a person leads exclusively healthy image life, a heart defect will still make itself felt. It is impossible to predict when this will happen and how it will manifest itself.

For a child, refusal to undergo surgery also risks developmental delays. Such children later begin to walk, talk, and have difficulties in learning. Then a psychological component is added: a child with CHD cannot run and play on an equal footing with everyone else. It is especially difficult for teenagers who find it more difficult to socialize due to health problems.

Types of operations for defects

Surgery for congenital heart disease – optimal solution Problems. This is a chance for a child to develop normally from an early age (months) and prevent heart disease in the future. Surgery is also often the only way out with an acquired disease. Regardless of the age of the patient, there are three types of operations.

open

Such interventions involve opening the chest in order to gain access to the heart. The operation takes place under general anesthesia and with the use of a heart-lung machine, which allows you to stop the heart for a while for the convenience of operating it.

An open method is used, for example, to eliminate a septal defect. This is a hole in the muscle, because of which the venous blood mixes with the arterial one. To access the defect, an incision is made in the right atrium. If the hole is small, it is simply sutured. The large one is closed with a patch - a “patch” cut out from the pericardial sac.

Closed

The advantage of such interventions is that there is no need to expose the heart muscle and stop the heart. But the operation is still performed under general anesthesia.

An example of a defect in which a closed operation can be performed is stenosis (narrowing) of the left atrioventricular orifice. The doctor makes a puncture in the sternum, enters the cavity of the heart through the left atrium and expands the mitral valve with special tools. The operation is performed under ultrasound guidance.

X-ray surgery

This is a separate technique for surgical treatment of various heart defects. Access to the affected area is through the femoral artery, through which the doctor moves a thin catheter. Depending on the type of pathology, there may be a folded patch or a balloon at the end of the catheter. The entire course of the operation is controlled by an X-ray device, which displays the image on the monitor.

If the heart defect is stenosis, then upon reaching the narrowed area, air begins to be pumped into the balloon. It increases in size and expands the hole to anatomical dimensions. If, on the contrary, it is necessary to eliminate the pathological lumen, then the patch opens like an umbrella, clogging the hole.

Features of the postoperative period

Primary rehabilitation after any type of surgery for heart disease is carried out in a hospital. The patient will be in intensive care for a couple of days so that doctors can monitor hemodynamics and immediately stop any complications that arise. Special attention given to newborns, as well as to all patients who have undergone open surgery.

When the patient's condition stabilizes, he is transferred to the ward. Over the next few days, he will undergo recovery procedures: IVs, injections, oxygen mask. The patient also works with a physical therapy specialist who teaches him breathing exercises. Medications include analgesics (to relieve pain), antibiotics (to avoid inflammatory diseases heart and lungs). Sometimes anticoagulants are additionally prescribed to prevent blood clots.

If the newborn has undergone open surgery, then the parents will have to treat the baby with triple responsibility. The child will not be placed on his tummy or pulled by the arms, because this will interfere with the normal fusion of the chest. You will have to exclude walks and guests in the house, because this is a risk of infections, and the crumbs’ weakened immunity is especially vulnerable.

Cost of surgery for heart disease

There are surgical interventions for heart defects in children and adults, but there are not enough of them for everyone. This issue has become especially acute lately, because more and more babies are being born with congenital heart disease. If the patient does not fall into the quota group, he has to pay for the operation out of his own pocket.

In pediatric cardiology, surgery occupies one of the main places. Even after elimination heart defect In children, therapeutic measures are necessary to consolidate the results obtained.

As can be seen from practice, a beneficial effect is achieved in children in 90 percent of cases. The fact is that babies grow quickly, and their weight increases. At the same time, they become more active physically. This activity should be monitored and limited during the recovery period. In cured children, weakness, difficulty breathing, and frequent fatigue disappear. Less common are pneumonia and bronchitis, which occur in patients with excessive pulmonary blood supply. Both hemodynamic and symptomatic parameters return to normal, and a constant arterial pressure. Many young patients have no heart murmurs after surgery.

Most heart surgeries are childhood is performed against the background of pathologies in the organ, valves, pulmonary system, diseases of other organs that appear in conditions of long-term pathological blood circulation. So even after surgery, patients should not be considered healthy. In addition to the consequences of the defect, complications can arise from surgery and from the use of artificial blood circulation.

If the child’s body condition is normal, then doctors recommend performing surgery from 1 to 2.5 years. During this period, the baby’s health is strong, and it is easier for him to tolerate the intervention. He will soon forget the therapeutic period he experienced and his psyche will not suffer in the future.

In what cases is heart surgery indicated?

Indications for heart surgery in childhood include:

• The presence of a through hole in the septum between the ventricles.
• Abnormal reflux of blood flow from the left ventricular section to the adjacent right.
• Hypertrophy of the atrial and ventricular sections on the right side.

In case of blood poisoning, irreversible vascular pathologies, or in the third stage of the disease, surgery may become impossible.

What are the operations?

Surgery to reduce the lumen of the pulmonary artery

The doctor, using a special thin band, closes the artery that carries blood to the pulmonary system from the heart, so that less blood enters the respiratory organs. This operation is considered a preparation stage before further elimination of the defect.

The operation is prescribed for frequent surges in pressure in the vascular system, in the event of blood reflux from the left ventricular section of the heart to the right. If the child’s health does not allow an operation to remove the hole in the ventricular septum, then intervention to narrow the lumen of the artery will be his only salvation.

Thanks to this operation, the volume of blood going to the lungs is reduced, thereby reducing the pressure in them. The child's breathing becomes easier.

The disadvantage of this type of intervention is that parents and the baby will have to undergo two operations. In the postoperative period, the function of the right ventricular part of the heart will be increased, from which it may subsequently hypertrophy.

Open heart surgery

This type of treatment requires an incision in the chest. To do this, the sternum is opened, the heart is temporarily disconnected from the vessels. It is replaced by artificial blood circulation equipment. The heart surgeon makes an incision on one of the heart chambers on the right side. Depending on the complexity of the defect, the doctor can choose one of the following ways treatment:

• Reducing the defect is appropriate when the size is no more than 1 centimeter and is located at a remote distance from important arteries.
• Installation of a special patch on the partition. It is made taking into account the size of the hole. The patches may consist of pericardium (the outer lining of the heart) or artificial substances.

Indications for surgery:

1. The operation is prescribed when there is no other way to alleviate the child’s condition.
2. Pathologies in the pulmonary vessels.
3. The right ventricular section is overloaded.

This operation has the following advantages:

• At the same time, blood clots are eliminated if they are present in the heart.
• During the intervention, other pathologies of the heart and its valves can be eliminated.
• It is possible to remove any defects regardless of their location.
• This operation can be performed on children at any age.
• An opportunity to overcome heart problems forever.

Important! After the postponed open surgery The child will need quite a long period of time to recover.

Closing a heart defect with an occluder

The meaning of the operation is that the hole on the cardiac ventricular septum is closed using a special device - an occluder, inserted into the heart through the arteries. This device looks like buttons fastened together. It is installed in the hole, due to which the blood flow is blocked. The procedure is carried out under the constant supervision of a radiologist.

Indications for surgery:

• Surgery may be indicated if the defect is located closer to the center of the ventricular septum.
• There are signs stagnation in the pulmonary vessels.
• The volume of blood is thrown from the left ventricular section to the right.
• The child turned 1 year old and gained weight of more than 10 kilograms.

The advantage of this type of surgery is that the recovery period does not last long - up to five days. After the operation, the baby’s condition immediately improves, and blood circulation in his pulmonary system is normalized.

However, this type of operation can only be prescribed to correct small pathologies that are located far from the edges of the septum. During the intervention, it is impossible to correct other heart pathologies.

Glenn's operation

During this operation, using anastomosis of the vena cava into upper section unites simultaneously with two pulmonary arteries (right and left). The blood flow from the vein will flow in two directions: into each part of the lung. Glenn's operation is widespread in modern cardiac surgery. Taking into account high efficiency new methods of surgical intervention, Glenn's method gives sick children a great chance of surviving until the age at which major operations can be performed.

The advantage of the operation is that it allows you to maintain hemodynamic parameters within normal limits. The success of treatment depends on this.

How is heart surgery performed?

Cardio surgical intervention consists of the following steps:

1. Preparatory stage. Parents must bring their child at the appointed time for an inpatient examination. The child will have to stay there for several days before the operation. In this case, all types of tests, a repeat ultrasound of the heart and an electrocardiogram will be performed. Before the operation, parents need to talk with the anesthesiologist and surgeon. They will additionally examine the little patient and answer questions.
2. General anesthesia. A painkiller is injected into the child's vein. During the intervention, the baby will not feel anything. The doctor determines exact dosage medications, so that parents can make sure that the child will not suffer at all from the anesthesia.
3. Making an incision in the sternum to gain access to the heart and connect the small patient to a heart-lung machine.
4. Hypothermia is a forced decrease in body temperature. Using special surgical equipment, the child’s blood is cooled to 15 degrees. This event helps the brain to easily endure the lack of oxygen, which often occurs during surgery.
5. The heart, disconnected from the vessels, will not contract for some time. With the help of a coronary pump, the organ is cleared of blood so that the surgeon can perform his task.
6. Making an incision in the ventricular region and eliminating the defect. A suture is placed on the incision to join the edges. If the hole is large, the surgeon applies a special patch to repair the defect.
7. The tightness of the septum between the ventricles is checked, the holes in the ventricular section are sutured, and the heart is connected to natural system blood circulation The borrowed blood is slowly heated to a standard temperature. As a result, the heart begins to contract on its own.
8. The doctor stitches up the wound. At the same time, drainage should remain in the neck, through which fluid will be drained from the wound.
9. Applying a bandage to the child's chest and moving to the intensive care unit. Here the little patient will have to spend about a day under the supervision of doctors. Parents may be allowed to visit the baby, but sometimes this may not be possible.
10. After resuscitation, the patient is transferred to the ward intensive care. In this room, parents can be close to the baby, support and take care of him.

Attention! After an operation, a rise in the child’s body temperature to 40 degrees is not a rare or terrible occurrence. There is no need to panic. Just in case, call a doctor or nurse. It should be remembered that the children's body is much more adapted to the struggle for life and recovers faster from injuries compared to adults.

Care after heart surgery

When the child is discharged home after surgery, parents should understand that the baby is beginning to recover, but they also need to make some efforts to help him with this.

It is advisable to carry the child in your arms more often during this period - this is the so-called positional massage. This is how the baby develops, calms down, and his blood circulation improves. You shouldn’t be afraid that your child will get used to being held, because his health is much more important than his behavior. After this, you can apply for disability for the child.

You need to protect your child from infections and try not to be in crowded places. Don’t be embarrassed to take your baby away from a person who is showing signs of illness. It is recommended to protect the child from prolonged exposure to heat or cold.

How to care for a wound?

The scar will take four weeks to heal. It is recommended to wipe it with tincture of calendula and avoid direct exposure to the rays of the sun. To prevent the formation of a scar, you can use creams such as Solaris or Contractubex. The doctor will recommend a remedy that is suitable for the baby.

When the stitches after heart surgery have healed, you can begin to bathe the child. To do this, use the first few times boiled water. Her temperature is 37 degrees. Reduce the duration of hygiene procedures.

The sternum is a bone, it takes two months to heal. During this time, you should not take the child under the armpits, pull by the hand, lay on the tummy, he needs to sleep on his side. It is better to avoid physical activity so that the chest does not become deformed. When the bone heals, you don’t have to limit the baby to motor activity. But for the first six months it is better to avoid injuries so that the child does not become disabled.

Dangerous post-operative symptoms

If the following symptoms appear, you should immediately go to the hospital:

• The temperature rises above 38 degrees for no apparent reason.
• The suture swells and ichor comes out of it.
• The child has chest pain.
• The skin becomes pale or bluish.
• The face swells, swelling occurs under the eyes.
• Shortness of breath and lethargy.
• Doesn't sleep well.
• Vomiting and dizziness.
• Loses consciousness.

Nutrition

A child who has undergone heart surgery is given a high-calorie, nutritious diet to help him recover faster. For infants better food- mother's milk. For older patients, it is recommended to prepare fresh homemade food, rich in vitamins and proteins.

After diagnosis, when can surgery be scheduled, and who makes the decision?

Major congenital cardiovascular diseases can be divided into:

• Diseases of the pulmonary-cardiac vessels without abnormal connections between arteries and veins.
• So-called “white” congenital heart defects.
• So-called “blue” congenital heart pathologies.

"White" heart defects it is customary to call such pathological conditions when venous blood does not enter the systemic circulation. Or, due to structural defects, blood flows from the left half of the heart to the right.

“White” congenital defects include:

• Patent ductus arteriosus.
• Narrowing of the aortic mouth.
• Pulmonary stenosis.
• Defect in the structure of the interventricular septum.
• Anomaly in the structure of the interatrial septum.
• Segmental narrowing of the aortic lumen (coarctation).

"Blue" VPS are characterized by pronounced cyanosis of newborns. This symptom indicates a lack of oxygen in the blood, which in turn is a threat normal operation and development of the patient's brain.

“Blue” congenital heart defects include:

• Abnormal prolapse of the pulmonary veins.
• Underdevelopment of the tricuspid valve.
• Fallot's disease in all its forms.
• Abnormal location (transposition) of the main great vessels - the aorta and pulmonary trunk.
• Connection of the aorta and pulmonary artery into a common arterial trunk.

The decision on the method of treatment for congenital heart defects is made after diagnosis. accurate diagnosis using modern methods of diagnosing CHD.

In some cases, such a diagnosis can be made already in utero. At the same time, a pregnant woman is examined by both gynecologists and cardiologists. The severity of the pathology existing in the infant is explained to the woman.

There are situations when a newborn needs to undergo heart surgery immediately after birth. The mother gives her consent in principle to this even before the birth, then it is necessary to properly prepare the child and his parents for heart surgery.

Unfortunately, not all congenital cardiac anomalies can be diagnosed in utero. In most babies, the presence of heart pathology is detected only after birth.

In case of severe “blue” defects that threaten the life of the baby, an emergency operation of the VPS can be performed for life-saving reasons.

If such urgent surgical intervention is not required, the operation is postponed until the child is three to five years old so that his body is prepared for the use of anesthesia. At the time of preparation, the child is prescribed maintenance therapy.

Three main categories of operations for congenital heart defects

All types of surgical intervention for cardiac pathology are divided into:

• closed operations.
• Open surgical interventions.
• X-ray surgical operations.

Closed Operations represent such actions of the surgeon in which the human heart is not directly affected and there is no need to open the heart cavity. All surgical operations occur outside the cardiac zone. When carrying out this type of operation there is no need for special specialized equipment.

In particular, such a surgical intervention as a closed commissurotomy consists of dividing the fused leaflets of the left atrioventricular orifice if they have existing stenosis.

The surgeon enters the heart cavity through the left atrial appendage, onto which a purse-string suture is first applied. Before performing this manipulation, doctors make sure that there are no blood clots.

Then, a digital inspection of the condition of the mitral valve is performed, and the degree of its stenosis is determined. The surgeon restores the loosened constrictions with his fingers to normal size.

If there are dense adhesions, a special instrument is inserted to remove them.

For open surgical procedures the surgeon needs to open the heart cavity to carry out the necessary surgical procedures in it. Such operations involve temporary shutdown of cardiac and pulmonary activity and are performed under general anesthesia.

Therefore, the patient must be connected to a special artificial blood circulation machine during the operation. Thanks to the operation of this device, the operating surgeon has the opportunity to work on the so-called “dry” heart.

The patient’s venous blood enters the device, where it passes through an oxygenator, which replaces the work of the lung. In the oxygenator, the blood is converted into arterial blood, enriched with oxygen and freed from carbon dioxide. The blood that has become arterial, with the help of a special pump, enters the patient’s aorta.

X-ray surgery for congenital heart defects are a fairly new type of cardiac surgery. To date, they have already proven their success and efficiency. These operations are carried out as follows:

• The surgeon uses a very thin catheter, at the ends of which tubes or special balloons folded like an umbrella are securely attached.
• The catheter is placed into the lumen of the vessel or inserted through the vessels into the cavity of the heart.
• Then the balloon expands using pressure and, depending on the defect, enlarges the narrowed lumen of the heart septum or ruptures the valve affected by stenosis. Or a completely missing hole is created in the septum. If umbrella tubes are inserted into the heart cavity using a catheter, they are used as a patch. The umbrella, which opens under pressure, covers the pathological hole.

The entire progress of the operation is monitored by doctors on the monitor screen. This type of surgery is much less traumatic and safe for the patient than abdominal surgery.

X-ray surgery can be used as an independent operation, not for all cardiac defects. In some cases, it is used as an auxiliary to the main one, facilitating the latter.

Three types of UPS operations by deadlines

Congenital heart defects (CHD)

Congenital heart defects (CHD)- an extensive and heterogeneous group of diseases associated with anatomical defects of the heart and great vessels. These diseases are dealt with by pediatric cardiology. The most common defects: septal defects (“holes” between the atria of the heart - atrial septal defect, between the ventricles of the heart - ventricular septal defect), patent ductus arteriosus (PDA, which normally should close during the first weeks after birth), vasoconstriction ( aortic stenosis, pulmonary artery stenosis).

Congenital heart disease occurs with a frequency of 6-8 per 1000 children born. Recently, this figure has been increasing, mainly due to improved diagnostics. The predisposing factors of the study are: unfavorable environmental factors, diseases suffered by the pregnant woman, genetic predisposition. Moreover, some congenital defects can be combined (for example, septal defect and patent ductus arteriosus), or combined with other developmental anomalies (for example, Down syndrome).

Congenital heart defects are treated mainly surgically, meaning heart surgery is required. The essence of surgical treatment is the correction of anatomical defects of the heart and blood vessels. Until relatively recently, only abdominal operations on the heart, i.e. with a cut into the chest open heart. Now many defects (but, unfortunately, not all) can be corrected “without an incision”: special instruments are passed through the vessels to the heart, with the help of which the holes or the vessel are closed, or, conversely, the lumen of the vessel is expanded. These are so-called endovascular operations. To close the atrial septal defect and ventricular septal defect, occluders are used, for patent ductus arteriosus - occluders or spirals (depending on the size of the defect), for vascular stenosis - balloons and stents.

The cost of a set of medical instruments for the correction of congenital heart disease is: for closing a PDA - from 30,000 to 100,000 rubles. for closure of ASD and VSD - from 150,000 to 220,000 rubles, for correction of stenoses - from 30,000 to 120,000 rubles. depending on the specific heart defect, model, manufacturer, and the presence of combined defects.

Currently, we provide assistance in purchasing medical instruments for endovascular operations to correct congenital heart defects for children undergoing treatment in more than 50 Russian clinics, their list is constantly expanding.

Heart disease

Heart disease is a unique series of structural anomalies and deformations of valves, septa, openings between the heart chambers and vessels, which disrupt blood circulation through the internal heart vessels and predispose to the formation of acute and chronic forms of insufficient circulatory function. According to etiological factors, heart disease can be of congenital origin or acquired.

Heart defects with a congenital etiology are divided into defects that are an anomaly of the embryonic formation of the S.S.S. and for heart defects that develop as a consequence of endocardial pathologies during fetal development. Considering the morphological lesions, this category of heart defect occurs with anomalies in the location of the heart, in pathological structure septa, both between the ventricles and between the atria.

There are also defects of the ductus arteriosus, valvular apparatus of the heart, aorta and movements of significant vessels. Heart defects with acquired etiology typically develop against the background of rheumatic carditis, atherosclerosis, and sometimes after trauma and syphilis.

Heart defect causes

The formation of heart defects of congenital etiology can be influenced by gene mutations, various infectious processes, endogenous, as well as exogenous intoxications during pregnancy. In addition, this category of heart defects is characterized by various disorders in the chromosome set.

From characteristic changes Trisomy 21 is noted in Down syndrome. Almost 50% of patients with such a genetic pathology are born with CHD (congenital heart disease), namely, these are ventricular septal or atrioventricular defects. Sometimes mutations occur in several genes at once, contributing to the development of heart disease. Mutations such as in TBX 5 are found in many patients diagnosed with Holt-Oram syndrome, which is an autosomal type disease with septal defects. The reason for the development of supravalvular aortic stenosis are mutations that occur in the elastin gene, but changes in NKX lead to the development of heart disease tetralogy of Fallot.

In addition, heart disease can occur as a result of various pathological processes occurring in the body. For example, in 85% of cases, the development of mitral stenosis and in 26% of the damage to the aortic valve is affected by rheumatism. It can also contribute to the formation of various combinations of insufficient functioning of some valves and stenosis. Sepsis, infectious endocarditis, trauma, and atherosclerosis can lead to the formation of heart defects acquired throughout life. and in some cases – Libman-Sachs endocarditis, rheumatoid arthritis. causing visceral lesions and scleroderma.

Sometimes various degenerative changes cause the development of isolated mitral and aortic insufficiency, aortic stenosis, which are characterized by non-rheumatic origin.

Heart defect symptoms

Any organic lesions of the heart valves or its structures that cause characteristic abnormalities are in a general group called “heart disease.”

The characteristic signs of these anomalies are the main indicators with which it is possible to diagnose a certain heart defect, as well as at what stage of development it is located. At the same time, there are symptoms with a congenital etiology, which are determined almost immediately from the moment of birth, but acquired cardiac anomalies are characterized by a meager clinical picture, especially in the compensatory stage of the disease.

As a rule, the clinical symptoms of heart disease can be divided into general signs of the disease and specific ones. Some disorders in the structure of the heart or blood vessels are characterized by a certain specificity of symptoms, but general symptoms are characteristic of many diseases of the entire circulatory system. Therefore, heart disease, for example, in infants has more nonspecific symptoms, in contrast to the symptoms of a certain type of disorder in the blood flow system.

Children's heart disease is differentiated by the type of skin color. When the skin color is cyanotic, blue defects are considered, and white defects are characterized by a pale tint. For heart defects white venous blood does not enter the ventricle located on the left side of the heart or its outlet narrows, as well as the aorta parallel to the arch. And with blue defects, mixing of blood or transposition of blood vessels is noted. It is very rare to observe the appearance of rapidly developing cyanosis of the skin in a child, which makes it possible to assume an existing heart defect, not in the singular. To confirm this diagnosis, additional examination is required.

To the symptoms common manifestations may include the appearance of symptoms in the form of dizziness, rapid heartbeat, increased or decreased blood pressure, shortness of breath, cyanosis of the skin, pulmonary edema, muscle weakness, fainting, etc. All these symptoms cannot accurately indicate an existing heart defect, so an accurate diagnosis of the disease is possible after a thorough examination. For example, an acquired heart defect can be identified after listening, especially if the patient has a history of disorders characteristic of this. The mechanism of hemodynamic disorders makes it possible to immediately reliably and quickly determine the type of heart defect, but the stage of development is much more difficult to identify. This can be done if signs of a nonspecific disease appear. Largest quantity clinical symptoms characteristic of heart defects in combination or combined form.

In a subjective assessment of congenital heart defects, a slight intensity of symptomatic manifestations is noted, while acquired ones are characterized by severity in such stages as decompensation and subcompensation.

The clinical symptoms of stenosis are more pronounced than valve insufficiency. Mitral stenosis manifests itself as a diastolic cat purr, a lag in the pulse in the artery of the left arm as a result of compression subclavian artery on the left, acrocyanosis, in the form of a heart hump, cyanosis in the nasolabial triangle.

In the subcompensation and decompensation stages, PH develops, leading to difficulty breathing, the appearance of a dry cough with scanty white sputum. These symptoms increase each time and lead to the progression of the disease, which causes the appearance of a worsened condition and weakness in the body.

With absolute decompensation of heart disease, patients develop edema in some parts of the body and pulmonary edema. For stenotic disease of the first degree, affecting the mitral valve, when performing physical exertion, shortness of breath with a feeling of a heartbeat and a dry cough is characteristic. Valve deformation is observed on both the aortic and tricuspid valves. With an aortic lesion, a systolic murmur is detected in the form of a purr, palpation of a weak pulse with the presence of a heart hump between the fourth and fifth ribs. With an abnormality of the tricuspid valve, edema and heaviness in the liver appear, which is a sign of complete filling of the vessels. Sometimes the veins in the lower extremities dilate.

Symptoms of insufficient functioning of the aortic valve consist of changes in pulse and blood pressure. In this case, the pulse is very tense, the size of the pupil changes in diastole and systole, and an Quincke pulse of capillary origin is observed. During the period of decompensation, the pressure is at low levels. In addition, this heart defect is characterized by its progression, and the changes that occur in the myocardium very quickly become the cause of HF (heart failure).

In patients at a younger age, as well as among children with heart defects of congenital etiology or early acquired, the formation of a cardiac hump is observed as a result of increased pressure of the enlarged and altered myocardium of the left part of the ventricle on the anterior wall of the chest.

With a congenital cardiac anomaly, there is a rapid beating of the heart and efficient circulation of blood, which are characteristic from birth. Very often with such defects cyanosis is detected. caused by a septal defect between the atrium or between the ventricle, transposition of the aorta, stenosis of the entrance to the right ventricle and its hypertrophy. All these symptomatic signs also has a heart defect such as tetralogy of Fallot, which very often develops in newborns.

Heart disease in children

Cardiac pathology, which is characterized by defects in the valve apparatus, as well as in its walls, is called heart disease. In the future, it leads to the development of cardiovascular failure.

In children, heart defects can be of congenital etiology or can be acquired during life. The reasons for the formation of congenital defects in the form of defects in the heart and adjacent vessels are considered to be disturbances in the processes of embryogenesis. Such heart defects include: defects between the septa, both between the ventricles and between the atria; a defect in the form of an open ductus arteriosus; aortic stenosis; tetralogy of Fallot; isolated pulmonary artery stenosis; coarctation of the aorta. All these cardiac pathologies in the form of heart defects are formed during the prenatal period, which can be detected using ultrasound of the heart, and early stages development using electrocardiography or Doppler.

The main reasons for the development of heart disease in children include: hereditary factors, smoking and drinking alcohol during pregnancy, an environmentally unfavorable area, a woman’s history of miscarriages or stillborn children, as well as an infectious disease such as rubella suffered during pregnancy.

Acquired cardiac defects are characterized by abnormalities in the valve area, in the form of stenosis or insufficient heart function. These heart defects in childhood develop as a result of certain diseases. These include infective endocarditis, mitral valve prolapse and rheumatism.

To determine a heart defect in a child, first of all, pay attention to murmurs during auscultation of the heart. Existing organic murmurs indicate a suspected heart defect. A child with this diagnosis gains very little weight every month, about 400 grams. he has shortness of breath and gets tired quickly. As a rule, these symptoms appear during feeding. At the same time, heart disease is characterized by tachycardia and cyanosis of the skin.

There is generally no clear answer to the treatment of childhood heart disease. In choosing a technique therapeutic treatment many factors play a role. This includes the nature of the disease, the age of the child and his condition. It is important to take into account such a moment that heart disease in children can go away on their own, after reaching fifteen or sixteen years. All this applies to heart defects with congenital etiology. Very often, treatment is initially started for the disease that caused the development of heart disease in children or contributed to its progression. In this case, preventive and drug treatment is used. But acquired cardiac pathology often ends in surgery. In this case, it is a commissurotomy, which is performed for isolated mitral stenosis.

Surgical intervention in the presence of mitral regurgitation is prescribed in cases of complications or deterioration of the child’s well-being. The operation is performed to replace the valve with an artificial one. For therapeutic therapy heart disease, an appropriate protein diet with limited water and salt, various general hygienic measures, as well as constant exercise therapy are prescribed. A child with a heart defect is taught to perform certain physical activities that constantly train the heart muscle. First of all, this is walking, which helps increase blood circulation and prepares the muscles for the next activity. Then they perform a set of exercises that straighten the spine and chest. Of course, an integral part of the training is exercises for the respiratory system.

Heart disease in newborns

In newborns, heart defects may have certain causes genetic nature, and environment can greatly influence its formation, especially in the first trimester of pregnancy.

In addition, if the expectant mother consumed some medicines, narcotic drugs, alcohol, smoked or suffered from certain diseases of viral or bacterial etiology, then there is a high probability of developing heart disease, first in the fetus and then in the newborn. Some types of heart defects develop due to hereditary etiology. All these pathologies can be identified even when examining pregnant women with an ultrasound, and sometimes with late diagnosis, but then heart defects manifest themselves at different ages.

In newborns, heart defects are a common pathology and a very serious problem. They are divided into heart defects characterized by shunting and without shunting. Clinical symptoms are most pronounced in the first variant of heart disease, when there is a defect between the atrial septa. In this case, blood without oxygen enrichment enters such a circulatory system as the systemic circulation, which is why the newborn develops cyanosis or a bluish coloration of the skin. The characteristic blueness is visible on the lips, which is why there is medical term"blue child" Cyanosis also appears with a defect in the septum between the ventricles. This is explained by a defect, as a result of which the heart and small circle are overloaded due to pressure in different departments hearts.

For heart defects of congenital origin, but without bleeding, coartation of the aorta is more typical. In this case, a cyanotic tint does not appear on the skin, but when at different levels development of the defect, cyanosis may form.

The most common malformations of newborns are tetralogy of Fallot and coartation of the aorta. But the most common defects are defects of the atrial and ventricular septa.

Tetralogy of Fallot is formed in the fourth to sixth weeks of pregnancy as a consequence of disturbances in the development of the heart. Heredity plays a significant role, but risk factors also play an important role. More often this vice occurs in newborns with Down syndrome. Tetralogy of Fallot is characterized by a defect in the septum between the ventricles, the position of the aorta changes, the pulmonary aorta narrows and the right ventricle enlarges. In this case, a rustling sound is heard in the heart, shortness of breath is noted, and the lips and fingers also turn blue.

Coartation of the aorta in newborns is characterized by narrowing of the aorta itself. Depending on this narrowing, there are two types: postductal and preductal. The last cardiac type refers to a very severe pathology incompatible with life. In this case, surgical intervention is necessary, as this heart defect leads to blue discoloration of the lower body.

Heart valve defects of congenital origin are presented in the form of protruding parts of the endocardium, which lines the inside of the heart. With such defects, blood circulates in only one direction. The most common heart defects in this category are aortic and pulmonary. The symptoms of this pathology consist of a certain heart rustling, difficulty breathing, swelling of the limbs, chest pain, lethargy and loss of consciousness. Electrocardiography is used to clarify the diagnosis, and surgery is considered one of the possible treatment methods.

Diagnosing heart defects in newborns involves identifying this pathology even before birth, that is, using the prenatal diagnostic method. There are invasive and non-invasive examinations. The first diagnostic method includes cordocentesis, chorionic villus biopsy and amniocentesis. The second method of examination includes a blood test for a biopsy from the mother, an ultrasound of the pregnant woman in the first half of pregnancy, and to clarify the diagnosis - a repeat ultrasound examination.

A certain group of heart defects in infants is in some cases simply life-threatening, so in this case emergency surgery is prescribed. For example, with a heart defect such as coartation of the aorta, the narrowed area is surgically removed. In other cases, surgery is postponed for a certain period of time, if this is possible without surgery.

Acquired heart defects

This pathology in the structure and functioning of the heart valves, which are formed throughout a person’s life under the influence of certain factors, leads to disturbances in the functioning of the heart. The formation of acquired heart defects is influenced by infectious lesions or various inflammatory processes, as well as certain overloads of the heart chambers.

A heart defect that a person acquires during life is also called valvular heart disease. It is characterized by stenosis or insufficient functioning of the valve, and at some points it manifests itself as a combined heart defect. When making this diagnosis, a disturbance in the functioning of the mitral valve is identified, which is unable to regulate blood flow and causes stagnation in both circulation circles. And overload of some cardiac parts leads to their hypertrophy, and this, in turn, changes the entire structure of the heart.

Acquired heart defects are rarely subject to timely diagnosis, which distinguishes them from UPS. Very often, people suffer from many infectious diseases on their feet, and this can cause rheumatism or myocarditis. Heart defects with acquired etiology can also be caused by improperly prescribed treatment.

In addition, this category of cardiac pathology is classified according to etiological criteria into heart defects of syphilitic origin, atherosclerotic, rheumatic, and also as a consequence of bacterial endocarditis.

Acquired heart defects are characterized by a high or moderate degree of hemodynamic disturbance inside the heart; there are also defects that are absolutely not affected by these dynamics. Depending on this hemodynamics, several types of acquired defects are distinguished, namely compensated, decompensated and subcompensated.

An important point for diagnosing the type of defect is its localization. Such heart defects as monovalve include mitral heart disease, aortic and tricuspid. In this case, only one valve is subject to deformation. If both are affected, they speak of combined valvular heart disease. This category includes mitral-tricuspid, mitral-aortic, aortic-mitral-tricuspid defects, etc.

With minor heart defects, the symptoms of the disease may not manifest themselves for a long time. But hemodynamically significant acquired heart defects are characterized by shortness of breath, cyanosis, edema, rapid heartbeat, pain in this area and cough. A characteristic clinical sign of any type of defect is a heart murmur. For a more accurate diagnosis, a consultation is scheduled with a cardiologist, who conducts an examination using palpation, percussion, and auscultation, which makes it possible to listen to a clearer heartbeat and murmur present in the heart. In addition, ECHO-cardioscopy and Dopplerography methods are used. All this will help to assess how severe a certain heart defect is, as well as its degree of decompensation.

Making a diagnosis such as heart disease requires a person to take greater responsibility for their health. First of all, it is necessary to limit the performance of heavy physical activity, especially in professional sports. It is also important to comply correct image life with rational nutrition and daily routine, regularly carry out the prevention of endocarditis, cardiac arrhythmias and poor circulatory function, since in this category of patients there are prerequisites for the formation of defects. In addition, timely treatment of infectious diseases with the prevention of rheumatism and endocarditis of bacterial etiology can prevent the development of acquired heart defects.

Today, two methods are used to treat the acquired category of this cardiac pathology. These include surgical method treatment and medication. Sometimes this anomaly becomes completely compensated, which allows the patient to forget about his diagnosis of an acquired heart defect. However, the important point remains timely diagnosis disease and proper treatment.

Therapeutic treatment methods include stopping the process of inflammation in the heart, then surgery is performed to eliminate the heart defect. As a rule, surgery is performed on an open heart and the effectiveness of the operation largely depends on the early timing of its implementation. But complications of heart defects, such as insufficient circulatory function or abnormal heart rhythm, can be eliminated without surgery.

Aortic heart disease

This disease is divided into stenosis and insufficiency of the aorta. Today, aortic stenosis, among acquired heart defects, is most often detected in North America and Europe. About 7% are diagnosed with calcifying aortic stenosis in people over 65 years of age and mainly among the male half of the population. Only 11% is accounted for by such an etiological factor as rheumatism in the formation of aortic stenosis. In the most developed countries, the cause of the development of this heart defect is almost 82% due to the degenerative calcifying process occurring on the aortic valve.

One third of patients suffer from bicuspid aortic valve disease, where leaflet fibrosis progresses as a result of damage to the valve tissues themselves and atherogenic processes accelerate, and this is what causes the formation of aortic defect in the form of stenosis. And provoking factors such as smoking, dyslipidemia, the patient’s age, and significantly increased cholesterol levels can accelerate fibrotic processes and the formation of aortic disease in the heart.

Depending on the severity of the disease, several degrees are distinguished. These include: aortic stenosis with slight narrowing, moderate and severe.

The symptomatic picture of aortic heart disease depends on the anatomical changes of the aortic valve. For minor lesions, most patients for a long time live and work in their usual rhythm of life and do not present certain complaints that would indicate aortic disease. In some cases, the first symptom of aortic disease is heart failure (HF). Hemodynamic disorders present increased fatigue, which is associated with centralization of blood flow. All this causes dizziness and fainting in patients. Almost 35% of patients experience pain characterized by angina pectoris. When the defect is decompensated, shortness of breath appears after any physical activity. But as a result of inadequate physical activity, pulmonary edema can occur. Signs such as cardiac-type asthma and angina attacks are unfavorable prognoses of the disease.

Visually, during examination of the patient, pallor is noted, and with severe stenosis, the pulse is small and slow in filling, and the systole pressure and pulse are reduced. The cardiac impulse at the apex is heard in the form of a powerful tone, diffuse, rising with a shift to the left and down. When you place your palm on the manubrium of the sternum, a pronounced systole tremor is felt. During percussion, the border of cardiac dullness is noted with a displacement to the left side and downward by almost 20 mm, and sometimes more. During auscultation, a weakened second tone is heard between the ribs, as well as a systolic murmur, which is carried out to all parts of the heart, to the back and cervical vessels. Sometimes a murmur can be heard remotely by auscultation. And when the second sound of the aorta disappears, we can speak with complete confidence about severe aortic stenosis.

Aortic heart disease is characterized by five stages.

The first stage is absolute compensation. The patients do not present any characteristic complaints; the defect is detected by auscultation. Using echocardiography, a slight gradient of systole pressure on the aortic valve is determined (about 40 mm Hg). Surgical treatment is not performed.

The second stage of the disease is a hidden insufficient work of the heart. Here fatigue, shortness of breath due to physical exertion, and dizziness appear. In addition to signs of aortic stenosis during auscultation, a characteristic sign of left ventricular hypertrophy is detected using X-ray and electrocardiographic studies. When conducting echocardiography, it is possible to determine moderate systolic pressure on the aortic valve (about 70 mm Hg) and here surgery is simply necessary.

The third stage is characterized by relative coronary insufficiency, which is manifested by pain resembling angina pectoris; shortness of breath progresses; are becoming more frequent fainting states and dizziness due to minor physical exertion. The borders of the heart are clearly enlarged due to the ventricle on the left. The electrocardiogram shows all the signs of an enlarged ventricle in the left side of the heart and hypoxia of the heart muscle. With echocardiography, systole pressure increases to a maximum above 60 mmHg. Art. In this condition, emergency surgery is prescribed.

At the fourth stage of aortic heart disease, left ventricular failure is pronounced. The complaints of patients are the same as in the third stage of the disease, but pain and other sensations are much stronger. Sometimes attacks of paroxysmal shortness of breath appear periodically and mainly at night; cardiac asthma; the liver enlarges and pulmonary edema occurs. The electrocardiogram shows all abnormalities associated with coronary circulation and atrial fibrillation. And an echocardiographic study reveals calcification of the aortic valve. An X-ray reveals an enlarged ventricle on the left side of the heart, as well as congestion in the lungs. Bed rest recommendations and prescription conservative methods therapy temporarily improves the general condition of some patients. In this case, surgical treatment is generally simply impossible. Everything is decided on an individual basis.

And the last stage of aortic heart disease is terminal. It is characterized by progression of RV and LV failure. At this stage, all the signs of the disease are quite pronounced. The patients are in extremely critical condition, so treatment in this case is no longer effective and surgical operations are also not performed.

Aortic insufficiency refers to one of the types of aortic defects. The frequency of its detection, as a rule, is directly dependent on the methods diagnostic studies. The prevalence of this type of defect increases with a person’s age, and all Clinical signs severe form deficiencies are much more common in males.

One of the common causes of the formation of this pathology is aortic aneurysm of the ascending part, as well as the bicuspid aortic valve. In some cases, the cause of the pathology is almost 50% due to degenerative disorders of the aortic valve. In 15%, the etiological factor is rheumatism and atherosclerosis, and in 8%, endocarditis of infectious origin.

As with aortic stenosis, there are three degrees of severity of aortic heart disease: initial, moderate and severe.

The symptoms of aortic insufficiency depend on the rate of formation and size valve defects. In the compensatory phase there are no subjective signs of the disease. The development of aortic heart disease proceeds calmly, even with a significant amount of aortic regurgitation.

With the rapid formation of extensive defects, the symptoms progress, and this becomes the cause of insufficient heart function (HF). A certain number of patients experience dizziness and feel their heart beating. In addition, almost half of patients diagnosed with aortic insufficiency, the causes of which are atherosclerosis or syphilis. The main symptom of the disease is angina.

Attacks of difficulty breathing develop at the beginning of the pathological process with increased physical activity, and with the formation of left ventricular failure, shortness of breath appears at rest and is characterized by symptoms of cardiac asthma. Sometimes everything is complicated by the addition of pulmonary edema. In addition, patients are very pale, their carotid, brachial and temporal arteries pulsate strongly, and Musset, Landolfi, Müller and Quincke symptoms are observed. On examination, Corrigan's pulse is observed; upon auscultation, a very strong and somewhat diffuse impulse is heard at the apex of the heart, and its boundaries are significantly enlarged to the left side and downwards. Over large vessels, a double Traube sound is noted, and when pressing on the area of ​​the iliac artery, a Durosier noise appears. Systolic pressure rises to 170 mm Hg. Art. and diastolic pressure indicators are characterized by a decrease to almost 40 mm Hg. Art.

This pathology develops from the appearance of the first signs until the patient’s death, on average it takes about seven years. Very quickly, insufficient work of the heart occurs in the process of tearing off the leaflet or quite severe damage to the valve due to endocarditis. Such patients live a little more than a year. A more favorable prognosis is characterized by aortic heart disease against the background of atherosclerotic origin, which rarely leads to significant changes in the valves.

Mitral heart disease

This category of diseases includes stenosis and insufficient function of the mitral valve. In the first case, stenosis is considered a common rheumatic heart disease, the cause of which is long-term rheumatic endocarditis. As a rule, this type of cardiac pathology occurs more among younger generation and in 80% of cases it affects the female half of the population. Very rarely, the mitral orifice is narrowed as a result of carcinoid syndrome, rheumatoid arthritis and lupus erythematosus. And 13% of cases are due to degenerative valve changes.

Mitral stenosis can be minor, moderate or significant.

All clinical symptoms of mitral heart disease in the form of stenosis have a certain dependence on the stage of this pathology and the state of the blood circulation. With a small area of ​​the hole, the defect does not manifest itself clinically, but this only applies to a state of rest. But with an increase in pressure in such a circle of blood circulation as the pulmonary circulation, shortness of breath appears, and patients complain of a strong heartbeat when performing minor physical exertion. In cases of a sharp increase in capillary pressure, cardiac asthma, dry cough, and sometimes with sputum production and even hemoptysis develop.

With PH (pulmonary hypertension), patients become weak and get tired quickly. With severe symptoms of stenosis, signs of mitral blush in the cheeks with a pale complexion, cyanosis on the lips, tip of the nose and ears are observed.

During a visual examination with mitral heart disease, a strong protrusion of the lower sternum and pulsation are noted as a result of the formation of a hump of the heart, which is a consequence of increased impacts of the pancreas on the chest wall in front. In the area of ​​the cardiac apex, diastole tremor is detected in the form of a cat's purr. During auscultation, an increase in the first sound in the upper part of the heart is heard and a click when the mitral valve opens.

Mitral stenosis can occur in several stages. The first is full compensation, in which you can do without the use of surgical treatment. The second is stagnation in the LH (pulmonary artery). In this case, surgical treatment is performed strictly according to indications. The third is insufficient work of the pancreas. Marked absolute indicators for surgical intervention. The fourth stage is characterized by dystrophic changes. With the use of drug therapy, it is possible to achieve a slight, short-term effect. At this stage, operations can be performed, however, briefly increasing the life expectancy of patients. For the last one, terminal stage, any treatment does not provide any effectiveness, neither medicinal nor surgical.

The second type of mitral heart disease is considered to be insufficient functioning of the mitral valve. Today, in the modern world, 61% of this disease accounts for degenerative mitral regurgitation and only 14% is rheumatic pathology. Other reasons for the development of this heart defect include systemic scleroderma and lupus erythematosus. endocarditis of infectious etiology and ischemic heart disease.

This disease is classified into initial severity, moderate and severe.

In compensation, this type of heart defect is accidentally detected during a medical examination. With reduced activity of LV contractions, attacks of difficulty breathing when performing certain work and heart palpitations develop. Then swelling occurs in the legs, pain in the hypochondrium on the right side, cardiac asthma and even shortness of breath in a state of absolute bye.

Many patients are diagnosed with aching, stabbing, pressing pain in the heart, which can appear without physical activity. With significant processes of regurgitation in the left part of the sternum, the formation of a cardiac hump is noted in patients; a push in the upper part of the heart of an intensified and diffuse nature is heard, which is localized under the fifth rib. On auscultation, the first heart sound is completely absent, the second heart sound is very often split above the LA and a dull third sound is heard at the apex.

With mitral insufficiency, five stages of the disease are also distinguished. The first is the stage of compensation, without indications for surgical treatment methods. The second is the subcompensatory stage, which requires surgical intervention. The third stage of mitral regurgitation occurs with decompensation of the pancreas. The operation is also scheduled here. The fourth is dystrophic changes in heart. In this case, surgical intervention is still possible. The fifth stage is terminal, in which surgical treatment is no longer performed.

To predictive parameters bad results include the age of the patients, the presence of certain symptoms and atrial fibrillation, progressive PH processes and low ejection fraction.

Heart disease treatment

Typically, treatment for heart disease is divided into medical methods and surgical. In the compensation phase of heart defects, it is not prescribed special treatment. It is recommended to reduce physical exercise and mental fatigue. An important point remains the implementation of exercises in the LF group. But during the decompensation period, antihypertensive drugs are prescribed to prevent pulmonary hemorrhages; beta-adrenergic receptor blockers and Endothelin, which reduces the resulting functional heart failure, which also allows you to endure physical activity. Anticoagulants are used for the development of fibrillation and atrial flutter.

For decompensated heart disease, such as mitral valve disease, digitalis preparations are used; for aortic defects - Strophanthin. But generally, when conservative treatment methods are ineffective, they resort to surgical operations for various heart defects.

In order to prevent the development of acquired heart defects, it is necessary to promptly and thoroughly treat diseases such as atherosclerosis, rheumatism, syphilis, and eliminate infectious foci in the oral cavity and pharynx, and also not to overwork and avoid nervous overload. In addition, it is important to observe sanitary and hygienic rules in everyday life and work, and to combat dampness and hypothermia.

To prevent heart disease from going into the stage of decompensation, it is necessary not to overeat, rationally distribute work and rest time with sufficient time for sleep. Various heavy types of work are completely contraindicated for people with heart defects. Such patients are constantly registered with cardiologists.

Heart defect surgery

In certain cardiac surgery clinics, various surgical methods are used to treat heart defects. In case of insufficient functioning of the valves, in some cases organ-preserving operations are resorted to. In this case, the adhesions are cut or fused. And with minor narrowings it produces a partial expansion. This is done using a probe and the method is referred to as endovasal surgery.

For more severe cases, a technique is used to completely replace the heart valves with artificial ones. In large forms of aortic stenosis and when it is not possible to expand the aorta, a resection is performed and a certain area of ​​the aorta is replaced with a synthetic Dacron prosthesis.

When diagnosing insufficiency of the coronary circulation, the method of bypass arteries that have lesions is simultaneously used.

There is also modern method surgical treatment of heart disease, which is developed and widely used in Israel. This is the rotablater method, which is characterized by the use of a small drill that allows you to restore the lumen of the vessels. Very often, heart defects are accompanied by rhythm disturbances, i.e. blockades are formed. Thus, valve replacement surgery is always accompanied by the implantation of artificial control and regulation of the heart rhythm.

After any surgical operation for heart defects, patients are in rehabilitation centers until they complete the entire course of treatment. rehabilitation therapy with the prevention of thrombosis, improvement of myocardial nutrition and treatment of atherosclerosis.

After discharge, patients periodically undergo examinations prescribed by a cardiologist or cardiac surgeon with preventive treatment Twice a year.

The frequency of congenital heart defects in the world is 8 cases per 1 thousand newborns. Heart defects occur in every third child born with Down's disease. In children born to mothers with diabetes, the frequency of congenital heart defects is 25 cases per 1,000, in children born to twins - 17 per 1,000.

Congenital heart defects are divided into:

• isolated - having one structural feature, for example, narrowing of the pulmonary trunk;
• combined - having several signs, for example tetralogy of Fallot;
• combined - combined with defects in other areas of the body, such as tetralogy of Fallot and esophageal atresia.

A large number of congenital heart defects are incompatible with life and. They are discovered mainly at autopsy. Based on their main characteristics, they can be divided into three groups:

• valvular defects - characterized by an abnormal condition of the valves of the heart and blood vessels;
• defects associated with the formation of abnormal messages between the small and large circles of blood circulation;
• vascular defects associated with abnormalities of the vessels leaving the heart.

All defects affect the state of blood circulation to one degree or another. These changes depend on many factors, therefore, along with their classification according to morphological characteristics A clinical and physiological classification has been developed. Any congenital malformation has structural and hemodynamic characteristics that can differ significantly even within the same type. More O.M. Bakulev clinically classified all defects according to the patient’s skin color into “white” - with insufficient blood flow in the systemic circle, and “blue” - with cyanosis.

Isolated congenital heart defects

The patent ductus arteriosus is a component of the so-called fetal circulation. After birth, the ductus arteriosus becomes empty for 1-3 months. life is overgrown. If it continues to function after these dates, it is called open.

Since the pressure in the aorta is higher than in the pulmonary trunk, shunting of blood from left to right takes place, i.e. the defect is initially “white”. If the defect exists for a long time, and the connection is wide, then, as with any shunt from left to right, pressure in the pulmonary circulation increases and right ventricular hypertrophy develops.

When the pressure in the pulmonary trunk becomes higher than in the aorta, shunting of blood occurs from right to left and the defect turns blue, i.e., cyanosis occurs.

From this point on, an open ductus arteriosus operation, which consists in removing the connection between the aorta and the pulmonary trunk (due to ligation or suturing with metal brackets), will be less effective.

Atrial septal defect (ASD) is a non-closure of the foramen ovale in the interatrial septum, which, like the ductus arteriosus, is an element of the fetal circulation. It grows over before the 6th month of life.

In 25% of adults, non-closure of the foramen ovale does not predetermine any hemodynamic changes, since it is reliably blocked from the left atrium by a valve.

In the absence of part of the interatrial septum, a true ASD is observed. The defect is associated with a shunt from left to right and causes an overload of the right ventricle.

The operation for an atrial septal defect consists in applying a patch to the defect under AIC conditions.

Ventricular septal defect (VSD), or Tolochinov-Roger disease. The defect can be located in the upper membranous part of the interventricular septum or in the lower muscular. In an isolated form, it does not develop very often, it is mainly a component of many combined defects, in particular Fallot's tetralogy.

Coarctation of the aorta is a congenital narrowing of the aorta at the level of its ascending part or arch. It is a “white” vice. Most often it is combined with open ductus arteriosus- the so-called infantile type. Surgery for this congenital heart defect involves plastic surgery of the defect using a patch or resection of the narrowed part.

Transposition of vessels. The aorta comes from the right ventricle, the pulmonary trunk - from the left. In its isolated form, such a defect is incompatible with life, since the systemic and pulmonary circulation are separated from each other. When combined with patent ductus arteriosus, VSD. ASD. i.e., with abnormal connections of the right and left hearts, children are born alive, and there is time to perform surgery for congenital heart disease.

Combined congenital heart defects

Heart defects of the Fallot group

Tetralogy of Fallot, described by him in 1888, is identified as a separate nosological unit. It is one of the most common and complex congenital heart defects. Its frequency is 30% of congenital heart defects and 75% total number defects that are accompanied by cyanosis.

Tetralogy of Fallot has four structural features:

1. Stenosis or atresia of the pulmonary trunk.
2. High VSD.
3. Dextroposition of the aorta is the so-called horseman aorta: the vessel is located above the VSD and arises simultaneously from both ventricles.
4. Hypertrophy of the right ventricular myocardium.

The main signs that form the clinical and hemodynamic picture and primarily require surgical correction are pulmonary stenosis and VSD.

The Fallot group also includes the Fallot pentad, which has all the signs of a tetralogy and ASD, and the Fallot triad. including pulmonary stenosis, ASD and left ventricular hypertrophy.

Heart defects of the Fallot group are severe and are accompanied by retardation of children in physical and mental development. Patients with uncorrected Fallot group defects live up to 12-14 years.

Radical surgery for tetralogy of Fallot and associated developmental defects is difficult and traumatic. Surgical intervention is performed in conditions of AIC, and not all children are able to withstand it, so in 1944 palliative surgery according to Blalock-Taussig was proposed. It consists of filling the pulmonary circulation with blood by forming an anastomosis of the left subclavian artery with the left pulmonary artery. Carrying out surgery for this type of congenital heart defect allows sick children to live until radical intervention.

the first radical surgery with the tetralogy of Fallot performed in 1955 by Lillihei. The main problem in radical correction of this defect is the elimination of pulmonary stenosis. There are several forms: subvalvular, valvular and pulmonary atresia. The valve shape is more or less amenable plastic surgery with congenital heart defects. Atresia of the pulmonary trunk in the initial part and fibromuscular degeneration of the conus arteriosus were considered not subject to surgery for quite a long time. In 1975, Cooley proposed surgery for this congenital heart defect - an external shunt with a valve (conduit) to bypass the narrowed areas of the conus arteriosus and pulmonary trunk. A VSD is eliminated through surgery in which a patch is placed.

Lutambashe syndrome is a combination of left atrioventricular orifice stenosis and a large ASD. With this defect, functional failure of the right ventricle develops very quickly and the negative consequences of the “left to right” shunt progress.

Ebstein's syndrome is a combination of congenital insufficiency of the right atrioventricular valve, patent foramen ovale and right ventricular hypertrophy. With this defect, blood shunting occurs “from left to right.”

Eisenmenger syndrome consists of extraposition of the aorta and ASD. Eisenmenger, based on morphological studies, found that the increase in pressure in the right half of the heart is due to stenosis and hypertrophy of the muscular lining of the small branches of the pulmonary arteries. Later it was revealed that any defects with a “left to right” shunt have the same consequences.