Correction of atrial septal defect in children is open heart surgery. Causes of congenital heart defects in children, symptoms and treatment, consequences

Treatment of congenital cardiac anomalies is only possible surgically. After establishing the diagnosis, the following questions are resolved: 1) the need and possibility of surgical treatment of the defect in a particular patient; 2) if necessary – type, volume and timing surgical intervention.

There are the following types of operations for congenital heart defects:

radical, implying complete correction of the defect;

palliative – partial correction of a defect, most often as the first stage of a radical operation, allowing radical correction to be performed in more favorable conditions;

hemodynamic – interventions aimed at correcting intracardiac hemodynamics, but not eliminating the defect itself.

Separation of congenital heart defects by type of possible operation

Group 1:

congenital defects in which radical surgery is possible and is the only choice. If there is a mild hemodynamic disturbance, the operation may be postponed. This group mainly includes:

patent ductus arteriosus;

defect interventricular septum;

defect interatrial septum;

partially open arteriovenous canal;

coarctation of the aorta;

stenosis and insufficiency of the mitral and aortic valves.

Group 2:

congenital defects, in which the choice between radical and palliative intervention depends on the anatomical severity of the defect and the patient’s condition. For these types of defects, palliative surgery is sometimes used as the first stage of radical correction. This group mainly includes:

tetralogy of Fallot;

pulmonary stenosis;

pulmonary atresia;

transposition great vessels.

Group 3:

congenital defects for which only palliative or hemodynamic correction of the defect is possible. This group mainly includes:

atresia of the mitral and tricuspid valves;

two-chambered heart;

hypoplastic right and left heart syndrome;

the only ventricle of the heart.

Separation of patients with congenital heart defects according to the timing of the operation (according to J. Kirklin, 1984):

group 0

patients with congenital heart disease who have minor hemodynamic disturbances and do not require surgery;

group 1

patients whose condition allows the operation to be performed as planned (in a year or later);

group 2

patients for whom surgery is indicated in the next 3–6 months;

group 3

patients with severe hemodynamic disturbances requiring correction within several weeks;

group 4

patients requiring emergency surgery (48 hours after hospitalization).

Most complex problem operations remain in children of the first year of life with congenital heart defects, since they are associated with high risk invasive examination and surgical intervention. In this category of patients, surgery is performed only if conservative methods fail to stabilize the condition. Most often, children of the first year of life with cyanotic congenital defects are operated on urgently and urgently. In the absence of severe heart failure and moderate cyanosis, children under one year of age are observed by a cardiologist at the place of residence. With age and increasing body weight, the risk of interventions decreases significantly.

To correct a number of congenital heart defects, endovascular methods are increasingly used, which can also be radical (for example, closure of an atrial septal defect, open ductus arteriosus, balloon angioplasty and stenting for coarctation of the aorta, stenosis of the branches of the pulmonary artery, embolization of aortopulmonary anastomoses) and palliative.

Ventricular septal defect in newborns Ventricular septal defect (VSD)– a heart defect in which holes form in the septum between the right and left ventricles.

Among congenital defects, this is the most common, its share is 20-30%. It is equally common in girls and boys.

Features of blood circulation in cases of ventricular septal defect in newborns

Then there comes a moment when the blood vessels of the lungs reflexively contract. They become sclerotic and the lumen in them narrows. The pressure in the vessels and in the right ventricle increases several times and becomes higher than in the left. Now the blood begins to flow from the right half of the heart to the left. At this phase of the disease, only a heart and lung transplant can help a person.

Causes

The following reasons contribute to its appearance:

1. Infectious diseases of the mother in the first three months of pregnancy: measles, rubella, chickenpox.
2. Use of alcohol and drugs.
3. Some medications: warfarin, drugs containing lithium.
4. Hereditary predisposition: heart disease is inherited in 3-5% of cases.

1. Multiple small holes are the mildest form, which has little effect on health.
2. Multiple large holes. The septum resembles Swiss cheese - the most severe form.
3. Holes in the lower part of the septum, consisting of muscles. They are more likely than others to heal on their own during the first year of a child’s life. This is facilitated by the development of the muscular wall of the heart.
4. Openings located under the aorta.
5. Defects in the middle part of the septum.

Symptoms and external signs

The size of the defect is compared with the lumen of the aorta.

1. Small defects - less than 1/4 of the diameter of the aorta or less than 1 cm. Symptoms can appear at 6 months and in adulthood.
2. Medium defects are less than 1/2 the diameter of the aorta. The disease manifests itself at 1-3 months of life.
3. Large defects – diameter equal to the diameter of the aorta. The disease manifests itself from the first days.

1. The first stage is stagnation of blood in the vessels. Fluid accumulation in lung tissue frequent bronchitis and pneumonia.
2. The second stage is vasospasm. The phase of temporary improvement, the vessels narrow, but the pressure in them increases from 30 to 70 mm Hg. Art. Counts best period for surgery.
3. The third stage is sclerosis of blood vessels. It develops if the operation was not performed on time. The pressure in the right ventricle and pulmonary vessels is from 70 to 120 mm Hg. Art.

With a large ventricular septal defect in newborns, their health worsens from the first days.

• bluish skin tone at birth;
• the baby gets tired quickly and cannot breastfeed normally;
• restlessness and tearfulness due to hunger;
• sleep disorders;
• poor weight gain;
• early pneumonia, which is difficult to treat.

• elevation of the chest in the area of ​​the heart - cardiac hump;
• during contraction of the ventricles (systole), a tremor is felt, which creates a flow of blood passing through the hole in the interventricular septum;
• when listening with a stethoscope, a noise is heard that is caused by insufficiency of the pulmonary valves;
• wheezing and hard breathing are heard in the lungs, associated with the release of fluid from the vessels into the lung tissue;
• tapping reveals an increase in heart size;
• enlargement of the liver and spleen is associated with stagnation of blood in these organs;
• in the third stage, the appearance of a bluish tint of the skin (cyanosis) is characteristic. First on the fingers and around the mouth, and then throughout the body. This symptom appears due to the fact that the blood is not sufficiently enriched with oxygen in the lungs and the body cells experience oxygen starvation;
• at the third stage, the chest is swollen and looks like a barrel.

Diagnostics

Radiography

Painless and informative examination of the chest using x-ray radiation. The stream of rays passes through the human body and forms an image on a special sensitive film. The image allows you to assess the condition of the heart, blood vessels and lungs.

With VSD in newborns, the following is detected:

• enlargement of the borders of the heart, especially its right side;
• enlargement of the pulmonary artery, which carries blood from the heart to the lungs;
• congestion and spasm of pulmonary vessels;
• fluid in the lungs or pulmonary edema, manifested by darkening on the image.

This study is based on recording electrical potentials that occur during heart function. They are recorded in the form of a curved line on a paper tape. The doctor assesses the condition of the heart based on the height and shape of the teeth. The cardiogram may be normal, but more often there is overload of the right ventricle.

Ultrasound of the heart Doppler study

Examination of the heart using ultrasound. Based on the reflected ultrasound wave, a real-time image of the heart is created. This type of ultrasound allows you to identify the characteristics of blood movement through the defect.

With VSD the following are visible:

• a hole in the septum between the ventricles;
• its size and location;
• Red color reflects the flow of blood that moves towards the sensor, and blue color reflects blood that flows in the opposite direction. The lighter the shade, the higher the speed of blood movement and pressure in the ventricles.

Data from instrumental examination in newborns

1. In the first stage:
   • increased size of the heart, it is round, without narrowing in the middle;
   • the blood vessels of the lungs look unclear and blurry;
   • Signs of pulmonary edema may appear - darkening over the entire surface.
2. In the transitional stage:
   • heart has normal sizes;
   • the vessels look normal.
3. The third stage is sclerotic:
   • the heart is enlarged, especially on the right side;
   • the pulmonary artery is enlarged;
   • only large vessels of the lungs are visible, and small ones are invisible due to spasm;
   • the ribs are located horizontally;
   • the diaphragm is down.

1. The first stage may not manifest itself with any changes or it may appear:
   • right ventricular overload;
   • enlargement of the right ventricle.
2. Second and third stage:
   • overload and enlargement of the left atrium and ventricle.
   • disturbances in the passage of biocurrents through the heart tissue.

• identifies the location of the defect in the septum;
• defect size;
• direction of blood flow from one ventricle to another;
• the pressure in the ventricles of the first stage is not more than 30 mm Hg. Art., in the second stage - from 30 to 70 mm Hg. Art., and in the third – more than 70 mm Hg. Art.

Treatment

Diuretics: Furosemide (Lasix)

They help reduce the volume of blood in the vessels and get rid of pulmonary edema. The drug is prescribed to children at a rate of 2–5 mg/kg. You need to take it once a day, preferably before lunch.

Cardiometabolic agents: Phosphaden, Cocarboxylase, Cardonate

They improve nutrition of the heart muscle, fight oxygen starvation of cells and improve metabolism in the body. If a doctor has prescribed Cardonate to a child, then the capsule must be opened and its contents dissolved in sweetened water (50-100 ml). Take 1 time per day after meals. Course from 3 weeks to 3 months.

Cardiac glycosides: Strophanthin, Digoxin

They help the heart contract more powerfully and pump blood through the vessels more efficiently. A 0.05% solution of strophanthin is prescribed at a rate of 0.01 mg/kg of body weight or digoxin 0.03 mg/kg. The drug is administered at this dose for the first 3 days. Then its amount is reduced by 4-5 times - a maintenance dose.

To relieve bronchospasm: Eufillin

Prescribed for pulmonary edema and bronchospasm, when the child has difficulty breathing. Eufillin solution 2% is administered intravenously or in the form of microenemas, 1 ml per year of life.

Taking medications will help reduce the symptoms of the disease and buy time to give the defect a chance to close on its own.

Types of operations for ventricular septal defect

If the child’s condition allows, then it is advisable to perform the operation between 1 and 2.5 years. During this period, the baby is already strong enough and will best tolerate such an intervention. In addition, he will soon forget the period of treatment and the child will not have psychological trauma.

What are the indications for surgery?

1. The presence of a hole in the interventricular septum.
2. Enlargement of the right side of the heart.

1. The third degree of development of the disease, irreparable changes in the blood vessels of the lungs.
2. Blood poisoning - sepsis.

Surgery to narrow the pulmonary artery for VSD

The surgeon uses a special braid or thick silk thread to tie off the artery that carries blood from the heart to the lungs so that less blood enters them. This operation is a preparatory stage before complete closure of the defect.

Indications for surgery

1. Increased pressure in the blood vessels of the lungs.
2. Return of blood from the left ventricle to the right.
3. The child is too weak to undergo surgery to correct the defect in the interventricular septum.

Advantages of the operation

1. Reduces blood flow into the lungs and reduces pressure in them.
2. It becomes easier for the child to breathe.
3. It makes it possible to postpone surgery to correct the defect for 6 months and allow the child to get stronger.

1. The child and parents will have to undergo 2 operations.
2. The load on the right ventricle increases, as a result it stretches and enlarges.

This type of treatment requires opening the chest. An incision is made along the sternum, the heart is disconnected from the vessels. For a while it is replaced by an artificial circulation system. The surgeon makes an incision in the right ventricle or atrium. Depending on the size of the defect, the doctor chooses one of the treatment options.

1. Suturing the defect. If its size does not exceed 1 cm and it is located away from important vessels.
2. The doctor places a sealed patch on the septum. It is cut to the size of the hole and sterilized. There are two types of patches:
   • from a piece outer shell heart (pericardium);
   • from artificial material.

Indications for open surgery

1. It is impossible to improve a child's condition with medications.
2. Changes in the blood vessels of the lungs.
3. Right ventricular overload.

1. Allows you to simultaneously remove blood clots that may have formed in the heart.
2. Allows you to eliminate other pathologies of the heart and its valves.
3. Makes it possible to correct defects in any location.
4. Suitable for children of any age.
5. Allows you to get rid of heart problems once and for all.

1. It is quite traumatic for a child and lasts up to 6 hours.
2. Requires long period recovery.

The essence of the operation is that the defect in the interventricular septum is closed using a special device that is inserted into the heart through large vessels. The device resembles interconnected buttons. It is installed in the hole and blocks the flow of blood through it. The procedure is carried out under X-ray control.

Indications for closing the defect with an occluder

1. The defect is located at least 3 mm from the edge of the interventricular septum.
2. Signs of blood stagnation in the vessels of the lungs.
3. Return of blood from the left ventricle to the right.
4. Age over 1 year and weight more than 10 kg.

1. Less traumatic for the child - there is no need to cut the chest.
2. Recovery takes 3-5 days.
3. Immediately after the operation, improvement occurs and blood circulation in the lungs normalizes.

Disadvantages of the operation

1. Used only to cover defects small size, which are located in the central part of the partition.
2. Closure cannot be performed if the vessels are narrow, there is a blood clot in the heart, problems with the valves, or persistent heart rhythm disturbances.
3. There is no way to correct other heart problems.

The only effective treatment for medium and large ventricular septal defects is open heart surgery. Surgeons at large cardiology centers perform this operation quite often and have extensive experience in this matter. Therefore, you can be confident of a successful outcome.

Indications for surgery

• defect in the interventricular septum;
• reflux of blood from the left ventricle to the right;
• signs of enlargement of the right ventricle;
• heart failure - the heart cannot cope with the function of the pump and poorly supplies blood to the organs;
• signs of circulatory disorders in the lungs: shortness of breath, moist rales, pulmonary edema;
• ineffectiveness of drug treatment.

• reflux of blood from the right ventricle to the left;
• an increase in pressure in the vessels of the lungs by 4 times and sclerosis of small arteries;
• severe exhaustion of the child;
• severe concomitant diseases of the liver and kidneys.

The urgency of the operation depends on the size of the defect.

1. Small defects, less than 1 cm - surgery can be postponed up to 1 year, and if there are no circulatory problems, then up to 5 years.
2. Medium defects, less than 1/2 the diameter of the aorta. The child needs to be operated on in the first 6 months of life.
3. Large defects, diameter equal to the diameter of the aorta. Urgent surgery is necessary before irreversible changes develop in the lungs and heart.

1. Preparing for surgery. On the appointed day, you and your child will come to the hospital, where you will have to stay for several days before the operation. Doctors will do it necessary tests:
   • blood type and Rh factor;
   • blood clotting test;
   • general blood analysis;
   • Analysis of urine;
   • stool analysis for worm eggs.
   An ultrasound of the heart and a cardiogram will also be performed again.
   
2. Before the operation there will be a conversation with the surgeon and anesthesiologist. They will examine your child and answer all your questions.
3. General anesthesia. The child will be given painkillers intravenously and will not feel any pain during the operation. The doctor accurately doses the drug, you can be sure that the anesthesia will not harm the baby.
4. The doctor will make an incision along the breastbone to access the heart and connect the child to a heart-lung machine.
5. Hypothermia is a decrease in body temperature. Using special equipment, the child’s blood temperature is reduced to 15°C. Under such conditions, the brain can more easily tolerate oxygen deprivation that may occur during surgery.
6. The heart, disconnected from the vessels, temporarily does not contract. The coronary pump will clear the heart of blood to make it more convenient for the surgeon to work.
7. The doctor will make an incision in the right ventricle and repair the defect. He will put a stitch over it to tighten the edges. If the hole is large, the surgeon uses a specially prepared patch made from the outer connective tissue of the heart or a synthetic material.
8. After this, the tightness of the interventricular septum is checked, the hole in the ventricle is sutured and the heart is connected to the circulatory system. Then the blood is gradually heated to normal temperature using a heat exchanger, and the heart begins to contract on its own.
9. The doctor stitches up a wound on the chest. He leaves a drainage in the seam - a thin rubber tube to drain fluid from the wound.
10. A bandage is applied to the baby's chest and the child is transported to the intensive care unit, where he will have to spend a day under the supervision of medical personnel. Perhaps you will be allowed to visit him. But in some hospitals this is prohibited in order to protect the baby from infections.
11. Then the child will be transferred to the department intensive care, where you can be close to him, reassure and support him. A rise in temperature to 40°C is a frequent occurrence - do not panic. It is worse when at this temperature the child turns pale and the pulse becomes weak and slow. Then you need to urgently inform your doctor.

Caring for a child after heart surgery

At this time, it is advisable to carry the child in your arms more - this is called positional massage. It develops, soothes and improves blood circulation. Don’t be afraid to teach your child to hold hands - health is more important than pedagogical principles.

Protect your child from infections: Avoid being in crowded places. Do not hesitate to take him away if a person with signs of illness appears nearby; protect your baby from hypothermia. If there is a need to visit the clinic, then lubricate the child’s nose Oxolinic ointment or use preventative sprays Euphorbium Compositum, Nazaval.

Scar care. The wound will take about 4 weeks to heal. At this time, lubricate the seam with calendula tincture and protect from sun rays. To avoid scar formation, there are special creams - Contractubex, Solaris. Ask your doctor which one is right for your child.

After the stitches have completely healed, you can bathe your child in the bath. It is better if the water is boiled with the addition of potassium permanganate the first time. The water temperature is 37°C, and reduce bathing time to a minimum. For an older child, a shower would be ideal.

Sternum– this is a bone, it will heal for about 2 months. During this period, you should not pull the child by the arms, lift his armpits, lay him on his stomach, give him a massage, and in general, you should avoid physical activity to prevent deformation of the chest.

After fusion of the sternum, there is no particular reason to limit the child’s physical development. But still, for the first six months, try to avoid serious injuries, so do not allow your child to ride a scooter, bicycle or rollerblades.
Taking medications prescribed by the doctor: Veroshpiron, Digoxin, Aspirin. They will help avoid fluid accumulation in the lungs, improve heart function and prevent blood clots. In the future, they will be canceled, and your baby will live like an ordinary child.

The first six months you will need take temperature morning and evening and record the results in a special diary.

Tell your doctor about these symptoms:

• temperature rise above 38°C;
• the seam is swollen and liquid begins to flow out of it;
• chest pain;
• pallor or bluish tint skin;
• swelling of the face, around the eyes, or other swelling;
• shortness of breath, fatigue, refusal to play;
• dizziness, loss of consciousness.

1. You will have to take a urine test every ten days for the first month. And for the next six months, 2 times a month.
2. An electrocardiogram, phonoradiogram, and echocardiography will need to be done once every three months for the first six months. Thereafter twice a year.
3. After some time, it is advisable to go with the child to a special sanatorium for 1-3 months.
4. Vaccinations will have to be postponed for six months.
5. In total, the child will remain registered with cardiologists for 5 years.

Nutrition

Older children eat according to their age. The menu should include:

1. Fresh fruits and juices.
2. Fresh and cooked vegetables.
3. Dishes made from meat, boiled, baked or stewed.
4. Dairy products: milk, cottage cheese, yogurt, sour cream. It will be especially useful cottage cheese casserole with dried fruits.
5. Boiled eggs or as an omelet.
6. Various soups and cereal dishes.

• margarine;
• fatty pork;
• duck and goose meat;
• chocolate, strong tea.

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, valve apparatus heart, aorta and movement of significant vessels. Heart defects with acquired etiology typically develop against the background of rheumatic carditis, atherosclerosis, and sometimes after traumas suffered 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 genetic pathology are born with 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 those in TBX 5 are detected in many patients diagnosed with Holt-Oram syndrome, which is an autosomal disease with septal defects. The cause of the development of supravalvular aortic stenosis is mutations occurring in the elastin gene, but changes in NKX lead to the development of cardiac defect.

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 aortic valve damage is influenced by rheumatism. It can also contribute to the formation of various combinations of insufficient functioning of some valves and stenosis. The formation of heart defects acquired throughout life can be caused by sepsis, an infectious nature, trauma, and in some cases – Libman-Sachs endocarditis, rheumatoid, causing visceral lesions, etc.

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 heart valves or its structures, which become the causes characteristic violations, 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 diseases and specific. 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 defects are differentiated by color types skin. When the skin color is cyanotic, blue defects are considered, and white defects are characterized by a pale tint. For heart defects white deoxygenated 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.

The symptoms of general manifestations include the appearance of signs 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 the subjective assessment of congenital heart defects, a slight intensity is noted symptomatic manifestations, 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 in the form of diastolic cat purring, delayed pulse in the artery of the left arm as a result of compression of the subclavian artery on the left, acrocyanosis, in the form of a cardiac hump, cyanosis in the area of ​​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 deterioration and weakness in the body.

With absolute decompensation of the heart defect, patients develop edema in some parts of the body and pulmonary edema. For a first-degree stenotic defect affecting the mitral valve, when performing physical activity, shortness of breath with a sensation of heartbeat and a dry cough is characteristic. Valve deformation is observed on both the aortic and tricuspid valves. With aortic damage, a systolic murmur is detected in the form of purring, palpation of a weak pulse with the presence of a cardiac 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 in this case the pulse is very intense, the size of the pupil changes in diastole and systole, and Quincke's pulse of capillary origin is also 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 over at a young age, as well as among children with heart defects of congenital etiology or early acquired, the formation of a cardiac hump is noted 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, it is discovered that it is caused by a defect in the septum 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 have 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 in the prenatal period, which can be detected using ultrasound of the heart, and in the early stages of 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 are 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 experiences 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. Many factors play a role in the choice of therapeutic treatment method. This includes the nature of the disease, the age of the child and his condition. It is also important to take into account that heart disease in children can go away on its own after reaching fifteen or sixteen years of age. 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.

Surgery in the presence of mitral insufficiency is prescribed in cases of complications or deterioration in the child’s well-being. The operation is performed to replace the valve with an artificial one. To carry out therapeutic therapy for heart disease, appropriate protein diet with restriction of water and salt, various general hygienic measures, as well as constant exercise physical therapy. 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 disease may be based on certain genetic causes, and the environment can greatly influence its formation, especially in the first trimester of pregnancy.

In addition, if the expectant mother used certain medications, narcotic drugs, alcohol, smoked or suffered from certain viral or bacterial etiology, then there is a huge 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 type 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. A characteristic blueness is visible on the lips, which is why the medical term “blue baby” exists. 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 parts of the heart.

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 at different levels of 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. 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 that lines the inner part hearts. 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 method prenatal diagnostics. 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 congenital heart disease. 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 high or moderate degree hemodynamic disturbances 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 prescribed with a cardiologist, who conducts an examination using palpation, percussion, and auscultation, which makes it possible to listen to a clearer heart rhythm and the 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 maintain a correct lifestyle with a balanced diet and daily routine, and regularly carry out the prevention of endocarditis, heart rhythm disturbances and poor circulatory function, since in this category of patients there are prerequisites for the formation of defects. In addition, timely treatment infectious diseases with the prevention of rheumatism and endocarditis of bacterial etiology will be able to prevent the development of acquired heart defects.

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

IN therapeutic methods Treatment includes 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 aortic stenosis and aortic insufficiency. 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 represent increased fatigue, which is associated with the 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 asthma cardiac type 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 in all parts of the heart, on 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 and shortness of breath appear due to physical exertion. 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; ; 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. Recommendations bed rest and the appointment of conservative methods of therapy temporarily improve general state 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 extreme in serious condition, therefore, 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 of 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 common reasons The formation of this pathology is the 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. At 15% etiological factor rheumatism and atherosclerosis appear, 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 of 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, in almost half of patients diagnosed with aortic insufficiency, the causes of which are atherosclerosis or angina, the main symptom of the disease is angina.

Attacks of difficulty breathing develop initially 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 in left side and down. Above the vessels large building Traube's tone of a double character is noted, and when pressing on the area iliac artery 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 sharp increase capillary pressure develops cardiac asthma, dry cough, and sometimes with sputum and even hemoptysis.

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

During visual inspection with mitral heart disease, there is a strong protrusion of the sternum lower section and pulsation as a result of the formation of a hump of the heart, which is a consequence of increased impacts of the RV 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 modern world, 61% of this disease is due to degenerative mitral regurgitation and only 14% is rheumatic pathology. Other reasons for the development of this heart defect include systemic scleroderma, 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, painful sensations in the hypochondrium on the right side, cardiac asthma and even shortness of breath in an absolute state.

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 compensation stage, without indications for surgical methods treatment. 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 interventions are still possible. The fifth stage is terminal, in which surgical treatment is no longer performed.

To prognostic 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 medicinal 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 impairment heart, which also allows you to endure physical activity. Anticoagulants are used for the development of fibrillation and atrial flutter.

In case of decompensation of heart disease, such as mitral valve disease, use digitalis preparations; 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, 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, resection is performed and a certain section of the aorta is replaced using a synthetic Dacron prosthesis.

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

There is also modern method surgical treatment heart disease, which was developed and widely used in Israel. This is a rotablater method, which is characterized by the use of a small drill to restore the lumen of blood vessels. Very often, heart defects are accompanied by rhythm disturbances, i.e. blockades are formed. Thus, an operation involving valve replacement 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 therapeutic rehabilitation therapy with the prevention of thrombosis, improvement of myocardial nutrition and treatment of atherosclerosis.

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

Today, 8-12 babies out of every thousand newborns have congenital heart pathologies, including defects. Modern medicine has in its arsenal, including, surgical treatment methods of this disease. Depending on the severity of the congenital cardiac pathology, surgeons perform the required type of surgery on an emergency or planned basis.

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

The main 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 big circle blood 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.
• 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 threatens the normal functioning 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.
• The connection of the aorta and pulmonary artery into the common arterial trunk.

In some cases, such a diagnosis can be made in utero. In this case, the pregnant woman is examined by both gynecologists and cardiologists. The woman is explained the severity of the pathology existing in the baby.

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. During 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.

Therefore, the patient must be connected to special apparatus artificial blood circulation. 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 surgical intervention 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

The timing of operations for congenital heart defects depends on the severity of the pathology.

Based on the timing of operations, VPS are divided into three types:

1. Emergency – when surgical intervention is necessary immediately after diagnosis, since delay threatens the patient’s life.
2. Urgent – these are operations that need to be done, but there is time so that both the child and the parents can be calmly prepared for the operation. Emergency operations allow doctors to collect all the necessary information about the patient by performing the necessary tests.
3. Planned surgical treatment of congenital heart defects is performed at a time chosen by both doctors and parents, that is, according to plan. Such operations are permissible in cases where the condition of congenital cardiac pathology does not directly threaten the life of the child. But the operation must be performed so that the condition does not worsen.

Two main types of surgical approach to operations

It should be understood that a competent cardiac surgeon will not suggest surgery if it is possible to avoid it.

Really necessary operations for congenital cardiac pathologies, depending on the surgical approach, are divided into:

• Radical.
• Palliative.

Palliative surgical interventions require auxiliary actions. They are called upon:

• Improve or normalize the blood circulation of the child’s body.
• Prepare the vascular bed for radical surgery.
• Improve the general condition of the patient.

If necessary, not one, but two palliative operations can be performed.

Heart defects in children are a problem that is often raised in the media. Many children are born with this pathology, and parents are faced with a difficult choice - to decide on a risky operation or to live in fear that the little heart may stop at any minute. What are the consequences of refusing surgery, and what does heart surgery involve?

Clinical picture of the pathology

A defect is a functional disorder of the heart associated with pathologies of the valve apparatus, septum, walls of the heart muscle or large vessels. As a result of any defect in the listed areas, normal blood circulation is disrupted: it can slow down, change direction, or venous and arterial blood is mixed, etc.

In children

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

By the way! Modern types of diagnostics make it possible to detect suspicions of heart defects 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, 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 the newborn’s life.

In adults

Man with healthy heart can also get a defect as a complication after certain diseases: sore throat, influenza, rubella, atherosclerosis, syphilis, gonorrhea, etc. Heart disease in adults manifests itself almost in the same way as in children: the heart periodically begins to “suddenly”, shortness of breath, increased heart rate, anxiety, pathological pallor of the face, and 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. Not all types of pathology are absolute indications for surgical intervention, but only some conditions:

• severe symptoms of aortic valve stenosis;
• patent ductus arteriosus;
• non-closure of the interatrial septum;
• inadequate oxygen supply 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.

That's not all possible types 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 such as bronchitis and pneumonia;
• pulmonary edema;
• hypoxia;
• thromboembolism;
• insufficient blood supply to the brain and, as a result, the risk of developing tumors, decreased mental development.

Even if a person leads an exceptionally healthy lifestyle, heart disease 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 congenital heart disease cannot run and play like 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 the child to develop normally with early years(months) and prevention of heart pathologies in the future. Surgery is also often the only solution for acquired disease. Regardless of the patient’s age, there are three types of operations.

Open

Such interventions involve opening the chest to gain access to the heart. The operation is performed under general anesthesia and using a heart-lung machine, which allows you to temporarily stop the heart for ease of operation.

The open method is used, for example, to eliminate a septal defect. This is an opening in the muscle that allows venous blood to mix with arterial blood. 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 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 for which it is possible to carry out closed operation, is stenosis (narrowing) of the left atrioventricular orifice. The doctor makes a puncture in the sternum, enters the heart cavity through the left atrium and uses special instruments to expand the mitral valve. 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 is especially acute in 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.