The minimum threshold of the heart in a child is 3 years. Causes and treatment of heart disease in children. Heart disease in newborns - causes

- a group of diseases united by the presence of anatomical defects of the heart, its valvular apparatus or blood vessels that arose in the prenatal period, leading to a change in intracardiac and systemic hemodynamics. Manifestations birth defect hearts depend on its kind; the most characteristic symptoms include pallor or cyanosis of the skin, heart murmurs, lag in physical development, signs of respiratory and heart failure. If congenital heart disease is suspected, an ECG, FCG, radiography, echocardiography, cardiac catheterization and aortography, cardiography, cardiac MRI, etc. are performed. Most often, with congenital heart defects, they resort to cardiac surgery - surgical correction of the identified anomaly.

General information

Congenital heart defects are a very extensive and heterogeneous group of diseases of the heart and large vessels, accompanied by changes in blood flow, congestion and heart failure. The incidence of congenital heart defects is high and, according to various authors, ranges from 0.8 to 1.2% among all newborns. Congenital heart defects account for 10-30% of all congenital anomalies. The group of congenital heart defects includes both relatively mild disorders of the development of the heart and blood vessels, as well as severe forms of heart pathology that are incompatible with life.

Many types of congenital heart defects occur not only in isolation, but also in various combinations with each other, which significantly complicates the structure of the defect. In about a third of cases, cardiac anomalies are combined with extracardiac congenital malformations of the central nervous system, musculoskeletal system, gastrointestinal tract, genitourinary system, etc.

The most common types of congenital heart defects encountered in cardiology include ventricular septal defects (VSD - 20%), atrial septal defects (ASD), aortic stenosis, coarctation of the aorta, patent ductus arteriosus (PDA), transposition of large main vessels (TCS) , pulmonary stenosis (10-15% each).

Causes of congenital heart defects

The etiology of congenital heart defects may be due to chromosomal abnormalities (5%), gene mutation (2-3%), the influence of environmental factors (1-2%), polygenic multifactorial predisposition (90%).

Various kinds of chromosomal aberrations lead to quantitative and structural changes in chromosomes. With chromosomal rearrangements, multiple multisystem developmental anomalies are noted, including congenital heart defects. In the case of trisomy of autosomes, the most common heart defects are defects in the interatrial or interventricular septa, as well as their combination; with anomalies of the sex chromosomes, congenital heart defects are less common and are represented mainly by aortic coarctation or ventricular septal defect.

Congenital heart defects caused by mutations of single genes are also in most cases combined with anomalies of other internal organs. In these cases, heart defects are part of autosomal dominant (Marfan, Holt-Oram, Cruson, Noonan, etc.), autosomal recessive syndromes (Kartagener, Carpenter, Roberts, Gurler, etc.) or X-linked syndromes. chromosome (syndromes of Goltz, Aase, Gunther, etc.).

Among the damaging environmental factors, the development of congenital heart defects is caused by viral diseases of a pregnant woman, ionizing radiation, certain drugs, maternal addictions, and occupational hazards. The critical period of adverse effects on the fetus is the first 3 months of pregnancy, when fetal organogenesis occurs.

Intrauterine damage to the fetus by the rubella virus most often causes a triad of anomalies - glaucoma or cataracts, deafness, congenital heart defects (Fallot's tetrad, transposition of the great vessels, open ductus arteriosus, common arterial trunk, valvular defects, pulmonary artery stenosis, VSD, etc.). Microcephaly, a disorder in the development of the bones of the skull and skeleton, and a lag in mental and physical development are also common.

In addition to pregnant rubella, the danger to the fetus in terms of the development of congenital heart defects is chickenpox, herpes simplex, adenovirus infections, serum hepatitis, cytomegaly, mycoplasmosis, toxoplasmosis, listeriosis, syphilis, tuberculosis, etc.

Complications of congenital heart defects can be bacterial endocarditis, polycythemia, peripheral vascular thrombosis and cerebral thromboembolism, congestive pneumonia, syncope, dyspnoea-cyanotic attacks, angina pectoris or myocardial infarction.

Diagnosis of congenital heart defects

Identification of congenital heart defects is carried out through a comprehensive examination. When examining a child, the color of the skin is noted: the presence or absence of cyanosis, its nature (peripheral, generalized). Auscultation of the heart often reveals a change (weakening, amplification or splitting) of heart tones, the presence of murmurs, etc. Physical examination for suspected congenital heart disease is supplemented by instrumental diagnostics - electrocardiography (ECG), phonocardiography (FCG), chest x-ray, echocardiography ( echocardiography).

ECG reveals hypertrophy of various parts of the heart, pathological deviation of the EOS, the presence of arrhythmias and conduction disturbances, which, together with data from other methods of clinical examination, makes it possible to judge the severity of congenital heart disease. With the help of 24-hour Holter ECG monitoring, latent rhythm and conduction disturbances are detected. By means of FCG, the nature, duration and localization of cardiac tones and murmurs are more carefully and in detail assessed. X-ray data of organs chest complement the previous methods by assessing the state of the pulmonary circulation, location, shape and size of the heart, changes in other organs (lungs, pleura, spine). During EchoCG, anatomical defects of the septa and valves of the heart, the location of the main vessels are visualized, and the contractility of the myocardium is assessed.

With complex congenital heart defects, as well as concomitant pulmonary hypertension, for the purpose of accurate anatomical and hemodynamic diagnosis, it becomes necessary to perform probing of the heart cavities and angiocardiography.

Treatment of congenital heart defects

Most difficult problem in pediatric cardiology is the surgical treatment of congenital heart defects in children of the first year of life. Most operations in early childhood performed for cyanotic congenital heart defects. In the absence of signs of heart failure in the newborn, moderate cyanosis, the operation may be postponed. Children with congenital heart defects are monitored by a cardiologist and a cardiac surgeon.

Specific treatment in each case depends on the type and severity of congenital heart disease. Operations for congenital heart septal defects (VSD, ASD) may include septal plasty or suturing, X-ray endovascular defect occlusion. In the presence of severe hypoxemia in children with congenital heart defects, the first stage is palliative intervention, which involves the imposition of various kinds of intersystem anastomoses. Such a tactic improves blood oxygenation, reduces the risk of complications, and allows for a radical correction in more favorable conditions. With aortic defects, resection or balloon dilatation of aortic coarctation, aortic stenosis plasty, etc. is performed. When PDA is performed, it is ligated. Treatment of pulmonary stenosis is to perform open or endovascular valvuloplasty, etc.

Anatomically complex congenital heart defects, in which radical surgery is not possible, require hemodynamic correction, i.e. separation of arterial and venous blood flows without eliminating the anatomical defect. In these cases, Fontan, Senning, Mustard and other operations can be performed. Serious defects that are not amenable to surgical treatment require a heart transplant.

Conservative treatment of congenital heart defects may include symptomatic treatment of dyspnea-cyanotic attacks, acute left ventricular failure (cardiac asthma, pulmonary edema), chronic heart failure, myocardial ischemia, arrhythmias.

Prediction and prevention of congenital heart defects

In the structure of neonatal mortality, congenital heart defects occupy the first place. Without the provision of qualified cardiac surgery during the first year of life, 50-75% of children die. In the compensation period (2-3 years), mortality decreases to 5%. Early detection and correction of congenital heart disease can significantly improve the prognosis.

Prevention of congenital heart defects requires careful planning of pregnancy, exclusion of the impact of adverse factors on the fetus, medical genetic counseling and explanatory work among women at risk for the birth of children with heart disease, addressing the issue of prenatal diagnosis of the defect (ultrasound, chorionic biopsy, amniocentesis) and indications for abortion. Pregnancy management in women with congenital heart defects requires increased attention from the obstetrician-gynecologist and cardiologist.

If your baby has been diagnosed with such a diagnosis - "heart disease in a child", do not fall into despair. Heart defects are treated. Today we will talk about some of the features of caring for babies with heart defects.

How to identify a child's heart disease? Recall how the heart works. It has four chambers - two ventricles and two atria, divided by a longitudinal septum into two non-communicating chambers. Arteries carry oxygenated blood from the heart to all parts of the body. The veins carry the oxygenated blood from the organs back to the heart.

Congenital heart defects are varied. The most common defects of the interatrial and interventricular septum - a hole appears in it and part of the arterial blood from the left half of the heart enters the right - venous. This leads to malfunctions in the circulatory system. Less blood is supplied to the systemic circulation than it should be - the supply of oxygen to the body is deteriorating. The more arterial blood enters the pulmonary circulation, the more severe the disease.

In children aged 5 to 12 years, doctors detect stenosis - a narrowing of the opening of the pulmonary artery, because of which the blood flow from the right ventricle to the pulmonary circulation is disturbed. Children with mild stenosis grow and develop normally. With a severe stage of stenosis, shortness of breath, tachycardia, pain in the heart appear in babies. The defect is treated surgically.

The next type of defect is narrowing of the aorta. In this case, children grow up without painful manifestations. But at the age of 4 to 10 years, with physical exertion, children may experience dizziness, headaches, nosebleeds, pain in the legs. Another symptom is constantly cold feet. The diagnosis is based on measuring the pulse and blood pressure in the arms and legs. With coarctation, the measurement results are not the same. Surgical treatment.

The most complex heart disease is Fallot's tetralogy. Cyanosis of the skin and shortness of breath appear in the child in the first months of life. In a severe form of the disease, children experience anxiety, convulsions, and a short-term loss of consciousness. Even with a slight physical exertion, for example, when walking, climbing stairs, the baby suddenly squats and even lies on his side, legs tucked to his chest. Babies with Fallot's tetrad require surgery.

Heart disease symptoms

How to identify a child's heart disease? What should parents be concerned about? Pain in the region of the heart in a child. They can occur with circulatory disorders in the heart muscle, with inflammation of the pericardium, but may not be associated with heart defects.

For example, in diseases of the lungs, neuralgia, inflammation of the muscles and diseases of the spine.

How do these pains manifest themselves? Trite - when walking or running fast, the baby complains that he has a "prick in his side." Parents often brush aside such complaints: “If you grow up, it will pass.” Any pain in the chest is a reason to show the child to the doctor. In newborns, heart disease is indicated by bouts of unreasonable anxiety, accompanied by poor appetite, lethargy, and pallor. Children also gain weight poorly, they develop cyanosis of the skin - especially around the mouth, in the area of \u200b\u200bheels and nails.

Heart hump - a bulge in the region of the heart, which can appear as early as 3-4 months. Parents should know the heart rate of children. At the age of up to a year, it is 125-130 beats per minute, at the age of 5-7 years - 90-100, at 8-10 years old - 80-85, at 11-14 years old - 70-85 beats per minute.

Monitor your baby's heartbeat and breathing. Rapid heartbeat occurs when high temperature, physical activity, in the heat, from excitement. But persistent palpitations are a sign cardiovascular disease. Problems can also be indicated by a slowing of the heartbeat - bradycardia. It can also be observed in children who are actively involved in sports.

There are rules for breathing. In the first year of life, the baby takes 30-40 breaths per minute, later this number decreases, at 5 years the number is 25 breaths. At 7-8 years old, the child takes 18-22 breaths, at 10-14 years old - 16-18 breaths. Increased respiration and cyanosis of the skin are observed with Fallot's tetrads.

Causes and treatment

Parents are surprised: Why are babies born with heart defects? No one in our family had a heart defect." Indeed, heredity in this case does not play a big role.

In women who suffer from heart disease, only 5% of children are born with the same disease. Also, children can have acquired heart defects.

The cause of pathology can be various negative influences on the body of a woman in the period from the third to the eighth week of pregnancy - it is at this time that the baby's heart is formed. It can be transferred influenza, rubella, herpes. Diabetes, neoplasms, work in hazardous industries, smoking also affect. Alcoholism is very dangerous - in 30% of cases children are born with heart disease.

Most often, the heart disease is based on a mutation or breakdown of the gene, chromosomal abnormalities. Diagnosis of congenital heart defects should be carried out in the maternity hospital - at the birth of a child. In 10-15% of cases, the opening in the interventricular septum closes spontaneously. Ventricular septal defect is treated with medication, the prognosis is favorable. Now children with heart defects are operated on in the first year of life, this allows them to save their lives and avoid serious changes in the heart and lungs.

A baby with a heart defect should be constantly under the supervision of a cardiologist. Most children who have undergone heart surgery are practically healthy, graduate from universities, create families and forget that they were sick.

In everyday life

How to ensure appropriate care for a child with heart disease? It is important to organize a sparing daily routine. Protect your baby from stress, long trips, do not load circles and sections.

Do not exclude physical education - good walks on fresh air, walking, games, light gymnastics. Watch your diet - offer your baby fresh vegetables and fruits. Strengthen the immunity of the crumbs, protect against colds. Showing soft hardening air baths rubbing with cool water. Develop a calm attitude towards doctors.

In no case:

do not arrange bed rest for the child, unless the doctor has given instructions;
do not give any medication without a prescription, even if it is vitamins or food supplements;
do not do inhalations, hot foot baths, mustard plasters, plentiful hot drinks are dangerous.

Heart disease in children is a pathology that occurs during fetal development, that is, it is congenital, it consists in a violation of the structure of the valve apparatus, the anatomical features of the heart muscle itself and its vessels. Acquired defects in childhood are almost never found.

Congenital heart diseases occur in approximately 8 newborns per 1000 and are the first cause of death before the first year of life. If the child lives up to a year, then the prognosis becomes more favorable: at the age of up to 15 years, the number of deaths as a result of a defect is only 5% of the total number of sick children. In any case, the numbers are such that it becomes clear why such a disease is considered a serious problem that requires urgent action.

Reasons for the development of defects in children

Most often, heart defects in children develop as a result of hereditary predisposition. But their development directly depends on some factors that can damage the baby in the first trimester of its intrauterine development, since the formation of the defect occurs at 2-8 weeks:

viral diseases of the mother (rubella);
use of certain medicines during pregnancy;
alcoholism and drug addiction of parents;
constant intoxication in hazardous production;
radioactive radiation.

A high risk factor for this pathology in children whose parents have endocrine diseases, the age of the mother over 35 years, severe toxicosis during gestation, the presence of stillborns in history, there are relatives who have children with heart defects. But it is not yet possible to identify reliably all the causes of defects. The health of the father also plays a significant role in the likelihood of developing heart disease The child has.

What are the vices

Heart defects in newborns can be different. In total, there are about 100 different pathologies. The following can be distinguished by frequency:

Ventricular septal defect (about 20%).
Atrial septal defect.
Open aortic duct.
Coarctation of the aorta.
Aortic stenosis.
Stenosis of the pulmonary artery.
Transposition of the great great vessels.

Clinicians divide the defects into varieties in which the skin of the child becomes cyanotic (blue defects) and turns pale (white defects).

Diseases can have different manifestations, each defect has its own symptoms. According to statistics, about 30% of children with such a diagnosis worsen from the first days of their lives. Parents should definitely pay attention if it is found that the baby:

The skin color changes, the distal parts of the limbs (fingers and toes), the nasolabial triangle, and the face require special attention.
Noticeable swelling in the region of the heart.
There are noticeable swelling.
When crying or straining, pallor or cyanosis appears with the simultaneous occurrence of cold sweat.
Poor suckling, slow development and weight gain.
Paroxysmal or persistent shortness of breath.
Heart rhythm disturbances.

This is how heart defects can manifest themselves in newborns. It is also necessary to pay attention if an older child complains of shortness of breath during physical exertion, palpitations that are not associated with emotional or physical overload, the occurrence of pain in the heart.

All these signs may indicate the presence of a pathology of the heart muscle and require immediate examination and treatment by a pediatrician and a cardiologist.

Timely diagnosis

It should be noted that many defects, if they are not too pronounced, can occur without any symptoms. But with a routine examination and auscultation of the heart, the doctor may pay attention to some features that are characteristic of this condition. In the heart, murmurs of varying intensity may be heard, which require differentiation. It is necessary to distinguish between organic, indicating the development of pathology, and functional, which do not require treatment and pass on their own.

Additional research methods in the form of an ECG, chest x-ray, Holter monitoring, ultrasound of the heart can reliably determine the presence or absence of heart disease in a child.

Necessary treatment

Heart defects in children vary in severity. And depending on this, the doctor prescribes treatment.

More than 50% of children with such a pathology may die without the use of urgent surgical intervention. Therefore, the only way out can be only an operation, which cannot be abandoned in any case. In the absence of immediate indications for a surgical solution to the problem, the cardiologist prescribes certain drugs that must be taken, strictly following the recommendations for time and dosage.

For example, diuretics, cardiac glycosides (digoxin), antiarrhythmics, etc. It does not make sense to give any recommendations on taking drugs, as well as on all drug treatment, since these pathologies are very serious, therefore it is not recommended to self-medicate.

Nevertheless, treatment for any should be to provide a regimen with the maximum stay of the child in the fresh air and exercise within the minimum load on the heart. Feeding of such children should be somewhat reduced in volume, but increased in frequency of food intake (for infants by 2-3 times), preference should be given to mother's milk.

Children who have been diagnosed with such a diagnosis as congenital heart disease should be registered with a cardiologist and pediatrician. In the first year of life, it is obligatory to examine the baby at least once every 3 months, as well as to conduct additional examinations every six months, and if necessary, more often. Severe course disease requires a monthly examination, and a sharp deterioration in the condition is a direct indication of hospitalization.

Parents play a big role in the treatment of such a child. They should closely monitor changes and symptoms and report the slightest deterioration to the attending physician. The presence of signs of respiratory or heart failure in a child serves as a reason for releasing him from lessons and physical education in children's preschool institutions and school. The cardiologist determines such a need. In the absence of such symptoms, sick children are shown therapeutic exercises, which are carried out in the clinic.

Children with heart defects should not be exposed to the sun for long periods of time. summer time and in severe frost in winter, since they have a high weather sensitivity, such a pastime can greatly worsen their condition.

There is no diet for such children, but nutrition must be varied and fortified. It is useful to use dried apricots, prunes, raisins, baked potatoes.

Susceptibility to infectious diseases in babies with congenital malformations requires careful sanitation of any focus of chronic infection. If an acute viral or infectious pathology appears, then the intensity of treatment should be maximum to prevent the development of complications from the heart. Bed rest compared to other children is extended by 2-3 days.

Even in the presence of a compensated defect, the salt regime should be limited. It is also necessary to protect the patient from drinking excessive amounts of fluid (the maximum daily volume is not more than 1.5 liters).

The environment in which the baby grows should be joyful and positive.

Constant prohibitions and a strict attitude can aggravate the condition and cause depression. You should only limit your mobility a little, especially when playing with older children, and avoid overexcitation. Nevertheless, it is necessary to show excessive guardianship or pity as little as possible. Such a child should not feel worse in something than other children.

The appearance of a baby in the family is always happiness. But the joy of parents fades sharply when they hear such a diagnosis as heart disease. Unfortunately, in recent years, heart defects in children are quite common. This disease is associated with impaired development of the heart and large vessels in babies, which leads to changes in blood flow, overload and myocardial insufficiency. Heart disease in children is congenital. According to statistics, from 5 to 8 children out of a thousand have this cardiovascular disease. All types of congenital pathologies are diverse in their anatomical features and severity of the course. Many of them are found in various combinations. With forms incompatible with life, children do not live up to a year. After the first year of life, mortality decreases, and in the period from 1 to 15 years, about 5% of sick children die from heart defects. As you can see, the disease is very serious, requiring a special approach and comprehensive treatment.

Heart disease symptoms

Some types of birth defects are diagnosed and successfully treated in the early stages, and some are asymptomatic for months or even years. After three years, the following deviations can be noticed in sick children:

poor appetite
liver enlargement
rapid breathing
frequent colds
cardiac arrhythmia
difficulty with physical activity

Older children may also complain of pain in the chest or under the shoulder blade, dizziness and headaches. Symptoms of heart disease in newborns may vary depending on specific anomalies, but common to all are heart failure, as well as insufficient intake nutrients and oxygen to tissues and organs.

According to the features of the discharge of blood, congenital heart defects are blue and white. As a rule, a decrease in the concentration of oxygen in the arterial blood manifests itself with the birth of a baby. Due to metabolic disorders, toxic metabolic products accumulate in the blood. The basis of this phenomenon is the mixing of arterial and venous blood inside the heart. These are blue defects, in which the child has cyanosis of the skin, auricles, lips, as well as rapid breathing.

White defects are characterized by discharge of venous blood from left to right. With white defects in babies, blanching of the skin and cold extremities are observed. Having a defect in the form of a heart disease, the child quickly gets tired during feeding, sucks badly at the breast. The pediatrician may hear heart murmurs and note slow weight gain. However, heart murmurs may not always mean the presence of a disease. Therefore, if a heart disease is suspected in newborns, a consultation with a cardiologist is necessary.

To date, it is not possible to determine the cause of congenital heart defects in children. This vital organ is laid down and formed from the 2nd to the 8th week of pregnancy, that is, during the period when a woman often does not yet know about motherhood. Therefore, it is very important at this time to avoid the influence of harmful factors that can lead to the development of defects. The most important among them are the following:

maternal bad habits (smoking, drug use)
the influence of some medicines(antibiotics, hormonal pills)
heredity
gene and chromosomal mutations
chronic diseases in women diabetes, endocrine diseases)
infectious diseases that a woman suffered during pregnancy (rubella, herpes, flu)
excessive exposure, radiation
harmful working conditions
woman's age (over 35)

Remember, the earlier heart defects in newborns are detected, the greater the hope for its timely and successful treatment.

Treatment of heart disease

Congenital heart defects in children are treatable in 90% of cases. Today, thanks to modern medicine, this disease is successfully cured. Like any other disease, heart disease is treated more easily if it has been detected on early stage. Therefore, as soon as you notice unusual changes in the behavior and condition of the baby, contact a specialist. An additional examination will be scheduled if the doctor confirms that the symptoms present may be signs of heart disease. Heart disease can be diagnosed from birth in the first 3 months of a child's life using the following methods:

1) electrocardiography - this ultrasound method helps to determine how the heart works, its structure, and also checks the function of the valves,

2) cardiac catheterization - this method allows you to determine any defects, their size, location and severity,

3) echocardiography is a very accurate diagnostic method that allows you to assess the structural features and contractility of the myocardium.

Congenital heart disease in children can be diagnosed even in utero. As a rule, this can be done starting from the 14th week of pregnancy, when the woman undergoes an ultrasound. At the slightest suspicion of a heart disease in the fetus, and also if a woman is at risk, she is sent to a specialized institution. If a congenital heart disease is found in the fetus, then the birth will take place under the supervision of specialists, in a specialized hospital, where the child will subsequently be operated on.

Children with mild heart disease need observation by a cardiologist and regular check-ups. Over time, their heart can grow on its own. With heart disease in a newborn, it is necessary to be in the fresh air more often, to protect it from infections and stress. Treatment of heart disease depends on the degree of its complexity. Severe defects require surgical intervention in the first days of the baby's life. Sometimes operations are carried out in several stages: initially, the child's condition is relieved, and then they are already prepared for the operation to completely eliminate the defects.

Heart disease surgery can be open or closed. During a closed operation, the heart is not affected, and the operation is performed on large blood vessels Around him. In open surgery, the cavity of the heart is opened. At the time of the operation, the heart and lungs are switched off from the circulation. And the blood is enriched with oxygen and pumped throughout the body with the help of a heart-lung machine. After surgery, children need high-calorie nutrition and intensive care.

If your child has a heart defect, do not panic - modern medical technologies allow you to treat all types of defects and give positive results.

Heart disease is a congenital or acquired anomaly of the structures of cardio-vascular system, which leads to the development of disorders of the systemic (throughout the body) blood flow. Most often, this pathology is congenital and is diagnosed in utero or immediately after the birth of a child, less often at an older age. The main signs are cyanosis or pallor of the skin, shortness of breath, swelling, lag in physical development. Timely treatment of heart disease in children in most cases allows not only to avoid disability and provide high quality life, but also to save life.

Congenital heart disease is usually diagnosed in the first few days of a newborn's life. However, there are times when it goes unnoticed and comes to light only years later. Acquired defects are now relatively rare. This is due to the widespread use of antibacterial agents and effective treatment streptococcal infection.

Types of anomalies

Children are diagnosed with a wide range of different heart defects. It is very important to determine exactly what kind of anomaly the patient has, because the prognosis and the effectiveness of treatment in the future depend on it. There are the following main types.

Pale defects. These are defects of the interventricular or interatrial septum, which are characterized by an increase in blood flow in the lungs with the development of pulmonary pathology and global circulatory disorders.
Blue vices. They are characterized by reduced blood oxygen saturation, which leads to hypoxia, cyanosis of the skin.
Narrowing of the lumen of the main vessels. Pathology that creates an obstacle to the exit of blood from the ventricles.

Congenital

The following congenital anomalies are most often diagnosed.

Ventricular septal defect. It is the most common congenital heart defect in newborns. At the "window" small size expectant management is often recommended, as nearly half of children with this pathology spontaneously close the defect within the first year of life. If there is a large hole, surgery is recommended.
Atrial septal defect. It is an opening in the wall between the right and left atria. This defect does not close on its own, therefore, an operation is required.
Atresia (absence) of the pulmonary artery. With such an anomaly, blood from the right ventricle cannot flow into the pulmonary vessels. Pathology leads to a lack of saturation of red blood cells with oxygen in the lungs. This type of defect within a few days leads to the death of the child, and therefore requires urgent surgical intervention.
Pulmonary valve stenosis. Associated with an anomaly of the valve leaflets at the outlet of the right ventricle. In this case, the valve does not open enough, which leads to an overload of the heart muscle. In the absence of surgery, the child may die within the first three to four weeks of life.
Tetralogy of Fallot. This is one of the most severe and complex heart defects. It is characterized by the presence of four different anomalies diagnosed simultaneously. This "window" between the ventricles, narrowing of the pulmonary artery, the wrong position of the aorta and hypertrophy of the muscles of the right ventricle. Development baby with such a heart disease, it is slow, there is a slow, unexpressed cyanosis.
Transposition of the vessels of the heart. A very serious and life-threatening defect, when the ventricles are “mixed up”, from which large vessels emerge. As a result, oxygen does not reach the tissues at all, which leads to death without medical intervention.

Acquired

Of the acquired defects, the most common are:

insufficiency of the bicuspid valve;
mitral stenosis;
aortic stenosis;
aortic valve defect.

The clinic of acquired defects is combined with symptoms of rheumatism. As in the case of congenital anomalies, the lack of timely treatment leads to an increase in blood pressure in the lungs or the development of heart failure.

Why develops

In the first months of its intrauterine existence, the child goes through a number of stages in the development of organs and systems. Violation of any of them leads to abnormal formation of anatomical structures. It is still not known exactly why such a failure in development occurs. In 80% of cases, it is not possible to establish the etiology (cause) of a congenital heart defect.

It is believed that the following factors can cause white and blue heart defects in newborns:

genetic defects;
viral infections;
metabolic diseases and diabetes in the mother;
Availability bad habits mother (alcohol abuse);
taking medications.

Proven bad influence on the fetus of certain groups of drugs and some viruses. Pharmaceuticals that can provoke heart disease include a group of antiepileptic drugs that increase the risk of congenital anomalies by one and a half times. The role of rubella, herpes and cytomegalovirus viruses has also been proven. Infection is especially dangerous in the first trimester of pregnancy.

Acquired heart disease in a child usually develops after an acute rheumatic attack, septic complications, and less commonly, a chest injury.

What is the danger

Depending on the type of defect (pale or blue), various disturbances in the blood flow occur, as a result of which either it is not saturated with oxygen or it does not enter the organs in sufficient quantities. The presence of an anomaly in the structure of the heart leads to the development of a number of compensation mechanisms, which subsequently cause gross changes in the tissues. Significant heart defects can lead to the most unfortunate consequences - the death of a child.

Symptoms of heart disease in children

In the case of a heart defect, it is very important to identify it in a timely manner, because the prognosis for the health and life of the child largely depends on this. The main signs of heart disease in children are as follows:

respiratory disorders (frequent, with increased inhalation);
cyanosis of the skin, lips, nail plates;
the appearance of shortness of breath or cyanosis of the face during feeding;
increased heart rate;
swelling in the legs, in the abdomen;
rapid fatigue of the child, shortness of breath;
developmental delay.

Symptoms of heart disease in children can be of varying severity and manifest both immediately after birth and during different periods life. In addition, minor defects sometimes do not manifest themselves by any external signs at all or are characterized only by psychological features(psychological maladaptation, emotional instability, increased anxiety).

The presence of any symptoms indicative of heart disease should force the parents to consult the child with a cardiologist and undergo an examination. It is not necessary, on the advice of friends, to use various folk remedies. They are ineffective and will not help cure heart disease. The sooner a cardiac pathology is detected and its treatment is started, the better the prognosis.

Diagnostics

Activities aimed at identifying a congenital defect consist of three stages.

prenatal diagnosis.
Initial examination by a neonatologist, then observation by a pediatrician.
Specialized cardiac examination.

Acquired heart defects are diagnosed on the basis of physical examination data, a history of rheumatism clinic, and ultrasound results.

Prenatal

Such diagnostics allows diagnosing many heart defects even before the birth of a child. Modern ultrasound machines detect cardiac pathology in utero starting from the 16th week of a child's development. However, the optimal period is 20-22 weeks.

Even the detection of very severe anomalies does not mean that we will talk about termination of pregnancy. Rather, the newborn will need special care and appropriate treatment.

Pediatrician examination

Often the reason for conducting a specialized diagnosis of heart disease is the detection of pathological heart murmurs in a child, heard by a pediatrician during the initial examination. A heart defect is indicated by a coarse scraping noise that does not change its character with a change in body position, splitting of heart sounds.

However, it should be remembered that in 33% of newborns, heart murmurs can be heard and then disappear (up to six months of age). This is not a pathology and is associated with an adaptive mechanism aimed at adapting the newborn to new conditions of existence outside the mother's body. If, after six months, the heart murmur persists, a heart defect should be suspected.

Echocardioscopy (ultrasound method) is sufficient to clarify the cause of a heart murmur. If a pathology is detected, further additional examination is carried out in specialized centers.

Cardiology

The volume of diagnosis of heart disease in children is determined primarily by the severity of clinical symptoms and the proposed diagnosis. The following methods are the most informative.

Echocardioscopy (ultrasound of the heart). This method provides very accurate information about the size of all four chambers of the heart, the state of the valvular apparatus, and the characteristics of heart contractions. During the examination, the speed of blood flow and its direction are also determined, areas of turbulence are identified. The procedure is completely painless, however, it is necessary to calm the child and ensure his immobility.
Electrocardiography (ECG). The method allows to detect arrhythmias, conduction disturbances, changes in the electrical axis of the heart. However, this examination is less informative than ultrasound.
Holter monitoring. It consists in conducting continuous electrocardiography during the day. Using this method, explosive rhythm disturbances are diagnosed.
Radiography of the heart and lungs. Helps to determine the size of the heart and its shape, pathological changes in the lungs.
Cardiac catheterization. This is an invasive method of examination, it is performed only in large specialized centers and is used for severe heart defects. During the procedure, a catheter is inserted through a peripheral vein and advanced towards the heart. The technique helps to study the difference in pressure and the concentration of oxygen in the blood in the chambers of the heart.
Computed and magnetic resonance imaging. Modern tomographs provide the ability to obtain very clear images of the structures of the beating heart. With the help of special computer add-ons, three-dimensional images are obtained, which is necessary before surgery.

How are defects received in the womb treated?

Treatment of congenital heart defects is most often surgical. According to clinical guidelines, the urgency of the operation, indications and contraindications are determined by the existing pathology, the condition of the child, the severity of pulmonary hypertension.

Severe anomalies (pulmonary artery atresia, vascular transposition) require surgery in the first few days after birth for health reasons. In the presence of milder defects, sometimes they adhere to expectant tactics or postpone surgical treatment and carry it out after a year or more.

Currently, the following types of heart operations are performed:

radical - a complete restoration of the normal anatomy of the heart is carried out;
palliative - allow only for a while to improve the state of hemodynamics;
with separation of circulatory circles - without complete restoration of the anatomy of the heart, blood flows from the right and left ventricles are separated.

Also, technically, heart surgery can be closed and open. In the latter case, the circulation is turned off and the cavity of the heart is opened.

Small defects are operated on using intravascular surgical techniques, when a surgical incision is not even required. According to doctors, such interventions are well tolerated by children and do not require long-term rehabilitation. How to treat blue or pale heart disease in infants in this way will be prompted in a specialized cardiac surgery center.

Rehabilitation

After surgical treatment, it will take some time for the rehabilitation of the child, the duration of which depends on the complexity and method of intervention. At home, you should adhere to the following recommendations:

good nutrition and rest;
fluid restriction;
observance of half-bed mode;
taking prescribed drugs (cardiac glycosides, diuretics);
physical therapy, massage, electrophoresis.

Treatment of acquired valvular disease

The therapeutic approach depends on the severity of clinical manifestations and the presence of complications. With compensated defects, clinical examination, good nutrition, adherence to the regimen, and limitation of physical activity are recommended.

With a severe degree of defect, accompanied by heart failure, the addition of drugs (cardiac glycosides, cardioprotectors) is required. According to indications, an operation is performed.

Risks and prevention

To rule out cardiac pathology in the fetus, ultrasonography and a number of genetic tests, the results of which can indirectly determine developmental defects.

There is no specific prevention of heart defects in young children. Mothers during gestation need to give up bad habits, apply medicines only if there is strong evidence. From the point of view of psychosomatics, it is recommended to avoid stress and negative emotions. In relation to acquired defects, timely antibiotic therapy of streptococcal infection is indicated.

Thus, heart disease in a child is a rather complex pathology that requires careful attention from parents and medical personnel. Best Option is a prenatal diagnosis that allows for early dates gestation to detect developmental anomalies. In addition, any symptoms in a newborn or infant that indicate heart disease should be the basis for contacting a pediatric cardiologist and performing echocardioscopy. modern medicine in many cases, it can effectively eliminate the pathology and ensure the full development of the child.