Congenital heart defects
are anatomical defects of the heart, its vessels or valve apparatus. Congenital heart defects arise in utero, the defects caused by them can be both isolated from each other, and can be combined with each other.
With heart disease, the blood flow changes and myocardial insufficiency of the heart chambers develops. This is due to a violation of the normal development of large vessels and heart. Congenital heart disease is a fairly extensive group of diseases. This group includes relatively light forms, and those states that are incompatible with life.
There are many factors that affect the risk of congenital heart disease. These include genetic predisposition, the age of the mother, her susceptibility to viral diseases during pregnancy, and others. The greatest risk of developing severe forms of heart disease in the fetus is during the first two months of pregnancy.
Prevention of congenital heart disease is multifaceted and rather complicated. It includes both the prevention of the disease itself and the prevention of complications. The first is mainly in medical genetic counseling. To prevent an unfavorable course of the disease, as well as the development of complications, timely diagnosis of congenital heart disease, timely treatment and proper parental care for the child are necessary.
Complications of congenital heart disease include bacterial endocarditis, polycythaemia, complications from the lungs. Professional plans for a patient with congenital heart disease should be coordinated with a specialist (with a cardiologist), as well as the expected physical stress on the body.
Pregnancy in women diagnosed with congenital heart disease is in most cases associated with a risk of complications. Therefore, consultation with a specialist on all issues is strictly necessary and preferably in advance.
Diagnosis of congenital heart disease is multifaceted and complex. At the initial stage, it includes an x-ray examination of the heart and lungs of the ECG, echocardiography. Further examination is selected individually for each patient.
Congenital heart disease develops before the birth of the baby.
You can even say that long before birth, since such a heart defect is formed in the fetus in the period from the second to the eighth week of development. Congenital diseases are diseases that developed before the birth of the baby or during delivery, such diseases are not necessarily due to heredity. Symptoms of congenital malformation can be observed either immediately after the birth of the child, or congenital malformation proceeds secretly.
Congenital malformations are one of the causes of infant mortality.
This disease occurs in six to eight newborns out of a thousand and ranks first in infant mortality. Infant mortality is the mortality of newborns and children under one year. Most children born with heart disease die during the first year of life – the first month is especially dangerous. After reaching the age of one year, the death rate from heart disease is significantly reduced, and at the age of one to fifteen years approximately 5% of children die. There is evidence that congenital heart disease accounts for approximately 30% of the structure of all developmental malformations.
The causes of congenital heart disease are unknown.
This concerns the congenital malformations of the entire cardiovascular system. If a congenital heart disease is diagnosed in one family in a family, the probability of having other children with congenital heart disease increases slightly. But this figure is still small and equal to 1-5%.
Geographical area and season affect the risk of congenital heart disease.
Such judgments are, rather, assumptions than scientific evidence.Thus, cases are recorded that in a specific geographical area the number of children born with heart disease exceeds the same number in other areas. As for seasonality, there are also some regularities. Some studies have shown that an open arterial defect (Botallov defect) in a greater number of cases develops in girls who were born between October and January; In addition, in the autumn months, the appearance of boys with congenital coarctation of the aorta is less likely – this probability rises in the spring months. This kind of seasonal fluctuations in the development of congenital heart defects can be associated with viral epidemics. Influence on the development of congenital heart disease of the impact of environmental factors that have unfavorable (teratogenic) effects on the developing fetus is also possible. The science substantiates the adverse effect on the body, including on the development of congenital heart disease in the fetus, the rubella virus. The most dangerous for the fetus are viruses, whose effect falls on the first three months of pregnancy.
Viral agent – decisive in terms of development of congenital heart disease.
This is not quite true. The existing viral disease does not mean that the child will be born with heart disease. Congenital heart disease can be formed under the condition of additional factors. These include the severity of a disease that is viral or bacterial in nature; predisposition due to heredity, and other factors. However, if these factors occur, then the viral agent can become the immediate and decisive impulse to the development of congenital heart disease.
Chronic maternal alcoholism leads to the development of heart disease in the fetus.
This is the case in 29-50% of cases. The teratogenic effect of alcohol on the fetus leads to the appearance of an open arterial blemish and the development of defects of the interatrial and interventricular septa. Therefore, it can be said with certainty that chronic alcoholism (and not only chronic) has a definite (and even significant) role in the development of congenital heart disease in future kids.
Maternal diabetes is a predisposing factor to the development of heart defects in the fetus.
Science has proven that children are born with congenital heart disease more often in mothers with diabetes than in healthy mothers. As a rule, these children have a transposition of large vessels or a defect of the interventricular septum.
Taking medications during pregnancy can lead to fetal heart disease.
Of course, we are talking about not all medications, but only some. In particular, about the following.
First, it does not currently apply thalidomide during pregnancy. Admission of this drug in practice led to the appearance of not a small number of congenital malformations, among which were congenital heart defects.
Secondly, amphetamines, as well as trimethadione and hydantoin, can have a negative effect on the fetus. The last two relate to anticonvulsant drugs and can lead to fetal development of coarctation of the aorta, pulmonary artery stenosis, transposition of the main vessels and other congenital heart defects.
After the expiration of two months of pregnancy, the probability of developing a heart disease in a fetus can be ruled out.
This judgment is false. The first two months of pregnancy are the most dangerous in terms of developing congenital heart disease. It is formed at this time, the vices are heavy or combined. In the period after the eight-week gestation period, the risk of heart disease in the fetus is significantly reduced. However, such a probability still exists. The defeat of the heart in this case, as a rule, is less complex.
Congenital heart disease is genetically determined.
This is, rather, one of the risk factors for congenital heart disease.Typically, based on the type of inheritance, a polygenic multifactorial model is used, the essence of which is the following judgment: the more serious heart defect there is among the family members, the more likely the development of this disease in future children. Another regularity that can be distinguished from the polygenic multifactorial model is that the more relatives in the family have congenital heart defects, the greater the likelihood of developing a secondary heart defect in future children. However, this type of inheritance is not unique. There are also chromosomal abnormalities and gene mutations. To say the same more precisely, how great is the risk of developing congenital heart disease in a baby’s future, only a geneticist is able, based on medical genetic counseling.
There are other risk factors for congenital heart disease.
These include the existing violations of the endocrine system in the spouses and the adoption by the mother of endocrine drugs in order to maintain the pregnancy, the age of the mother, the threatened termination of pregnancy and others.
Prevention of congenital heart disease is a multi-faceted concept.
First, preventive measures aimed at directly preventing the development of congenital heart diseases can be referred to such preventive measures. Secondly, we can talk about preventing an unfavorable development of congenital heart disease for a patient, if this disease already exists. Third, prevention repents and prevents the occurrence of complications of this disease.
Preventing the development of congenital heart disease is quite complicated.
As a rule, such prevention includes medical genetic counseling. In this case, explanatory work is also carried out among those future parents who have an increased risk of developing a congenital heart disease in a future child. For example, if three family members who are in direct relationship are diagnosed with congenital heart disease, the probability of having a child with a similar disease varies from 65% to 100%. In these cases, of course, pregnancy is not recommended. In addition, it is undesirable to consider marriage between two people with congenital heart disease. Preventing the development of congenital heart disease in the fetus also includes the constant observation by specialists of those women who were exposed to the rubella virus. Preventive measures aimed at counteracting the unfavorable development of congenital heart disease include the following: timely diagnosis, the specialist’s definition of the best method for correcting a blemish in each specific situation (as a rule, this method is a surgical correction of congenital heart disease), as well as the fulfillment by the parents of all requirements specialists in the care of a child.
Providing proper care for a child in case of congenital heart disease is an important stage in preventing complications and unfavorable development of the disease.
Approximately 50% of deaths of children under one year due to congenital heart disease have occurred due to lack of competent and required care for the baby.
Detection of congenital heart disease does not mean the need for immediate special care for the child.
If there is no critical threat to the life of a sick child, optimal timing is chosen for special treatment, to which cardiosurgery also applies. They depend on several factors, in particular, on the capabilities of the cardiosurgical department to conduct operations for all who need it and the natural development of the child. It often happens that in the early stages of surgical treatment is not appropriate.
Prevention of complications of the disease depends on the complications themselves.
No matter how contradictory this may sound, it is so. One of the most dangerous complications that congenital heart disease can give is bacterial endocarditis.In principle, bacterial endocarditis can complicate any kind of blemish. To develop this complication in a child can already at preschool age. Some types of congenital malformation can provoke the development of polycythemia. Polycythemia is a disease of the blood system, which proceeds in a chronic form. This disease is characterized by an increase in the absolute number of red blood cells (erythrocytes). That’s why polycythemia is often called “blood thickening.” This complication can be manifested by the appearance of frequent headaches. With polycythemia often the development of peripheral vascular inflammation and the development of thrombosis. Quite often congenital heart disease is complicated by the development of diseases from the lungs. This can be as frequent respiratory diseases, as well as more serious complications.
When congenital heart disease should be much lower physical activity.
This opinion exists due to the fact that the heart of patients with a similar diagnosis and so subjected to increased stress and even at rest. Actually, it was this approach (reduction in physical activity) that was scientifically substantiated earlier for all children with congenital heart disease. However, it can be argued that this approach was seriously criticized and was changed. The mobility of children diagnosed with congenital heart disease should not be restricted for any special reasons – this is due to the fact that there are only a small number of congenital heart diseases in which physical activity is actually needed. Moreover, children who are older and have non-serious types of congenital heart disease can freely participate in outdoor sports games (it is not recommended to take part in sports competitions, which, as a rule, is characterized by increased nervous tension and the load itself). If the congenital defect is quite serious, then the patient’s well-being does not in itself encourage him to active physical activity. In principle, the choice of profession for patients with congenital heart disease should be associated with regulation and physical activity including.
The choice of profession for patients with congenital heart disease should be agreed with the cardiologist.
And it’s not just about regulating physical activity (although this, too), but about assessing the impact on the patient of various unfavorable factors for him. Such factors may include, for example, the negative impact on the patient’s body of high temperature.
Pregnancy in the presence of congenital heart disease is associated with a risk of complications.
At present, this problem is really acute. This is justified by the complexity of this problem and the significant prevalence. The risk of complications in pregnant women, who are diagnosed with congenital heart disease, is available in most cases. The exception is hemodynamically and anatomically compensated heart defects, and even then the risk may appear with an insignificant degree of compensation. Some congenital heart defects do not allow an increase in the load on the body during pregnancy. This is due to the possibility of a woman developing heart failure. Such congenital malformations, for example, include aortic stenosis and an interventricular septal defect.
Diagnosis of congenital heart disease is based on a comprehensive examination of the heart.
At the initial stage of diagnosis, when a doctor suspects having a congenital heart disease, the following examinations are carried out. These are electrocardiography (ECG) and echocardiography. The radiographic examination of the heart and lungs is also mandatory. The data of these surveys make it possible to determine a set of characteristics (direct and indirect) that indicate the presence of a certain defect. Further, the diagnosis and examination are based on which heart defect is suspected in the patient.If necessary, the patient is probing the heart chambers and angiocardiography. Angiocardiography is an X-ray examination of the heart cavities, which is performed immediately after the introduction of radiocontrast into the blood. It’s about the blood in the heart. Heart sounding is a test, the essence of which is to hold a catheter in the left or right heart, which makes it possible to get information about the blood pressure in the chambers of the organ. Also, heart probing allows you to take blood samples for a study. The specialist gets an opportunity to get acquainted with the images of the coronary arteries and ventricles of the heart, which is possible due to the introduction of contrast medium in them. This kind of examination of the patient is carried out in the cardiosurgical hospital.
There are several variants of classifications of congenital heart diseases.
The most important and generalizing is the following classification. Its basis is, mainly, the effect of congenital heart disease on pulmonary blood flow. In this regard, four groups are distinguished. The first includes congenital malformations with unchanged pulmonary blood flow. These can be, for example, anomalies of the location of the heart, aortic stenosis, mitral stenosis, defects in the conduction system of the heart and coronary arteries. The second group includes vices with hypervolemia (i.e., a situation where the volume of blood circulating abnormally increases) of the small circle of blood circulation. This can include congenital heart defects that are not accompanied by early cyanosis and which are accompanied by cyanosis. The first subgroup includes the following: coarctation of the aorta of the children’s type, aortolegoic fistula, Lutambash syndrome, etc. The second subgroup includes, for example, an open arterial malformation characterized by a flow of blood from the pulmonary trunk to the aorta. The third group includes congenital defects with hypovolemia (an abnormal decrease in the volume of circulating blood) in the small circle of the circulation. This subgroup also includes congenital sponges that are not accompanied by cyanosis (isolated stenosis of the pulmonary trunk – an example of such a blemish) and which are accompanied by cyanosis (eg, right ventricular hypoplasia, Ebstein abnormality). The fourth group includes the combined vices, which are characterized by a disruption of the connection between the major vessels and the heart. This, for example, is a three-chambered heart with a single ventricle. This classification of congenital heart disease is important for the diagnosis of the disease. It enables, for example, to suspect a patient of a defect belonging to the fourth group. To diagnose these defects, angiocardiography is usually required.