Etiology:
Due to the disturbance of the fetal heart during the development process, so that part of the development is halted or defective, as well as some of those who should degenerate fail to degenerate completely.
I. Environmental factors surrounding the fetus. Viral infections in utero in early pregnancy, most often after rubella virus infection, often cause ductus arteriosus and pulmonary artery stenosis, followed by coxsakie virus infection (Coxsakie ) can cause endocardial elastin fiber hyperplasia, in addition to amniotic membrane lesions, mechanical compression around the fetus, maternal nutritional disorders, vitamin deficiency and metabolic diseases, maternal use of cytotoxic drugs or prolonged radiation exposure, may
Genetic factors: 5% of patients with precordial disease occur in the same family with the same or similar disease, which may be due to genetic abnormalities or chromosomal aberrations.
Third, other. The incidence of patent ductus arteriosus and atrial septal defect is higher in highland areas, and the occurrence may be related to hypoxia. Some precordial diseases are gender predisposed.
Symptoms:
Mild cases are asymptomatic and found on physical examination, while severe cases may have dyspnea, cyanosis, syncope after activity, etc. Older children may have growth retardation. The presence or absence of symptoms is also related to the type of disease and the presence or absence of complications.
Clinical staging:
According to the hemodynamic combined with pathophysiological changes, three categories can be issued.
I. No shunt category. No shunt on the left or right side, no cyanosis, such as pulmonary artery orifice stenosis, aortic stenosis, aortic constriction, primary pulmonary artery dilatation, primary pulmonary hypertension or right-sided heart, etc.
Second, left-to-right shunt class. There is an abnormal channel between the left and right heart chambers or main and pulmonary arteries, the pressure on the left side is higher than the right side, and the left arterial blood enters the right venous blood through the abnormal channel – left to right shunt, such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, main pulmonary artery septal defect, partial pulmonary vein malformation drainage, and Valsalva (Valsalva) sinus aneurysm breaking into the right heart. There is usually no cyanosis, but if pulmonary hypertension occurs in the late stage with bidirectional or right-to-left shunt, cyanosis occurs, also called late cyanotic type.
Third, right-to-left shunt type. The pressure in the right heart cavity or pulmonary artery is abnormally increased and the blood flows into the left heart cavity or aorta through an abnormal channel. Cyanosis is usually present soon after birth, such as tetralogy of Fallot, tetralogy of Fallot, tricuspid atresia, permanent arterial trunk, great vessel borrowing, Eisenmenger’s syndrome, etc.
Examination :
The diagnosis can be made by symptoms, signs, electrocardiogram, X-ray and echocardiogram, and the hemodynamic changes, degree and extent of the lesion can be estimated to determine the treatment plan. For combined with other malformations and complex precordial disease, we can combine with cardiac catheterization or cardiovascular imaging to understand the degree, type and scope of abnormal lesions, make a clear diagnosis and formulate a treatment plan.
Differential diagnosis
The main differentiation is to identify which kind of congenital heart disease belongs to.
(1) Ductus arteriosus, ventricular septal defect, atrial septal defect: In the early stage of the disease, there is no cyanosis because the blood from the artery is shunted to the vein, which is a left-to-right shunt type; however, in the late stage, the pressure on the left side of the heart exceeds that on the right side, and cyanosis appears.
(2) Tetralogy of Fallot, transposition of the great arteries, pulmonary valve atresia: because some or all of the venous blood shunts directly into the arteries, it belongs to the right-to-left shunt type, so there is cyanosis after birth.
(3) Pulmonary stenosis, aortic stenosis, aortic constriction: Despite the presence of cardiac malformation, there is no abnormal channel between the left and right sides, which is a non-shunt type, and therefore, cyanosis does not appear throughout life.
Prevention
1, in early pregnancy (before 3 months) try not to sit too long in front of the computer, microwave ovens and other places with strong magnetic fields, because at this time the fetus is still unstable and various organs are still in the forming stage, which is likely to cause congenital heart disease in children.
2. Don’t touch pets, because bacteria and microorganisms on pets may also cause congenital heart disease in children.
Complications
Atrial septal defect, ventricular septal defect and patent ductus arteriosus are often prone to pneumonia and heart failure, and tetralogy of Fallot can often be complicated by cerebral thrombosis and brain abscess.
Treatment:
Generally depends on the type and severity of the malformation, timing of surgery for those suitable for surgical correction and preoperative cardiac function status, presence of comorbidities. The prognosis is better for those with no shunt or left-to-right shunt, those with mild asymptomatic, no abnormal ECG and X-ray, and those with moderate or severe can be corrected surgically, but the prognosis is worse if severe pulmonary hypertension with bidirectional shunt has been produced, and those with right-to-left shunt or compound malformation, and those with more severe disease should strive for early surgery. In mild cases, the timing of surgery can be chosen, preferably around 10 years of age.
Among congenital cardiovascular diseases, ventricular septal defect, patent ductus arteriosus and tetralogy of Fallot are more likely to be complicated by infective endocarditis, which affects the prognosis and requires attention to prevention and treatment.
Surgical treatment is divided into surgical and interventional blocking treatment, blocking treatment is minimally invasive, the operation time is short, the hospital stay is three or four days, and the cost is relatively reasonable, simple congenital heart disease (such as atrial septal defect, ventricular septal defect, arterial catheterization) can be the first choice of interventional blocking treatment.