A heart with a local anatomical abnormality caused by a disorder in the formation of the heart and large blood vessels during human embryonic development (within the first 2-3 months of pregnancy), or a failure to close channels that should close automatically after birth (normal in the fetus), is called congenital heart disease. Except for small ventricular septal defects that have a chance to heal spontaneously before the age of 5 years, the vast majority require surgical treatment.
The main clinical manifestations are cardiac insufficiency, cyanosis, and dysplasia. Congenital heart disease is a cardiovascular malformation caused by abnormal development of the heart vessels during fetal life, and is the most common heart disease in children. Its incidence is about 0.4-0.8% of births, and 60% of them die within 1 year of age. The onset of the disease may be related to genetics, especially chromosomal translocations and aberrations, intrauterine infections, high-dose radiation exposure and drugs.
With the development of cardiovascular pathology and pathophysiology, advances in medical imaging technology, extracorporeal circulation technology, improved economic base and strong support from national policies, many common congenital heart diseases have been accurately diagnosed and reasonably treated, and the morbidity and mortality rates have decreased significantly.
Common congenital heart diseases include atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary valve stenosis, tetralogy of Fallot, complete transposition of the great arteries, ectopic drainage of pulmonary veins, double outlet of the right ventricle, aortic constriction, etc.
Etiology and pathogenesis.
Precardiac disease is the result of a complex interaction of genetic and environmental factors and other relationships.
The following factors may affect fetal development and produce congenital malformations.
1, environmental factors of fetal development :
(1) Infections, viral or bacterial infections in the first trimester of pregnancy, especially rubella virus, followed by coxsackievirus, have a higher incidence of congenital heart disease in babies born with them.
(2) Other, such as amniotic membrane lesions, fetal pressure, early pregnancy, pre-eclampsia, maternal malnutrition, diabetes, phenylketonuria, hypercalcemia, the application of radiation and cytotoxic drugs in early pregnancy, the mother is too old, etc. are likely to make the fetus develop congenital heart disease.
2.Hereditary factors.
Congenital heart disease has a certain degree of family tendency to develop, which may be caused by parental germ cell and chromosomal aberrations. Genetic studies have concluded that most congenital heart disease is formed by the interaction of multiple genes and environmental factors.
3.Other.
Some congenital heart diseases are more frequent in highland areas, and some congenital heart diseases have significant differences in incidence between the sexes, indicating that the altitude and sex of the place of birth are also related to the occurrence of the disease. Among patients with congenital heart disease, those who can find out the cause are very few, but strengthening health care for pregnant women, especially actively preventing rubella, influenza and other rubella viral diseases and avoiding all factors related to the onset of the disease in early pregnancy, is of positive significance to prevent congenital heart disease.
What are the symptoms of children with congenital heart disease.
1. Heart failure.
Neonatal heart failure is considered an emergency and is usually mostly due to a more severe heart defect in the child. Its clinical manifestations are due to congestion of the pulmonary and body circulations and a decrease in cardiac output. The child is pale, breathless, dyspneic and tachycardic, with a heart rate of up to 160-190 beats per minute, and blood pressure is often low. A galloping horse rhythm may be heard. The liver is large, but peripheral edema is less common.
2. Cyanosis.
It arises from mixing of arterial and venous blood due to right-to-left shunt. It is most obvious in the tip of the nose, lips of the mouth, and nail beds of the fingers (toes).
3, Squatting.
Children with cyanotic congenital heart disease, especially those with tetralogy of Fallot, often show signs of squatting after activity, which increases the vascular resistance of the body circulation thereby reducing the right-to-left shunt produced by the septal defect and also increases venous blood return to the right heart, thereby improving pulmonary blood flow.
4. Pestle and mortar fingers (toes) and erythrocytosis.
Cyanotic congenital heart disease is almost always associated with pestle and mortar finger (toe) and erythrocytosis. The mechanism of pestle finger (toe) is not clear, but erythrocytosis is a physiological response of the body to arterial hypoxia.
5. Pulmonary arterial hypertension.
When a patient with a septal defect or an unclosed ductus arteriosus presents with a syndrome of severe pulmonary hypertension and cyanosis, it is referred to as Eisenmenger’s syndrome. The clinical manifestations are cyanosis, erythrocytosis, pestle fingers (toes), signs of right heart failure such as jugular venous anger, hepatomegaly, and peripheral tissue edema, at which point the patient has lost the opportunity for surgery and the only thing waiting is a heart-lung transplant. Most patients die before the age of 40.
6. Developmental disorders.
Children with congenital heart disease often develop abnormally, manifesting as thinness, malnutrition, growth retardation, etc.
7, Other.
Chest pain, syncope, sudden death.