Overview of congenital heart disease
Congenital heart disease is the most common type of congenital anomalies, accounting for about 28% of all congenital anomalies. It refers to an anatomical abnormality caused by the formation disorder or abnormal development of the heart and large blood vessels during embryonic development, or the failure to close channels that should be closed automatically after birth (normal in the fetus).
Precordial disease staging]
According to the hemodynamic combined with pathophysiological changes, congenital heart disease can be divided into cyanotic or non-cyanotic type, and can also be divided into three categories according to the presence or absence of shunts: non-shunt type (such as pulmonary stenosis, aortic constriction), left-to-right shunt type (such as atrial septal defect, ventricular septal defect, arteriovenous insufficiency) and right-to-left shunt type (such as tetralogy of Fallot, large vessel misalignment).
Etiology of precordial disease
It is generally believed that early pregnancy (5-8 weeks) is the most important period of fetal heart development, congenital heart disease has many causes, genetic factors account for only about 8%, while the vast majority of 92% are caused by environmental factors, such as women taking drugs during pregnancy, infection with viruses, environmental pollution, radiation, etc. can cause abnormal fetal heart development. In particular, rubella virus infection in the first three months of pregnancy can dramatically increase the risk of congenital heart disease in children.
Clinical manifestations of congenital heart disease
There are many types of congenital heart diseases, and their clinical manifestations mainly depend on the size and complexity of the malformation. Complex and severe malformations can show serious symptoms soon after birth and even become life-threatening. It should be noted that some simple malformations, such as ventricular septal defect and patent ductus arteriosus, can have no obvious symptoms in the early stage, but the disease can still potentially develop and worsen, requiring timely diagnosis and treatment to avoid losing the opportunity for surgery. The main symptoms are.
1. Frequent colds, recurrent respiratory infections and susceptibility to pneumonia.
2.Poor growth, wasting and excessive sweating.
3.Impotent sucking during breastfeeding, difficulty in feeding, or infant refuses to eat, choking and coughing, and usually shortness of breath.
4.Children complain of easy fatigue and poor physical strength.
5.Blue lips and nails or bruising after crying or activity, pestle-like fingers and toes (nail bed bulging like a hammer).
6.Like squatting, fainting, hemoptysis.
7. Auscultation reveals a heart murmur.
[Congenital heart disease treatment
1, general congenital heart disease in only a few types of congenital heart disease can be natural recovery, some of them will gradually increase complications with age, and the condition will gradually worsen. The choice of treatment has been the right timing of surgery, mainly depends on the scope and degree of congenital heart malformation. Simple and mild malformations such as atrial septal defects and simple pulmonary valve stenosis, if the diameter of the defect is small, have no significant impact on hemodynamics and can be treated without any treatment for life. Severe congenital heart disease such as complete transposition of the great arteries or hypoplastic left heart syndrome must be operated immediately after birth, otherwise the child will not survive.
2.Conservatively observed cases of congenital heart disease.
(1) Those with small diameter and no tendency of pulmonary hypertension with secondary hole atrial defect can be observed until 3 to 5 years old before surgery;
(2) Membranous ventricular septal defect less than 4 mm in diameter has a mild effect on cardiac function and has the possibility of automatic closure, so it can also be observed until the age of 3 to 5 years, and if the ventricular defect still fails to close then surgery should be considered. Since small ventricular defects have the potential to induce bacterial endocarditis, and the safety of surgery is currently very high, it is not recommended to wait for a longer period of time;
(3) aortic valve with a transvalvular pressure difference of less than 40 mmHg and pulmonary valve stenosis of less than 60 mmHg. The prerequisite for conservative treatment in these cases is that the cardiac ultrasound must be checked more than twice in a hospital with a high level of precordial surgery treatment, and in addition, regular follow-up observations and necessary examinations are needed during the observation period to avoid misdiagnosis and delayed treatment.
3, choose the appropriate timing of surgery is the key to successful surgery and achieve a good prognosis of precordial disease.
At present, there are several main factors to determine the timing of surgery.
(1) The pathological characteristics of the precordial disease itself and the degree of impact on hemodynamics Generally speaking, the more complex the malformation, the greater the impact on hemodynamics, the more early the surgery should be treated.
(2) Progression of secondary pathological changes In left-to-right shunt type of precordial disease, surgical correction should be sought before the occurrence of obstructive pulmonary vascular changes. Cyanotic, obstructive congenital heart disease should strive for surgery before the occurrence of severe myocardial hypertrophy and fibrous degeneration.
4.Treatment methods of congenital heart disease.
There are various kinds of surgical treatment, interventional treatment and drug treatment. The choice of treatment and the most appropriate time for surgery should be based on the condition, and the cardiologist should make recommendations according to the specific circumstances of the child. The non-shunt or left-to-right shunt category has a good outcome and a good prognosis after timely surgery. For those with right-to-left shunt or compound malformation, the surgery is complicated and difficult in more severe cases, and some patients cannot be completely corrected due to imperfect development of certain cardiac structures, so only palliative surgery can be performed to alleviate symptoms and improve the quality of life.
Interventional treatment is broadly divided into two categories: one is the use of balloon dilation to release the stenosis of blood vessels and valves, such as aortic stenosis, pulmonary stenosis, aortic constriction, etc.; the other is the use of a variety of special blockers made of memory metal to close the undesirable defects, such as atrial septal defect, ventricular septal defect, arterial catheter closure, etc. Due to the progress of medical technology and the continuous research and improvement of materials and processes, interventional treatment is now further developed in domestic and foreign clinical applications, which not only can avoid the risk and trauma of open-heart surgery, but also has short hospitalization time and fast recovery, and is a very effective treatment method. Interventional therapy has partially replaced but not completely replaced surgical open-heart surgery, and the technique has strict indications.
The surgical methods for precardiac disease are mainly based on a combination of factors such as the type of heart malformation and the degree of pathophysiological changes, and the surgical methods can be divided into three categories: radical surgery, palliative surgery, and heart transplantation.
(1) Radical surgery allows the patient’s heart anatomy to return to a normal human structure.
(2) Palliative surgery can only improve the symptoms but not the radical effect. It is mainly used for complex precordial diseases for which there is no radical cure, such as modified Glenn and Fontan surgery, or as a preparatory surgery to promote the growth and development of the original undeveloped structures to create conditions for radical surgery, such as body-lung bypass.
(3) Heart transplantation is mainly used for end-stage heart disease and complex precordial diseases that cannot be treated by current surgical methods.
Post-operative instructions for precardiac disease
Parents should make sure their babies rest after surgery. Bring your baby back for regular visits and check-ups. The baby needs to take medication as prescribed by the doctor. The baby needs proper nutrition after surgery, but it should not be over supplemented and the food should be easy to digest.