With the improvement of medical care, the spectrum of diseases in children has changed greatly, and various congenital malformations have become the main diseases that seriously affect the growth and development of children and the quality of their future survival, among which congenital heart disease is currently the first cause of death of newborns in China, and the incidence has a tendency to increase gradually.
It is gratifying that the treatment level of congenital heart disease at home and abroad has been greatly improved in recent years, and almost all congenital heart diseases can be effectively treated, which has been differentiated from general cardiac surgery into specialized pediatric congenital surgery. However, congenital heart disease is complex and diverse, and the timing, method, cost and effect of treatment also vary greatly, and there are various misconceptions among non-professional doctors and parents of children, which affect the treatment effect and prognosis, and even lose the chance of treatment, so we must pay great attention to them.
Myth 1: Congenital heart disease is poorly treated and cannot work and live normally after treatment.
The traditional view is that the poor treatment effect of congenital heart disease and the inability to live normally even after treatment are related to the previous treatment level and the late visit to the doctor.
With the improvement of medical equipment and technology, most congenital heart diseases can now be effectively treated with an overall success rate of over 95%, and the success rate for single malformation congenital heart diseases such as patent ductus arteriosus, atrial septal defect, preoperative uncomplicated ventricular septal defect, and pulmonary stenosis in the Children’s Cardiovascular Center is close to 100%.
With proper timing of surgery and technical assurance, the success rate of surgery for some complex and critical precocious heart diseases is also around 90-95%. The early stage of congenital heart disease is mainly morphological malformations, so except for a few congenital heart diseases that cannot be anatomically corrected but only hemodynamically corrected, such as severe pulmonary atresia and complete transposition of the great arteries in older children, most children with congenital heart disease can be completely cured after treatment, which has little impact on future growth and development and life and work, and can completely reach or approach the level of normal people.
Myth 2: The older or younger the age of congenital heart disease, the better the treatment effect?
The old popular science books and related early monographs on the timing of treatment of congenital heart disease are made age and weight specification, with the research of the last two decades, this knowledge has been updated, because timely diagnosis and treatment can reduce the co-morbidity of congenital heart disease and can reduce the mortality rate. Most children with congenital heart disease die in the neonatal and infant period, and the reasons for this are related to the type of congenital heart disease, the functional status of the heart, whether there is a co-infection and whether the treatment is appropriate or not.
Many parents think that the children are young and have poor resistance, so they want to wait for the children to grow up and then treat them, which is often a missed opportunity, and some patients may not achieve the desired effect even if they are treated later;
The timing of treatment for congenital heart disease should be decided after a comprehensive assessment of the type of congenital heart disease, the systemic functional status of the child, and the impact of heart disease development on growth and development.
At present, there are two tendencies that should be paid attention to: one is that the older the age, the better the effect of surgery, for general surgery, as the child grows older tolerance for surgery will improve accordingly, but congenital heart disease is a progressive change of congenital malformations, many secondary pathologies such as heart failure, pulmonary hypertension, structural and functional changes in the ventricle, etc., thus delaying the best time for surgical treatment and affecting the treatment This delays the optimal timing of surgical treatment and affects the outcome.
Theoretically, the earlier the corrective surgery is performed, the more the damage to the heart can be reduced, and there have been individual cases of congenital heart disease surgery for fetuses in developed countries. With the improvement of surgical technology and safety assurance level, the age of congenital heart disease surgery for children in China is also advancing, and in large pediatric specialty centers, it is generally recommended that children with congenital heart disease such as ventricular septal defect, atrial septal defect and patent ductus arteriosus be operated within 6 months of birth.
Another tendency is that the younger the age, the better the result, but due to the limitations of medical technology development, small infants have completely different physiological characteristics from older children, the organs are not yet mature and have low tolerance for surgery, so the surgery is difficult and requires higher requirements for various techniques; in addition, different kinds of precardiac diseases have different indications for surgery and different age requirements. Therefore, the best time for surgery for precardiac disease should be based on the specific condition of the child.
The most common precardiac diseases: atrial septal defect, arteriovenous ductus arteriosus, the operation time depends on the size of the defect, such as large defect, large fractional flow, severe pulmonary congestion, often accompanied by heart failure, pneumonia and other co-morbidities, should be operated early, and the operation can be performed in infancy (within 1 year). For children with cyanotic precordial disease, such as tetralogy of Fallot with frequent episodes of hypoxia, pulmonary venous ectopic drainage and other serious conditions, surgery should be performed in infancy. If the condition is not very severe tetralogy of Fallot, surgery can be performed around 1 year of age with better results.
For serious cardiovascular malformations, such as aortic dislocation, the need for surgery in the neonatal period should be decided according to the different conditions of the sick child in order to improve the success rate, long-term results and save the life of the child; in addition, patients are especially reminded that choosing a specialized pediatric cardiovascular center to treat pediatric congenital heart disease, especially infantile congenital heart disease can achieve a higher success rate of surgery and better long-term treatment results.
Myth 3: The cost of congenital heart disease treatment.
The cost of congenital heart disease treatment is related to the severity of the child’s condition, age and the materials used in the surgery. The child’s age and complexity, in order to ensure the safety of the operation, the materials to be used, such as artificial lung, ultrafilter, etc. require higher requirements, the current choice of imported materials is more appropriate; at the same time, the intraoperative, post-treatment is difficult, therefore, the cost of treatment is relatively high; while the age, the disease is light and does not use imported surgical materials, the cost is relatively low.
Therefore, the cost of treatment varies from case to case. Therefore, the choice of treatment hospital, not simply to compare the high cost of treatment, but should be based on the level of professionalism and popularity of doctors, the hospital’s overall strength to choose, because it determines the safety of surgery, treatment results and the success rate of treatment.
Myth 4: Looking around and waiting for non-surgical treatment methods, delaying the best time for surgery.
With the development of interventional technology, especially minimally invasive interventional technology in cardiac surgery, some common precordial diseases can be effectively treated by interventional technology, and interventional treatment has the advantages of less trauma, no blood transfusion, fast recovery and aesthetics. At present, precordial diseases with good results and mature technology for interventional treatment include patent ductus arteriosus, atrial septal defect, pulmonary valve stenosis, and certain parts of ventricular septal defect. However, each method has its own indications and advantages and disadvantages, and should be chosen according to the size of the advantages and disadvantages.
Myth 5: Treatment opportunities are lost while waiting for physical development to improve.
Pneumonia, cardiac insufficiency, growth retardation, and other complications often occur in precardiac disease, especially in some severe and complex malformations. It is often encountered clinically that cardiac insufficiency is mistaken for pneumonia for long-term treatment, or that attempts are made to increase nutrition and other means to improve physical fitness before surgical treatment. However, since many of these conditions are due to lesions in the heart itself, these conditions cannot be improved without curing the underlying preconditioning, but rather delaying treatment. The best approach is to develop a treatment plan after a joint study by cardiovascular surgeons, and if necessary, emergency surgery is needed to save the child’s life.