Dialogue between doctors and families
The prevalence of congenital heart disease and the mortality rate of newborns can vary depending on the region. In foreign countries, the prevalence of congenital heart disease is about 6.8‰ among babies born alive; in China, about 7-11‰ of babies born each year suffer from congenital heart disease, and the prevalence of congenital heart disease in high-altitude areas is about 13.7‰. Except for a very small number of precocious heart diseases that do not require surgical treatment, the vast majority of them need surgical treatment. China’s cardiovascular surgery for cardiovascular disease surgical treatment of about 170,000 cases / year (2009 statistics), about 10% of the incidence of cardiovascular disease, of which precardiac disease accounted for 55-60% (based on the 2007 epidemiological survey). Li Xuewen, Cardiovascular Surgery Department, Shaanxi Provincial People’s Hospital
Our Cardiovascular Surgery Center of Shaanxi Provincial People’s Hospital has been established for more than 20 years, with more than 140 professional and technical staff, 110 beds in the staff, 20 intensive care beds, an independent laminar flow operating room with 7 operating rooms and advanced equipment, and an annual surgical volume of nearly 2,000 cases, covering the catalog of cardiovascular surgery textbooks (of which precardiac disease accounts for about 55%). In recent years, we have strictly controlled the quality of medical care, so that the mortality rate and post-operative complications have decreased year after year, and the mortality rate in the past two years has been controlled below 2% (1.76% in 2008 and 1.36% in 2009). In August 2010, our cardiovascular center successfully performed swich surgery for a 48-hour-old child with large-vessel transposition without ventricular septal defect, which is the first case in Northwest China, marking the advanced level of pediatric cardiac surgery in China.
Our center has been pursuing the policy of “helping people and helping the poor” in the context of “saving lives and helping people”, and has reduced medical expenses for the majority of people who lack income by about 50 million yuan. This year, we have also obtained the designated hospital of the “Angel Sunshine Action” of the China Red Cross Foundation and the “Pre-heart Disease Relief” of the Kuo Foundation of the Hong Kong Kerry Group to provide eligible patients with pre-heart disease and some patients with wind heart disease with full medical expenses or The following is my response to the questions raised by many patients’ families.
The following are my answers to the common questions about congenital heart disease raised by many patients’ families.
Family members ask: What is congenital heart disease?
Doctor’s answer: The local anatomical abnormalities caused by viral infection, nutritional disorders, hypoxia, exposure to radiation, medication, or other diseases such as diabetes, as well as environmental and genetic factors that interfere with the fetus during embryonic development (within the first 2-3 months of pregnancy), or the failure to close channels that should close automatically after birth (in fetus is normal) of the heart, is called congenital heart disease. Most of them require surgery, except for a few cases of patent ductus arteriosus (before the age of half a year) and small ventricular septal defects that have a chance of healing spontaneously before the age of 5.
Q: What are congenital heart defects?
A: Congenital heart disease can be divided into extracardiac malformations and intracardiac malformations, and intracardiac malformations can be divided into non-cyanotic and cyanotic types. Extracardiac malformations include ductus arteriosus, aortic arch narrowing, aortic arch dissection, main pulmonary artery window, etc. Non-cyanotic types include simple intracardiac shunts: such as atrial septal defect and ventricular septal defect, as well as pulmonary stenosis, congenital valve diseases such as aortic stenosis, tricuspid stenosis, and mitral valve closure insufficiency. Cyanosis occurs when a certain amount of blood with low oxygen content in the venous system enters the left heart system through abnormal channels and converges into the body circulation due to special structural changes of the heart, such as tetralogy of Fallot, single ventricle, transposition of great vessels, etc. Moreover, the above malformations can exist alone or several malformations can occur in the same patient, which is called compound malformation. Q: What are the manifestations of congenital heart disease?
A: Shortness of breath, cyanosis, squatting phenomenon and heart murmur are the most common clinical manifestations in congenital heart disease. Shortness of breath and respiratory distress can cause feeding difficulties in newborns and make the children easily irritable; some of them only show increased respiration and shortness of breath during activity or breastfeeding. Secondly, heart murmur: it is an important sign for the diagnosis of precordial disease, but the heart murmur of newborn babies is mostly atypical. Many newborns born shortly after only show symptoms of shortness of breath and cyanosis, and no heart murmur, so it is important to pay attention to whether the baby has serious heart malformations, such as single ventricle, single atrium, complete transposition of the great arteries, etc. Third cyanosis: It only occurs in some complicated or combined severe pulmonary hypertension precardiac disease and can be accompanied by squatting, not all precardiac diseases have cyanosis. Also recurrent or persistent upper respiratory tract infections, pale face, low cry, moaning and hoarseness suggest the possibility of congenital heart disease.
Q: What treatments are available for congenital heart disease?
A: At present, there are two kinds of treatment methods for congenital heart disease: traditional surgery and interventional treatment. Surgery is the main treatment method, which is practical for all kinds of simple congenital heart disease (such as: ventricular septal defect, atrial septal defect, arteriovenous ductus arteriosus, etc.) and complex congenital heart disease (such as: combined with pulmonary hypertension, tetralogy of Fallot, etc.). Interventional therapy is a new treatment method developed in recent years, mainly for children with patent ductus arteriosus, atrial septal defect and partial ventricular septal defect without other anomalies requiring surgical correction. The difference between the two is that surgical treatment has a wider scope of application and can cure all kinds of simple and complex congenital heart diseases, but it is traumatic and has a long recovery time, and a few patients may have complications such as arrhythmia, chest and pericardial effusion, and it also leaves surgical scars that affect the aesthetics. Interventional treatment is narrower in scope and more expensive, but less invasive, with quick recovery and no surgical scars.
Q: Is it possible to cure congenital heart disease?
A: The level of heart disease treatment in China has been at the forefront of the world, and some of the treatment methods have reached the leading position, and the prognosis for the treatment of some complex congenital heart diseases has been greatly improved compared with before. Objectively speaking, most of the children with congenital heart disease who can survive until they are more than one week old are patients with mild left-to-right shunt or just without shunt, and the treatment effect for this kind of congenital heart disease is very good. For congenital heart diseases with right-to-left shunt (such as tetralogy of Fallot), the prognosis is relatively less favorable due to hemodynamic changes that lead to persistent impairment of cardiopulmonary function, but with timely treatment, the child may still be cured. In summary, most congenital heart diseases are curable, the key is early detection and early treatment.
Q: What is the best time to treat congenital heart disease?
A: First of all, it should be noted that for the current medical level, age is no longer a qualifying factor for surgery. In layman’s terms, surgery can be performed on a newborn to an old man over 90 years old. Of course, the timing of surgery depends on a number of factors, including the complexity of the congenital malformation, the age and weight of the child, and the general development and nutritional status of the child. Therefore, we suggest that surgery or interventional treatment for simple congenital heart disease at the age of 1 to 5 years is the best time. If the child is too young, with low weight, poor general development and nutritional status, it will increase the risk and cost of surgery; if the child is too old, the heart will compensate for the increase in size, and the heart function will decrease, or some will have severe pulmonary hypertension, which will also increase the risk of surgery and longer recovery time after surgery. For children with severe congenital malformations that have affected their growth and development or whose heart malformations have threatened their lives, such complex malformations should be operated early. In August 2010, our Cardiovascular Center performed a successful swich procedure for a child with a large-vessel transposition without a ventricular septal defect who was just 48 hours old, the first of its kind in Northwest China.