To the general public, interventional therapy for precardiac disease sounds unfamiliar. What are the advantages over traditional surgical treatment? In this article, we will unveil the mystery of congenital interventional therapy.
Statistics show that the incidence of congenital heart disease (congenital heart disease) is very high among infants, about 0.8% to 1.2%, which means that about 150,000 to 200,000 children with congenital heart disease are born in China every year. Some data show that half of the children with precocious heart disease die by the age of 1 year and 2/3 by the age of 2 years due to untimely treatment.
What is precocious heart disease?
Congenital cardiovascular disease (or congenital heart disease) is a structural abnormality of the heart and large blood vessels before birth due to genetics, gene expression, viral infections, drugs, radiation, etc. The common ones are atrial septal defect, ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot.
What are the symptoms of children with congenital heart disease?
Some patients with atrial septal defect and patent ductus arteriosus are diagnosed in infancy, childhood, and adolescence, while some are detected in adulthood. Patients with ventricular septal defects are usually detected in early childhood because of their large heart murmurs. Most infants and children with precordial heart disease will have the following symptoms.
● frequent colds, recurrent bronchitis and pneumonia.
● Difficulty feeding or refusal to feed, choking and coughing, frequent eating and stopping, shortness of breath, pallor, and breath-holding in infants.
● persistent cyanosis of the child’s skin, especially in those areas of the nose tip, lips of the mouth, and finger (toe) nail beds, where it is most evident.
● the child often crouches for a moment while walking or playing
● the toddler’s fingers and toes are thickened and darkened at the end.
● the toddler cries out for tiredness, sweats a lot, and is blue around the mouth.
● Infants and toddlers with precordial disease are significantly behind their peers in development, manifesting as thinness, malnutrition, and growth retardation.
● Toddlers present with chest pain and syncope.
What is interventional therapy for precardiac disease?
Interventional therapy for congenital heart disease is a treatment method in which a puncture needle and catheter are inserted along the blood vessel to the site of the heart under the guidance of X-ray and ultrasound, and then the lesion is quantitatively and qualitatively analyzed after imaging diagnosis, and then the lesion is blocked, dilated or embolized with special equipment.
The interventional treatment of congenital atrial septal defect, for example, involves the insertion of a 2-3 mm diameter transmitter from the child’s femoral vein and the placement of a self-expanding double-disc blocker made of nickel-titanium memory alloy wire at the atrial septal defect. The atrial septal defect was cured. In about 3 months thereafter, the endocardial epithelial cells will gradually grow along the surface of the blocker like a creeper, forming a smooth endothelium.
Currently, some types of atrial septal defects, ventricular septal defects, patent ductus arteriosus, and pulmonary valve stenosis can be completely cured by interventional therapy, and the children can live, study, and work as normal after surgery. The success rate of interventional treatment has reached 95% to 100%.
The advantages of interventional treatment for precardiac disease Traditional open-heart surgery requires three hurdles: general anesthesia, open-heart surgery and postoperative recovery, and leaves lifelong scars. In contrast, the advantages of interventional treatment are obvious.
The incision on the back of the chest is not necessary, but only a 2-3 mm incision in the groin (usually without scarring). No need to open the thoracic cavity and pericardium, much less to cut open the heart, and almost no damage to the heart.
●No need for general anesthesia, only local anesthesia in the groin, avoiding the accidents of general anesthesia and the toxic side effects of general anesthesia on the brain, liver, kidneys and other organs, especially avoiding the effects of anesthetic drugs on the intellectual development of children’s brains.
●No blood transfusion is needed because of the low bleeding of interventional treatment, and blood transfusion is not needed to avoid infectious diseases that may be caused by blood transfusion, such as hepatitis and AIDS.
●Short procedureThe operation time of interventional treatment is relatively short; for example, the time required for the operation to seal an atrial septal defect is only about 30 minutes, and the child can get up and move around 6 to 12 hours after the operation and can be discharged from the hospital in 3 to 5 days.
The blocking device is made of nickel-titanium memory alloy, which is non-antigenic and does not cause any rejection in the child’s body.
Which conditions are not suitable?
Children with atrial septal defects should not undergo intervention for the following conditions.
● Concurrent cardiac malformations requiring surgical intervention.
● Pulmonary venous malformation drainage.
● severe pulmonary hypertension – with bidirectional shunts.
● with atrial fibrillation (a type of heart rate arrhythmia).
The following children with ventricular septal defects are not suitable for interventional treatment.
● vessels that are too thin for insertion of the delivery sheath.
The anatomical location of the defect is poor and may affect the function of the aortic valve after placement of the blocker.
Interventional treatment is contraindicated in children with patent ductus arteriosus who have
● coexistence of several cardiac defects or malformations.
● The child’s weight is less than 4 kg.
In addition, some infants and children have small atrial (ventricular) septal defects of only 1 to 2 mm. Doctors recommend that such children should not be rushed to undergo blocking because many of these defects can close naturally with age, and even if they do not close, there is no health risk as long as they do not develop and are not combined with infective endocarditis. All parents need to do is to take their children to a specialized hospital for regular checkups and keep an eye on the development of the defect, and if it develops, they should follow the doctor’s instructions for relevant treatment.