Congenital heart disease is a group of diseases caused by abnormal development of the heart vessels during the embryonic period, and is the most common heart disease in pediatric patients. It mainly includes four simpler types of precordial diseases, such as arteriovenous ductus arteriosus, atrial septal defect, ventricular septal defect and pulmonary valve stenosis, and complex ones, such as tetralogy of Fallot, right ventricular double outlet, pulmonary atresia, tricuspid atresia, mitral atresia, transposition of the great arteries and complete endocardial cushion defect. The cyanotic precordial disease.
There are several treatment methods as follows.
(a) Surgical open-chest repair: direct open-chest repair of the lesion. It is a classical traditional method for the treatment of congenital heart disease, but it is very traumatic and leaves scars after surgery, and may leave complications after extracorporeal circulation and blood transfusion. It is basically adapted to the treatment of all congenital heart diseases.
(II) Interventional occlusion: A catheter is inserted from the peripheral blood vessels, and a specially designed device is delivered from the peripheral blood vessels to reach the lesion site to be treated, and the device is released and fixed in the lesion site to achieve a cure.
Features: No incision, few complications, quick recovery, no scarring, etc. It has now become the treatment of choice for most congenital heart diseases.
Indications for interventional occlusion.
(1) Patent ductus arteriosus (PDA): age > 6 months, weight > 4 kg.
(2) Atrial septal defect (ASD): age older than 3 weeks, secondary foramen ovale defect less than 36 mm in diameter.
(3) Ventricular septal defect (VSD): age > 3 years, weight > 10 kg, except for sub-stem ventricular defect.
(4) Pulmonary stenosis (PS): typical pulmonary stenosis with trans-pulmonary valve pressure difference > 50 mmHg by cardiac catheterization at normal cardiac output. age > 3 months.
Contraindications to interventional occlusion.
(1) Active endocarditis, intracardiac bulky organisms, or other infections causing bacteremia.
(2) Presence of thrombus at the blocker placement and venous thrombosis at the catheter insertion site.
(3) Poor anatomical location of the defect, affecting the function of the aortic or atrioventricular valve after placement of the blocker.
(4) Severe pulmonary hypertension with bidirectional shunts.
Treatment flow: echocardiography, selection of indications -> preoperative preparation such as blood sampling -> interventional cardiac catheterization blocking -> postoperative review.
Hospitalization time: 5-7 days.
(C) Surgical blocking: Through a small incision in the chest (about 3cm-5cm long), without extracorporeal circulation, a specially designed device (blocker) is delivered directly to the lesion through the surface of the heart under the beating of the heart to achieve the treatment purpose.
Features: small incision, no extracorporeal circulation, wide range of indications, few complications, fast recovery, etc.
Limitations of interventional occlusion.
(1) Restricted by peripheral vascular conditions, it is not suitable for children who are small in age, light in weight and need early intervention.
(2) It is difficult to seal the ventricular defect close to the aortic valve, such as the inferior stem type.
(3) Low success rate when the ventricular defect is large and inconvenient to transfer to surgery.
(4) For myocardial ventricular defect sealing, percutaneous intervention to establish the track is complicated and the success rate is low.
(5) It is mainly applied to small membrane ventricular defects, and a few myocardial ventricular defects.
(6)The effect of radiation on children.
Indications and advantages of surgical occlusion.
(1) Most ventricular defects except large ventricular defects of the inflow tract and the vast majority of atrial defects.
(2) A variety of umbrella types can be used for different ventricular defects.
(3) It is not limited by the patient’s age and weight.
(4) It is easy to change the umbrella, and a relatively small umbrella can be selected.
(5) It can be directly transferred to direct vision surgery after blocking failure.
(6) No damage to the child from radiation.
(7) No damage to blood vessels is caused.
(8) The skin wound and trauma are very small and relatively minimally invasive.
(9) It can be combined with other cardiac surgery.
(10) Surgical atrial defect closure
With the above three methods, the majority of congenital heart diseases are satisfactorily cured radically. If a patient with congenital heart disease comes in, the first step is to clarify the diagnosis, and if it is a simple congenital heart disease (atrial defect, ventricular defect, patent ductus arteriosus and pulmonary valve stenosis), interventional occlusion is preferred; if interventional occlusion is not suitable, then surgical occlusion treatment is considered; finally, surgical open-heart surgery under direct vision is considered.