1. What is the prevalence of precocious heart disease?
①, the first cause of birth defects.
②, the leading cause of perinatal death and child mortality.
③, the first among the non-infectious fatal diseases in newborns.
④, the incidence of 0.8-1% of live births, according to this projection, about 100,000-150,000 new children are born in China every year.
⑤, about 25?% of children with precocious heart disease have extracardiac malformations.
2.What are the causes of precordial disease?
On top of genetic defects, it is influenced by environmental factors.
Environmental factors include: intrauterine infections (rubella virus), teratogenic drugs (birth control pills, aspirin, erythromycin), industrial chemicals, pollutants, tobacco and alcohol, diabetes, etc.
3.Is precordial disease hereditary?
(①) The incidence of precocious heart disease is 10 to 14 times higher in siblings and children of patients with precocious heart disease than in the general population.
(ii) If the parents are healthy and the first child has precocious heart disease, the possibility of the second child having the disease is 1-6%.
③, if the parents are healthy, the possibility of having another child with precocious heart disease increases to 10% if both children are born in a row.
④, if the first child is sick and either parent is also sick, the risk of the second child becoming sick increases to 3-18%.
4. What are the common types of precocious heart disease?
Ventricular defect and predominantly ventricular defect account for 50% of the cases, followed by atrial defect, tetralogy of Fallot, patent ductus arteriosus and pulmonary stenosis, which account for 90% of the common types of precardiac disease.
5.Which precardiac diseases require surgery? Which ones can heal on their own without surgery?
(1) Small ventricular defects (less than 5 mm in diameter) with a natural closure rate of 30-40% within 1 year of age, with a higher natural closure rate for types close to the tricuspid valve (perimembranous).
②, sub-stem or high perimembranous ventricular defect, which is difficult to heal spontaneously and also involves the function of aortic valve closure and should be treated with early surgery.
(iii) large perimembranous ventricular defects and inflow tract ventricular defects that cannot become smaller or close naturally should be treated surgically.
(iv) Small secondary foramen ovale defects (less than 8 mm in diameter), mostly without hemodynamic significance, have a natural closure rate of up to 80% within 18 months.
(⑤) Atrial defects with right heart overload manifestations are mostly medium to large defects, which cannot heal on their own and require surgical treatment.
(vi) Primary foramen ovale type atrial defect, which cannot be self-healed and also affects tricuspid valve function and requires surgical treatment.
(vii) Functional closure of the ductus arteriosus begins 15 hours after birth, complete closure after 1 month, and very low natural closure rate after 3 months of age.
(viii) Interventional treatment may be attempted first for simple patent ductus arteriosus.
⑨, interventional treatment of pulmonary stenosis, safety and efficacy have been well demonstrated, and the recommendation level of both domestic and international guidelines is grade I.
⑩.Farrow tetralogy of Fallot, transposition of the great arteries and other complex precordial diseases can only be cured by surgical means.
6.When is the best time for surgical operation?
As each child’s condition is different, the timing of surgery should be consulted with a cardiac surgeon at a children’s specialty hospital.
7.Which children must have emergency surgery in the neonatal period?
①, transposition of the great arteries (D-TGA).
②, complete ectopic pulmonary venous connection (TAPVC)
③, aortic arch malformation combined with ventricular septal defect (AAA/VSD)
④, diseases such as hypoplastic left heart syndrome (HLHS), which evolve into irreversible pulmonary vascular obstructive lesions if not completely or partially corrected in the neonatal period
(v) Other conditions such as pulmonary atresia/intact ventricular septum (PA/IVS) without right ventricle-dependent coronary circulation that require surgery in the neonatal period in order to decompress the right ventricle.
(6) In cases of heart failure caused by left-to-right shunt, the decision to operate in the neonatal period should be made depending on the failure.
8.Will the artificial material grow with the child? Will it be rejected?
The implantation of artificial material will not affect the development and growth of the whole heart, because the defect is much smaller than other septal areas, so of course the patch will not grow, and other septal tissues will grow just fine; for some diseases such as interruption of the aortic arch, when the whole blood vessel needs to be anastomosed, the patient’s own tissue (e.g. subclavian artery) or direct anastomosis will be considered first, so that the blood vessel can grow with the patient, and if necessary, artificial blood vessels will be used The endocardial tissue will crawl and grow after the surgery, covering the surface of the artificial material, which is equivalent to the patient’s own tissue and will not be rejected.
9.What tests should be done before heart surgery?
The necessary tests: electrocardiogram, cardiac duplex, echocardiogram, routine laboratory tests; general congenital heart disease with ultrasound diagnosis, after detailed medical and surgical expert evaluation and planning, surgery can be performed; complex congenital heart disease or ultrasound results with clinical discrepancies, MRI/MRA examination is required, if necessary, CT/CTA examination is also feasible; cardiac catheterization for difficult cases, or with serious complications (such as Cardiac catheterization is still indispensable for difficult cases or those with serious complications (such as severe pulmonary hypertension, etc.) in order to clarify the diagnosis and determine the indications for surgery.
10.What should I pay attention to before surgery for precordial disease?
①, reasonable feeding: generally no strict restriction is required, if there is shortness of breath, abdominal distension, edema, medical advice should be followed.
②, oxygen: mild, non-cyanotic preconditioning generally does not require oxygen; cyanotic preconditioned children, unless contraindicated, should be given intermittent oxygen to improve the body’s hypoxic condition.
③, prevention of respiratory tract infection: children with left-to-right shunt preconditioning should be prevented from catching a cold and pneumonia, and once the infection is treated actively to prevent the deterioration of cardiac function due to infection.
④, medication: mild cases may not require medication, those with cardiac insufficiency manifestations should be medicated under the guidance of a doctor, with symptomatic treatment such as cardiac strengthening, diuretic, vasodilator and potassium preservation.
11.What should I pay attention to after surgery for precordial disease?
The output includes urine, stool, drainage fluid, sweat, vomit, etc.
②, prevention of infection: strengthen back patting physical therapy, encourage coughing and sputum production, prevent pulmonary infection, pulmonary atelectasis and other complications, older children are encouraged to move to the ground as early as possible, which can stimulate gastrointestinal peristalsis, improve appetite and promote wound healing. Surgical incision: Keep the area dry, avoid rubbing and scratching, and give analgesic treatment if the pain is severe. Temperature: Some children may have a low fever (<38℃) 3-5 days after surgery, which is usually absorption fever. Daily monitoring of the child's heart rate is required before the administration of digitalis (digoxin).