What is congenital heart disease? A heart lesion that is caused by a local anatomical abnormality during human embryonic development (within the first 2-3 months of pregnancy) due to a disorder in the formation of the heart and large blood vessels, or a failure to close a channel that should close automatically after birth (which is normal in the fetus), is called congenital heart disease. Congenital heart disease is the most common type of congenital malformation. The incidence of congenital heart disease in China is about 7 to 10 per 1,000. What are the categories of congenital heart disease? According to the hemodynamic changes, congenital heart disease is customarily divided into three categories: 1. No shunt type (no cyanosis), that is, no abnormal pathways and shunts between the left and right sides of the heart or between the arteries and veins, and no cyanosis is produced. This includes aortic constriction, pulmonary stenosis, aortic stenosis and simple pulmonary artery dilatation. 2.Left-to-right shunt type (latent cyanosis type) This type has abnormal pathways between the circulatory pathways of blood flow between the left and right sides of the heart. In the early stage, because the pressure of the left side of the body circulation of the heart is greater than the pressure of the right side of the pulmonary circulation, the blood flow normally shunts from the left to the right without bruising. When the pressure in the pulmonary artery or the right ventricle increases and exceeds the pressure in the left side of the heart due to crying, breath-holding or any pathological condition, the blood can be shunted from the right to the left and temporary cyanosis can occur. For example, atrial septal defect, ventricular septal defect, patent ductus arteriosus, main pulmonary artery septal defect, and aortic sinus aneurysm breaking into the right heart or pulmonary artery. 3. Right-to-left shunt type (cyanotic type) The malformations included in this group also constitute abnormal traffic within the cardiovascular cavity on the left and right sides. The venous blood in the right cardiovascular cavity flows into the left cardiovascular cavity through the abnormal traffic, and a large amount of venous blood is injected into the body circulation, so persistent cyanosis can occur. For example, Tetralogy of Fallot, Tetralogy of Fallot, double outlet of right ventricle and complete transposition of the great arteries, permanent arterial trunk, etc. What are the risks of congenital heart disease? There are different risks depending on the different structural changes of the heart in children with congenital heart disease. If the pulmonary blood is reduced, the tissues become hypoxic and the activity ability is reduced, which affects the growth and development of the child; if the pulmonary blood is increased, it is easy to have repeated pulmonary infections and increase the burden on the heart, which can lead to heart failure; the stenosis and shunt in different parts of the heart can cause turbulence in the blood, which can lead to damage of the local endocardial structure and easily breed bacteria, causing infective endocarditis, etc. What are the clinical symptoms of congenital heart disease? Congenital heart disease is asymptomatic in mild cases and can be detected during physical examination, but in severe cases, there may be dyspnea, cyanosis and syncope after activity, and growth retardation in older children. The presence or absence of symptoms is also related to the type of disease and the presence or absence of complications. Those with severe pulmonary congestion are prone to frequent colds, recurrent bronchitis and pneumonia; infants have difficulty feeding or refuse to eat, choke and cough, and often have shortness of breath, pallor, and breath-holding. Children with little blood in the lungs show purple lips, face, fingers and toes, easy sweating, and a tendency to squat when walking or playing. Infants with congenital heart disease often lag significantly behind children of the same age in terms of development, manifesting as thinness, malnutrition, and delayed growth. When to treat congenital heart disease? Parents often think that their children are too young to withstand surgery, resulting in many children missing the best time for surgery, or seriously affecting the growth and development of the child. With the development of medicine, the timing of treatment for congenital heart disease should be determined according to the specific condition of the child. Once a child is considered to have precocious heart disease, he or she should be seen by a cardiac surgery specialist as soon as possible to determine the best time for surgery. Currently, the youngest age for cardiothoracic surgery at Xinhua Hospital is 2 weeks after birth. How is congenital heart disease treated? The treatment methods of congenital heart disease include interventional treatment, minimally invasive surgery with small incisions and conventional incisional surgery. All of the above treatment methods are the treatment techniques routinely carried out in our department, and we will choose the best treatment plan according to the specific condition of the child. Interventional treatment is less invasive, shorter, and has faster recovery, but only a small number of simple precardiac patients can use this method. Young and complex precardiac disease is not suitable for interventional treatment. For patients who need open-heart surgery, some patients can also complete the surgery through minimally invasive small incisions, which can achieve the purpose of curing heart disease, but also achieve hidden incisions, small trauma and meet the requirements of aesthetics. Should congenital heart disease surgery be done in stages? Most common congenital heart diseases can be cured in one stage of surgery. Children with cyanotic heart disease, or “purple babies” as they are often called, often present with a persistent generalized cyanosis after birth (or three to four months after birth) that worsens with activity and crying. This type of child should be treated as early as possible. If the heart and pulmonary vascular development meet the conditions for radical treatment, a one-time radical surgery is feasible. For those who are not eligible for radical surgery, they can undergo a reduction surgery first to improve their symptoms and create conditions for second-stage surgery. With the development of medicine, most of the “purple children” can be cured, or can improve the symptoms and quality of life.