The most common congenital heart diseases in adults
Two-valve aortic and atrial defects are the most common, followed by aortic constriction and pulmonary valve stenosis. The most common ventricular defect in pediatric patients can survive into adulthood without surgery, and most of these ventricular defects have auto-atresia. Adults are not likely to have complex congenital heart disease, and if they do, they usually do not survive into adulthood.
What are the congenital anomalies of the coronary arteries?
The most common is a portion of the left anterior descending branch that travels inside the myocardium. This causes ischemia (angina pectoris) or even myocardial infarction and sudden death in the left anterior descending coronary artery during myocardial contraction. Ectopic right or left coronary artery is usually asymptomatic, unless the ectopic coronary artery travels between the aorta and the right ventricular outflow tract, in which case the proximal coronary artery can be compressed, resulting in myocardial ischemia. Coronary ectopia originates in the pulmonary artery, and congenital coronary arteriovenous fistulas are symptomatic at a young age.
Symptoms of diastolic aortic valve
The bicuspid aortic valve may be normal at birth, and some patients have normal valve function for a long time and are asymptomatic. Most patients develop aortic stenosis and aortic valve insufficiency. The main cause is progressive fibrous calcification and thickening of the aortic valve of the bicuspid type, and finally aortic stenosis. About 50% of cases
About 50% of cases require surgical treatment.
The bicuspid aortic valve is the most common cause of isolated aortic insufficiency. Both aortic stenosis and insufficiency progress slowly, and sudden onset aortic insufficiency is usually caused by infective endocarditis. Diastolic aortic valves are a risk factor for infective endocarditis.
Signs and Symptoms of Atrial Defect
Many patients with atrial defects have no symptoms and no obvious signs. Although life expectancy is shortened, there is usually a long asymptomatic period. Most patients do not become symptomatic until after the age of 40 years, when the left-right shunt, combined with age-related decrease in left ventricular compliance, leads to exertional dyspnea and heart failure. Atrial arrhythmias, especially atrial fibrillation, can induce heart failure. Prolonged left-right shunt causes pulmonary hypertension, which may also lead to exertional cyanosis, hemoptysis, and chest pain.
Typical manifestations of atrial fibrillation
1, wide fixed splitting of the second tone in the pulmonary valve area;
2, murmur in the pulmonary valve area (due to increased blood flow through the pulmonary valve);
The electrocardiogram shows a right-sided electrical axis with large right ventricle (increased V1 R); pulmonary hypertension in the late atrial defect may cause cyanosis, rod-like fingers, pulmonary valve P2
Because atrial defect is often combined with mitral valve prolapse, regurgitant murmur and karate sound can be heard in the mitral valve area, and many patients have atrial premature.
What are the typical manifestations of aortic constriction?
A: 1, upper extremity pulses are more obvious than lower extremity pulses;
2.Systolic murmur can be heard in the left back;
3, Chest radiograph shows rib compression, caused by the expansion of the collateral circulation of the intercostal artery;
4, upper extremity hypertension, advanced heart failure, and susceptibility to endocarditis.
What are the congenital anomalies of tetralogy of Fallot?
1.Ventricular defect;
2, right ventricular outflow tract obstruction;
3.Aortic span;
4. right ventricular hypertrophy.
Tetralogy of Fallot accounts for 10% of all congenital heart diseases and is the most common type of congenital heart disease after 1 year of age. The presence of clinical symptoms depends on the degree of pulmonary artery flow obstruction.
Patients with tetralogy of Fallot are prone to ventricular arrhythmias after surgery, and the risk factors for sudden death in these patients are
1. advanced age;
2. right ventricular end-diastolic pressure > 10 mm Hg;
3, right ventricular end-systolic pressure > 60 mm Hg;
4, poor right ventricular systolic function;
5. Significant tricuspid or pulmonary regurgitation.
What is Eisenmenger syndrome? What is Eisenmenger syndrome?
Eisenmenger syndrome is a broad term that refers to any pathophysiologic process that increases pulmonary blood flow and causes increased pulmonary artery resistance with or without a right-to-left shunt. Eisenmenger’s syndrome is irreversible, but in less severe cases, pulmonary hypertension may improve after corrective surgery for congenital heart disease.
Diagnostic value of UCG for atrial defects
UCG can detect atrial diaphragm defect, right atrium and right ventricle enlargement; pulmonary artery hypertension; Doppler examination can detect high velocity blood flow through the atrium; UCG imaging can diagnose left-right shunt; intravenous injection of tiny bubbles of saline can reveal left-right shunt at the level of the atrium. In a right-to-left shunt, a negative column of blood flow without contrast is seen in the right atrium with bubble echoes around the column.
What are the congenital heart diseases that are prone to endocarditis?
diastolic aortic valve, aortic constriction, interventricular diaphragm defect, tetralogy of Fallot, pulmonary stenosis (moderate or severe), severe mitral or tricuspid regurgitation, and prosthetic heart valves.
Is mitral valve prolapse a congenital heart defect?
Although some congenital heart diseases can be associated with mitral valve prolapse, mitral valve prolapse is generally not a congenital heart disease. Many diseases can cause degenerative changes to the mitral valve, affecting the valve itself and surrounding structures.
Can people with congenital heart disease participate in sports activities?
The risk of physical activity depends on the type of congenital heart, the functional status of the heart, and the type of physical activity.
1.Congenital aortic stenosis (mild, pressure difference < 20mm Hg) can be avoided if the ECG exercise test, cardiac function and Holter monitoring are normal, but it is contraindicated if angina pectoris or syncope occurs after exercise. In moderate and severe cases, sports activities should be avoided;
2, pulmonary stenosis: mild; pressure step difference < 25 mm Hg, can be no restrictions, moderate to severe should be avoided;
3, tetralogy of Fallot: restrict or do not participate, dyspnea, increased cyanosis, arrhythmia may occur after exercise;
4, left coronary artery ectopic: do not participate, after exercise may appear angina pectoris, myocardial infarction, sudden death;
5, pulmonary hypertension: do not participate, after exercise may appear fainting, sudden death;
6.Atrial ischemia: according to the condition, exercise at your discretion. Small atrial defect – no limitation, medium to large atrial defect – do not participate.
Can congenital heart disease lead to pregnancy?
Pregnancy is possible in atrial defect, patent ductus arteriosus, pulmonary valve stenosis, aortic constriction, aortic valve disease, and tetralogy of Fallot.
The maternal mortality rate is related to the cardiac function; the mortality rate is 14% for YHA class I and II and up to 61.8% for class III and IV. Fetal morbidity and mortality rates are also related to maternal cardiac function class, ranging from 0% in N YHA class I to 30% in class IV. Atrial defect, diastolic aortic valve, and aortic constriction have little effect on the rate of pregnancy mortality, but attention should be paid to emboli and endocarditis. Pulmonary hypertension greatly increases the rate of death in pregnancy.
The maternal mortality rate in Eisenmenger syndrome can be 30-70% during pregnancy and after delivery. In congenital heart disease after surgical correction, the risk of pregnancy is not high, but it is also related to cardiac function. There is also a relationship between the number of residual defects after surgical correction. The mortality rate of the fetus is related to the state of the mother’s heart function, the presence of cyanosis, and the use of anticoagulants after delivery.