Prevention begins during pregnancy
Congenital heart disease (congenital heart disease) often causes great suffering and a heavy financial burden to both the child and the family. So, how can we nip congenital heart disease in the bud?
The development of the heart begins when the embryo is 2 weeks old in the mother’s body, and the circulatory effect is present at about the 4th week, and the atria and ventricles are formed on the heart’s exterior by the 8th week. During this critical period of embryonic development, any intrinsic or extrinsic factors that affect the development of the heart can impair the development of a certain part of the heart, resulting in various types of congenital heart disease. Therefore, prevention of pediatric congenital heart disease should start before and during pregnancy.
Pre-pregnancy care
Before pregnancy, we should increase nutrition and strengthen physical exercise to enhance resistance to disease; for those who are exposed to radiation for a long time or receive radiation treatment, they should get pregnant after six months of being free from radiation; women who are often exposed to various pesticides and chemical drugs should strengthen protective measures; we should not use or use less sulfonamide and hormone drugs and do not use cosmetics containing hormones. The fetus is also highly susceptible to precocious heart disease if it is exposed to more indoor pollutants in the first trimester of pregnancy.
Health care during pregnancy
Prenatal checkups are performed on time, and fetal heart exams are usually available after 4 months for high-risk fetuses. During the third to eighth week of pregnancy, the fetus is susceptible to cardiovascular malformations if infected by viruses. Rubella virus is the main culprit of fetal precocious heart disease, and influenza, mumps, coxsackie virus and herpes virus are also often triggering factors.
The following symptoms are indicative of precocious heart disease in children
Various types of precardiac disease exhibit symptoms of varying severity, and a child should be thought of as having precardiac disease when the following symptoms occur.
1. persistent cardiac and whistling malfunction after birth
2. restlessness, high crying, weak sucking during feeding, difficulty in breastfeeding, and lack of weight gain
3, persistent cyanosis or recurrent confusion, easy shortness of breath after crying or activity, and bruised lips.
4, repeated pulmonary “pneumonia” manifestations, as well as repeated whistling infections.
5, some children with cyanotic precordial disease, can also appear pestle-like fingers and toes (i.e., soft tissue hyperplasia at the end of the hands or toes, in the shape of a drumstick), the longitudinal and transverse diameter of the nails are excessively curved like a parrot’s beak, which are caused by chronic hypoxia.
6, doctor auscultation found heart murmur, it should be noted that the severity of the murmur is not always proportional to the severity of the disease, some serious precardiac disease or the development of precardiac disease to a serious stage, cardiac auscultation on the contrary, no murmur.
The diagnosis of precardiac disease is mainly based on medical history, physical signs, chest X-ray and electrocardiogram, especially echocardiography. Some complex precordial diseases can be further diagnosed based on cardiac catheterization and selective cardiovascular angiography.
Timing of surgery for common precordial diseases
The main options include direct cardiac surgery, thoracoscopic techniques and interventional treatment. The timing and methods of treatment for common precordial diseases are divided according to different diseases as follows.
1, atrial septal defect: natural closure is possible within 1 year of age, the possibility of closure after 1 year of age is very small, it is appropriate to operate at the age of 4-5 years, asymptomatic and heart enlargement can continue to observe. If combined with heart failure or cyanosis, early surgery should be considered.
2, ventricular septal defect: small defects have the possibility of natural closure, but the possibility of closure after 5 years of age is very small, if there is no heart enlargement can continue to be observed. For children with large defects and often complicated by pneumonia or intractable heart failure, early surgery is recommended.
3, arteriovenous catheter failure: some children can avoid surgery and be cured by interventional treatment. Interventional treatment is suitable for children over 3 months of age and weighing more than 4 kg.
4. Tetralogy of Fallot: It is a common cyanotic heart disease, which is mostly treated by one-stage correction method and has better effect within 1 year of age. However, it is related to the degree and location of pulmonary artery stenosis, and the operation time can be postponed appropriately in mild cases.
5, transposition of great vessels: It is currently believed that the ideal transposition of great arteries should be performed within 2 weeks after birth.
6.Endocardial cushion defect: complete endocardial cushion defect needs to be operated within 1 year of age, while partial type can be operated at an optional stage, usually around 3 years of age.
Home care for children
For children with congenital heart disease, while cooperating with doctors for active treatment, parents’ attentive care is also important.
1, children with cardiac insufficiency tend to sweat more, need to keep the skin clean, bathe regularly in summer, use hot towels in winter to wipe their bodies (pay attention to keep warm). Keep the bowel movement smooth, so that excessive force will increase the abdominal pressure and increase the burden on the heart when it is difficult to defecate.
2. Children generally need to take cardiac drugs (digoxin tablets), diuretic drugs (spironolactone tablets) and potassium supplements (potassium citrate oral solution) for a period of time after surgery. It is worth noting that the child’s pulse should be monitored every day and digoxin tablets should be stopped if the heart rate is lower than 70 beats per minute.
3. Early activities after discharge should be moderate, especially in the 1 to 3 months after discharge, activities should be limited. The amount and intensity of activity can be gradually increased later. Avoid crowded public places to reduce the chance of whistle infection.
4.Weigh yourself regularly in the early postoperative period (within 1 to 2 months), usually once a week.
5.Regularly go to the hospital for review to understand the recovery of cardiac function. The principle is 3 months to 6 months after surgery. Those with cardiac insufficiency at the time of discharge need to be reviewed earlier.