Tips.
1, precordial disease can generally be diagnosed by symptoms, signs, ECG, X-ray and echocardiography.
2, the clinical manifestations of precordial disease: easy to catch a cold, repeated whistling infections, susceptible to pneumonia, weakness to eat milk, blue lips, poor growth, wasting, murmurs in the anterior chest and other manifestations. Pan Xiangbin, Department of Pediatric Cardiac Surgery, Fu Wai Hospital, Beijing
3. Choosing the right timing for surgery and the surgical method is the key to successful surgery and good prognosis for precardiac disease.
Surgical open-chest direct vision surgery has the widest indications and is suitable for most patients; percutaneous interventional occlusion is the least traumatic and is suitable for older pediatric patients, and ultrasound-guided transthoracic occlusion is the most prudent and is suitable for younger children.
5, reduce the incidence of congenital heart disease to maintain good living habits, marriage and childbirth at an appropriate age, try to avoid taking drugs during pregnancy, less exposure to radiation, electromagnetic radiation, etc.
Congenital heart disease is the most common type of congenital anomalies, refers to the anatomical structure abnormalities caused by the formation of heart and large blood vessels during embryonic development or developmental abnormalities, or the failure to close the channel that should be automatically closed after birth, accounting for about 28% of all kinds of congenital anomalies. The incidence of congenital heart disease accounts for about 0.6% to 1% of all live births. Every year, up to 150,000 newborn babies are born with congenital heart disease in China. The common simple precocious heart diseases are: atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary valve stenosis, etc.
I. Etiology
It is generally believed that early pregnancy (5-8 weeks) is the most important period of fetal heart development, congenital heart disease has many causes, genetic factors only account for about 8%, while the majority of environmental factors, such as women taking drugs during pregnancy, infection with viruses, environmental pollution, radiation, etc. can cause abnormal fetal heart development. In particular, rubella virus infection in the first trimester of pregnancy can increase the risk of congenital heart disease in children dramatically.
II. Clinical manifestations
There are many types of congenital heart disease, and their clinical manifestations mainly depend on the size and complexity of the malformation. Complex and severe malformations can show serious symptoms shortly after birth and even become life-threatening. It is important to focus on some simple malformations, such as atrial septal defect, ventricular septal defect and patent ductus arteriosus, which can have no obvious symptoms in the early stage, but the disease can still potentially develop and worsen, requiring timely diagnosis and treatment to avoid missing the time for surgery. The main signs and symptoms in the early stage are usually.
(1) Frequent colds, recurrent whistling infections, and susceptibility to pneumonia.
(2) Blue lips and nails, or bruising after crying or activity.
(3) Infants usually have shortness of breath, choking and coughing, weakness in sucking during breastfeeding, and difficulty in breastfeeding.
(4) Poor growth, wasting, and weak crying.
(5) Poor physical strength, easy fatigue, long breaths.
(6) Squatting phenomenon: infants and toddlers do not hold their legs straight, but prefer to bend in the adult’s abdomen, like to lift their feet to the stool surface when sitting, and keep their lower limbs in a bent position when standing. After walking for a while, older children will squat down and rest for a while with both knees close to the chest.
(7) A heart murmur is detected on auscultation.
If the above symptoms appear, it is more likely that the child is suffering from precordial disease, and he/she should go to a regular hospital for examination in time to confirm whether he/she is suffering from precordial disease.
III. Diagnosis
Generally, diagnosis can be made through symptoms, signs, ECG, X-ray and echocardiography, and the hemodynamic changes, degree and extent of lesions can be estimated to determine the treatment plan. For congenital heart disease with multiple malformations and complex and difficult cases, the specialist will selectively take 3D CT examination, cardiac catheterization or cardiovascular angiography to understand the degree, type and scope of the lesion, make a clear diagnosis and guide the formulation of treatment plan according to the situation.
IV. Treatment
Choosing the right timing and surgical method is the key to successful surgery and good prognosis of precordial disease.
There are two principles for choosing the timing of surgery: early detection and early intervention; the benefits must outweigh the risks. Precocious heart disease is like a whip that whips the child every day. When we plug the defect, it is equivalent to taking away the whip, but the trauma and scars left by the whip whip need to be repaired by the child himself. The later the treatment, the greater the trauma and the slower the recovery. Many parents ask me, “Why do other children’s hearts return to normal size so quickly after surgery, but our children have been there for so long and their hearts are still big?” This is the danger of late treatment. So shouldn’t all children be treated as soon as they are born? Of course not, because the timing of surgery must be weighed against whether doing it at this time will do more good or more harm. The younger a child is, the less able he or she is to withstand the blows of surgery, and the surgery itself is a kind of injury to the child, just like a punch with the same force on an adult, which may be stabilized with a few steps back, but on a child it may be injured. So when it comes to the timing of treatment, parents should be reminded that there are risks involved in waiting and treating precardiac disease, and they must follow the advice of their doctor, who will judge the situation on a case-by-case basis, and we make any decision to take the lesser of two evils, whichever method is the least harmful.
Since surgery can be harmful to the child, and different surgeries have their own advantages and disadvantages, it is important to choose the right surgical procedure. Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are common congenital heart diseases, and the conventional treatment methods include open-chest direct vision surgery and radiation-guided percutaneous interventional occlusion. Conventional open-heart surgery requires stopping the heart through a median or lateral incision, then cutting open the heart and repairing the defect by sewing a patch to the heart with a needle. Because of the high trauma and the need to stop the heart, radiation-guided percutaneous interventional occlusion has emerged to completely avoid the disadvantages of the first method, with the advantages of less trauma and no need to stop the heart, realizing the treatment of heart disease without surgery, but this method has the risk of radiation damage and failure of occlusion. Surgeons combined the two methods mentioned above and introduced ultrasound technology to create a third method that combines the advantages of both: ultrasound-guided transthoracic occlusion.
This method is performed through a tiny incision of about 2 cm in the chest, without radiation, without radiation, and without stopping the heart.
In order to treat heart disease without surgery or radiation, we have developed a fourth-generation treatment: ultrasound-guided percutaneous interventional occlusion. This new method is less invasive, with a wound the size of a grain of rice, and replaces the traditional percutaneous interventional occlusion with one that is done under ultrasound guidance, without the use of radiation, without radiation, without special protection, safe and reliable; most patients do not need general anesthesia, local anesthesia is sufficient, and the patient can fully communicate with the doctor during the procedure. The greatest benefit is that once the blocker is in place and the patient is found to be unsuitable for blocking, the procedure can be changed to open-chest direct vision surgery immediately, which can not only cure the disease by entering the operating room only once, but also reduce the patient’s burden and pain, and maximize the safety of the patient.
The above treatment methods complement each other and are suitable for different patients: surgical open-chest direct vision surgery has the widest indications and is suitable for most patients; ultrasound-guided percutaneous interventional occlusion is the least traumatic and is suitable for slightly older pediatric patients, and ultrasound-guided transthoracic occlusion is the most secure and is suitable for younger toddlers.
The invention of new technologies is better and more advanced than one another, but at the same time there are potential risks, only the benefits of the new technologies far outweigh the risks and are worth the risk. Let’s say: With the advancement of technology, daily transportation has also changed rapidly, and each kind of transportation also has potential risks, but why don’t you choose to walk from Beijing to Guangzhou, but prefer to choose the plane as the transportation? The reason is simple: this new mode of transportation brings us more convenience and benefits us more compared to the risks, and the same is true for the choice of surgery.
For daily care after blocking, some patients need to take six months of aspirin anticoagulation, which is very widely used and is very safe and does not have many side effects. The main side effect is that some children bleed when they brush their teeth. If this happens, contact the attending doctor first and reduce the amount of aspirin appropriately, and if the wound is accidentally cut, the bleeding can be stopped with more pressure.
In addition, there are some parents who have the following concerns.
(1) In some children with ventricular septal defect, the diameter of the defect is about three or four millimeters. (1) Some children with ventricular septal defects are about three or four millimeters in diameter. Our indication for surgery is three millimeters, and the child is right on the red line for surgery. It is important to note that the three-millimeter surgical indication is artificial and does not apply to all children, because people are different. For some children, a three-millimeter ventricular defect may have little effect, but for others, three millimeters is too large and may be too much for them. It is important to make a comprehensive judgment in combination with whether the child has frequent colds and fevers, no weight gain, enlarged heart and other symptoms.
(2) Will the blocker fall off as the child gets older after blocking surgery? This is a very good question, I have to explain this question many times almost every day in the clinic. First of all, the blocker is a drum-like structure with wide ends and narrow middle. Even if the two sides move back and forth, the wide position will be stuck on the edge of the defect, so it will not fall off. We will push it back and forth during the process of pushing in the blocker to see if it is stable. The force of this push is much stronger than the force of the heart beating by itself, and it will not fall off even with such a strong force to push, so the risk of it falling off again after release is very low.
In addition, there is a layer of endothelium inside our heart, which can be imagined as a layer of skin inside the heart. After the blocker is put in, the endothelium slowly climbs up and wraps the blocker inside, just like a cut in the skin, which will grow back after a while. There are several advantages of the endothelium encapsulating the blocker: the first one is that no more thrombus will grow, because it is completely its own endothelium, not a foreign body. The second advantage is that the plug will never fall out again, the umbrella will not grow, but the endothelium will grow together with the child, which means that in the future there will be no problem that the child grows up and the umbrella is not large enough and leaks again. A simple example is that for the grapevine climbing on the wall, the bamboo pole is just a guide, and after climbing up there is no need for the pole.
(3) Why is there a case of not being able to plug it up?
It is like buying shoes, although you wear size 40 shoes, but not all size 40 shoes in the mall you can wear, only when you put the shoes on your feet, you will only know whether they fit or not, the same with blocking surgery, first of all, try to block, only after the blocker has reached the correct position and really stuck on the defect, then you can check whether there is shunt, whether there is AV block, if there is no such situation, it means the surgery is successful. But if there is AV block, or if there is a shunt, we have to retract the blocker. This is a sign of good safety of the composite technique, and there is a way in and out. After retracting the blocker, the small incision is extended upward into a conventional surgical incision, and then the extracorporeal circulation is followed.
I often give parents an analogy, like going to buy a lottery ticket, as long as you enter the operating room, it is equivalent to winning five million, this time definitely cured the disease, if you can make the blocking surgery, it is equivalent to winning 10 million. It doesn’t matter if you don’t win $10 million, at least you can win $5 million. If the blocking is not successful, you can change to conventional surgery, and at least you can cure the child. This is the biggest advantage of the compound technology, only need to enter the operating room once, only anesthesia once, only spend a share of money, and then the disease can be cured.
V. Prevention
1.Marriage and childbirth at the right age
Medicine has proved that the risk of fetal genetic abnormalities increases significantly in pregnant women over 35 years old. Therefore it is best to have children before the age of 35. If this is not possible, then it is recommended that pregnant women of advanced age must undergo strict perinatal medical observation and health care.
2.Prepare to have a child before the psychological and physiological state should be well adjusted
If the mother-to-be has habits such as smoking and drinking alcohol, it is best to stop at least six months before pregnancy.
3.Strengthen the health care for pregnant women
Especially in the early pregnancy actively prevent rubella, influenza and other viral diseases. Pregnant women should try to avoid taking drugs, if they must use them, they must do so under the guidance of a doctor.
4.Minimize exposure to radiation, electromagnetic radiation and other adverse environmental factors during pregnancy.
5.Avoid traveling to high altitude areas during pregnancy
Because it has been found that the incidence of congenital heart disease in high altitude areas is significantly higher than that in plain areas, which may be related to the lack of oxygen.