I. What is congenital heart disease (precocious heart disease)?
During pregnancy, during the first 2-3 months of pregnancy, is the period when the fetal heart and large blood vessels are formed. During this period, if the formation of the heart and large blood vessels is impaired and thus causes abnormalities in the local anatomy of the heart and blood vessels, it is called congenital heart disease.
Second, what is the incidence of congenital heart disease?
Congenital heart disease has become the first cause of birth defects, the main cause of perinatal death and child mortality, and the first among non-infectious death diseases in newborns, of which about 80% are simple congenital heart disease.
Congenital heart disease within 1 year after birth accounts for 7‰-8‰ of live births, the incidence of premature infants is 2-3 times that of immature children, the incidence of stillbirth congenital heart disease is 10 times that of live births, with severe congenital heart disease accounting for about 20%. According to this projection, there are about 100,000 to 150,000 new children with prematurity in China every year, and if they are not diagnosed and treated, about 1/3 of them die within one month after birth, and about 10% of them have pulmonary hypertension, which seriously affects the physical and mental health of the children.
About 25% of children with congenital heart disease have extracardiac malformations, such as malformations of the muscular and skeletal systems (polydactyly, upper limb malformation, microcephaly), deafness, mental retardation, etc.
What are the causes of congenital heart disease?
The causes of congenital heart disease are multifaceted and are currently believed to be based on genetic defects (chromosomal abnormalities, single gene mutations, multiple gene mutations) and influenced by environmental factors. Common environmental factors are
1, intrauterine infection, intrauterine hypoxia, rubella virus is the main culprit of fetal CHD. Pregnant women infected with rubella virus, especially in the 4-12 weeks of pregnancy, the incidence of cardiac malformation can reach 15-20%
2.Use of teratogenic drugs during pregnancy (such as birth control pills, aspirin, erythromycin, etc.)
3, physical and chemical factors: parents before pregnancy, or pregnant women in early pregnancy exposure to dyes, paints, coatings, organic solvents (such as xylene), pesticides, herbicides, rodenticides, etc. can increase the risk of the development of precardiac disease
4, early pregnancy fever can increase the occurrence of precocious heart disease in the offspring reported
5, Pregnant women smoking and drinking alcohol during pregnancy can increase the risk of fetal precocious heart disease
6, living around dangerous garbage dumps and some areas with toxic chemicals in the air, the incidence of precocious heart disease is significantly higher
7, diabetes and anemia during pregnancy are closely related to the occurrence of precocious heart disease
8, obese pregnant women have an increased risk of fetal precocious heart disease, which may be related to the decrease in glucose tolerance of these pregnant women
9, early pregnancy mental stimulation is also one of the possible risk factors for the occurrence of congenital heart disease
4. Is congenital heart disease hereditary?
The incidence of congenital heart disease is 10 to 14 times higher in siblings and children of patients with congenital heart disease than in the general population, which suggests that congenital heart disease has a hereditary character. Those with a family history of CHD should monitor the fetal heart during pregnancy.
If the mother has CHD, the risk of developing precordial disease in the second generation is about 10% for atrial septal defect, and the risk of reoccurrence in siblings and children of the first witness is 2.5% to 4.6%. The population prevalence of ventricular septal defect in Asia is 1.2% to 3.1%, and the risk of reoccurrence is 3.3% to 4.4% for siblings and 3.7% to 4.0% for their children.
If the parents are healthy and the first child has preeclampsia, the probability of the second child having the disease is 1-6%. If the first child has precocious heart disease and either parent also has precocious heart disease, the risk increases to 3-18% for the second child.
If two consecutive children are born with congenital heart disease, the possibility of having another child with congenital heart disease increases to 10%.
V. How many types of congenital heart disease are there?
According to the presence or absence of cyanosis (cyanosis refers to the purple color of the skin and mucous membranes), patients can be roughly divided into two categories: non-cyanotic and cyanotic. The non-cyanotic type includes atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary valve stenosis, etc. The cyanotic type includes tetralogy of Fallot, right ventricular double outlet, single ventricle, etc. The common precordial diseases in China are, in order: 21.4% for atrial septal defect, 21.2% for patent ductus arteriosus, 13.1% for tetralogy of Fallot, 2.8% for Eisenmenger’s syndrome, 1.4% for aortic constriction, etc. The same patient can have two or more malformations co-existing.
Six, what are the main manifestations of children with precordial disease?
1, heart failure: neonatal heart failure is considered an emergency, usually most of them are due to more severe heart defects in the child. The child is pale, breath-holding, dyspnea and tachycardia, with a heart rate of up to 160-190 beats per minute, and blood pressure is often low. The liver is large, but peripheral edema is less common.
2. Cyanosis: It arises due to shunting of venous blood into arterial blood due to right-to-left shunt. Appears cyanosis of nasal tip, lips of mouth, finger (toe) nail bed.
3.Squatting: Children with cyanotic congenital heart disease, especially those with tetralogy of Fallot, often squat after activity to relieve respiratory distress, which increases the vascular resistance of the body circulation thereby reducing the right-to-left shunt produced by intracardiac defects and also increases the return of venous blood to the right heart, thereby improving pulmonary blood flow.
4, pestle finger (toe) and erythrocytosis: cyanotic congenital heart disease is almost always accompanied by pestle finger (toe) and erythrocytosis. Erythrocytosis is a physiological response of the body to arterial hypoxia. Normal human hemoglobin is about 130g/L, while it can increase to more than 180g/L or even more than 200g/L in children with cyanotic congenital heart disease.
5. Pulmonary hypertension: When a patient with septal defect or ductus arteriosus develops severe pulmonary hypertension and cyanosis and other syndromes, it is called Eisenmenger’s syndrome. The clinical manifestations are cyanosis, erythrocytosis, pestle-like fingers (toes), and signs of right heart failure such as jugular venous anger, hepatomegaly, and peripheral tissue edema, and most patients die before the age of 40. Previously, it was thought that the patient had lost the chance of surgery at this time, and the only thing waiting was heart-lung transplantation, but with the progress of science and technology, the rapid development of cardiovascular surgery, new pulmonary artery pressure-lowering drugs have been developed, and some patients with pulmonary hypertension can be cured.
6, developmental disorders: children with congenital heart disease often develop abnormally, manifesting as thinness, malnutrition, and delayed growth.
7, other: chest pain, syncope, sudden death.
Seven, how to early detection of children with congenital heart disease?
1. Growth retardation and feeding difficulties.
2. Cyanosis, shortness of breath and reduced activity tolerance after birth.
3, Occasional transient loss of consciousness, convulsions, with the age of the child appears like squatting, pestle finger, these children are easier to diagnose early.
4, cyanosis is not obvious. There is a murmur on auscultation of the heart. In mild cases, there may be no symptoms or only mild symptoms, and the symptoms appear late. This type of children is often missed.
5.Children with congenital heart disease often have thoracic deformity.
VIII. What is the prognosis of congenital heart disease?
Mild type: can live to adulthood or even old age. Patients with cyanotic type and compound malformation, if not treated surgically, often have difficulty to live to adulthood, and some die in infancy.
How to prevent congenital heart disease?
The cause of congenital heart disease has not been elucidated, but it is generally believed that it is the result of the interaction between genetic and environmental factors. Therefore, the main preventive measures are: pay attention to pregnancy health, avoid contact with disease-causing environmental factors; regular fetal examination, early detection of congenital heart disease.
Can congenital heart disease heal naturally?
Some congenital heart diseases have a certain rate of self-healing. Small secondary foramen ovale septal defect: the natural closure rate is higher before 3 years old, about 40%, and the natural closure rate is as high as 80% within 18 months. small ventricular septal defect before 3 years old: the natural closure rate is 30-40%, and the natural closure rate is higher for small membrane septal defect within 1 year old, and the inflow or outflow septal defect cannot become smaller or close naturally. Arteriovenous ductus arteriosus: functional closure starts 15 hours after birth, complete closure after 1 month, and the natural closure rate is very low after the poppy stage.
XI. What tests are routinely required for congenital heart disease?
1.Color ultrasound examination of the heart (so-called color ultrasound, ultrasound or color Doppler examination);
2.Electrocardiogram;
3.Frontal and lateral views of the heart;
4, if necessary, cardiac catheterization and cardiovascular angiography to further clarify the diagnosis and understand the severity of the disease
12.What is congenital heart disease intervention?
Interventional treatment of congenital heart disease is carried out on the basis of interventional diagnosis. Under the guidance of x-ray television and ultrasound, catheters are sent along the inguinal vessels to the heart, and after diagnosing the heart with imaging such as manometry or imaging, quantitative or qualitative treatment is done to the lesion site, and then the lesion is blocked, dilated or embolized with specially designed equipment.
XIII. Which congenital heart diseases can be treated by intervention?
About 50% or more of congenital heart diseases can be cured by intervention. The common ones are atrial septal defect, patent ductus arteriosus, ventricular septal defect, pulmonary valve stenosis, aortic constriction, pulmonary artery branch stenosis, pulmonary arteriovenous fistula, coronary artery fistula, aortic sinus aneurysm rupture, Farrow’s triad, Ruedenbach’s syndrome, pulmonary artery atresia with intact septum, anomalous main-pulmonary artery side branch, and leukoaraiosis, etc.
XIV. What is the appropriate age for interventional treatment?
1.Arteriovenous catheterization: interventional treatment can be performed at least 6 months old.
2.Atrial septal defect and ventricular septal defect: Since there is a certain rate of self-healing before the age of 3, intervention should be performed after the age of 3.
3.Pulmonary valve stenosis or atresia: intervention can be performed more than 3 months.
4, other precordial diseases according to the condition, age flexibility is greater.
15.What is secondary foramen ovale septal defect?
Atrial septal defect is a kind of congenital heart disease due to the septal development disorder of the atria, there is a defect between the two atria, so that blood is shunted from the left atrium to the right atrium through the defect, and its incidence accounts for about 12-20% of congenital heart disease. It is divided into two major categories, secondary orifice type and primary orifice type. Secondary foramen type atrial defect is suitable for interventional treatment.
16.What are the precautions after secondary foramen atrial septal defect treatment?
After the interventional treatment, children should be allowed to eat water only after 2 hours after waking up from general anesthesia, and adults who undergo intraoperative esophageal ultrasonography should also eat water after 2 hours after the operation. The salt bag at the puncture site is pressurized for 6 hours, and the lower limb on the operated side cannot be flexed for 24 hours, and the gauze can be removed after 24 hours. Those with normal postoperative reexamination can be discharged in 2 to 3 days. Avoid infection after surgery, avoid strenuous exercise for 3 months, and outpatient review at 1 month, 3 months and 6 months after surgery.
XVII. What is the treatment effect of secondary foramen atrial septal defect?
Previously, atrial septal defect of secondary foramen requires open-heart surgery to be cured, and patients need to overcome the hurdles of general anesthesia, open-heart surgery and postoperative recovery. Even if the surgery is successful, the postoperative scar often affects the quality of life. Interventional treatment is simple, with a success rate of more than 99%, no chest opening, little trauma, fast recovery, short hospital stay and no scar, so it has become the preferred method for atrial defect treatment.
18.What is oval foramen ovale failure?
During the development of fetal heart, one secondary septum is separated from the other primary septum when the septum is fully developed, and a live valve-like orifice, namely foramen ovale, can remain between the two septums. The fetus relies on the foramen ovale to deliver nutritious blood throughout the body during its growth and development in the mother’s uterus. After birth, the fetal circulation is terminated, the blood pressure in the left atrium is higher than that in the right atrium, and the valve is closed. If the residual valve orifice is not closed, the foramen ovale is not closed. About 25% of normal people have unclosed foramen ovale.
Does the foramen ovale not need to be treated?
However, for those who are older than 40 years old, especially women, if they are at risk of lower extremity vein thrombosis (such as pregnancy, lower extremity varicose veins, etc.), right heart thrombus may enter the left heart through the foramen ovale, causing cerebral embolism and migraine, and interventional treatment to seal the unclosed foramen ovale can be considered at this time.
20.What is arteriovenous catheter failure?
The main arterial duct is located between the descending part of the aortic arch and the pulmonary artery, and is an important channel for fetal circulation. After birth, the pulmonary vessels open and the ductus arteriosus closes. If there is a congenital defect in the closing mechanism, it constitutes a clinical ductus arteriosus. In the past, arteriovenous ductus arteriosus was mainly treated by open-heart surgery ligation, which had a certain recanalization rate. Currently, intervention has become the treatment of choice for patent ductus arteriosus. For patients with recanalization after open-heart ligation, blocking treatment can also be performed without re-opening the chest.
21.What is interventional treatment for unclosed arterial catheter?
Interventional treatment of unclosed arterial catheter refers to the creation of a wire track by puncturing the inguinal vessels and feeding a mushroom-type blocking device along the track to seal the arterial catheter in the unclosed catheter. The blocking method avoids the risk of fatal hemorrhage caused by disconnection of the ligature point.
22.What are the advantages of interventional treatment of unclosed arterial catheter compared with surgical repair surgery?
Surgical ligation of the arterial catheter requires an open chest, which is traumatic and results in long recovery and hospitalization times, and carries certain risks and complications, such as recurrent laryngeal nerve paralysis of about 2-5%, recanalization of the arterial catheter of about 2-3%, and surgical mortality of about 0.5-1% in adult patients, and fatal hemorrhage due to the increased fragility of the catheter and rupture of the ligature. Interventional treatment is embolization from inside the catheter, which does not affect the catheter wall and has the advantages of safety, reliable efficacy, simple method, short recovery and hospitalization time, etc. It has become the preferred method.
23.What is pulmonary stenosis?
Congenital pulmonary valve hypoplasia causes fusion of the valve leaflet junction, thickening of the valve leaflet, and narrowing of the opening, resulting in obstruction of right ventricular ejection, which is called pulmonary valve stenosis.
What is interventional treatment of pulmonary stenosis?
Open-heart surgery for pulmonary stenosis is to cut open the adherent valve leaflets, while interventional treatment is to send a balloon through the femoral vein to expand the adherent pulmonary valve and reduce the right ventricular ejection resistance, which is safe, minimally invasive and has the advantages of short hospital stay.
What is the effect of interventional treatment for pulmonary valve stenosis?
The FDA officially approved interventional therapy for the treatment of pulmonary stenosis in children and adults in 1987. Surgical procedures are highly invasive and have a mortality rate of about 3%. Interventional treatment is simple and technically mature, with quick recovery, short hospital stay, significant improvement in symptoms during long-term follow-up, and a very low incidence of postoperative restenosis.
26.What is ventricular septal defect?
A congenital ventricular septal hypoplasia in any part of the ventricular septum, or an acquired disruption of the integrity of the ventricular septum, resulting in blood flow from the left ventricle to the right ventricle, is called a ventricular septal defect.
What are the advantages of interventional treatment of ventricular septal defect compared with open-heart surgery?
Previously, ventricular septal defects were mainly repaired by open-heart surgery, sometimes requiring incision of the tricuspid valve or the right ventricular wall, which is highly traumatic and has an operative mortality rate of about 2-5%, and the postoperative myocardial scar can cause ventricular arrhythmia. The myocardial ventricular defect is deep, the surface is uneven, surgical repair is difficult, and there is a greater chance of residual separation. For acquired ventricular septal defects, such as ventricular septal perforation after myocardial infarction, the surgical mortality rate is 20-40%, while interventional treatment is safe and effective. Our hospital has completed more than 600 cases of interventional treatment for ventricular septal defect, which is less traumatic, with short hospitalization time and definite efficacy.
What should parents pay attention to after the interventional treatment?
1, one month after the operation should limit the amount of activity of the child, after one month should gradually increase the amount of activity and observe whether there is obvious shortness of breath and increased heart rate after the activity. If there is a discharge with medication, it should be taken on time.
2. Prevent colds. Especially for children who are prone to recurrent respiratory infections before surgery or children with pulmonary hypertension, more attention should be paid after surgery.
3.Aspirin should be taken for 6 months after the intervention of atrial septal defect and ventricular septal defect to avoid thromboembolism.
4.Generally, you can go to school after discharge from the hospital.
5, 1, 3, 6 months after the operation should go to the hospital for review.
What are the precautions before performing esophageal ultrasound examination?
Liver function and hepatitis must be checked before the esophageal ultrasound examination. It is best to eat easily digestible food 1 day before the examination, and no water should be consumed in the morning of the examination. If you have removable dentures before the examination, you must remove them, otherwise there is a risk of them falling out and accidentally entering the trachea. During the transesophageal ultrasound examination, the patient should control the respiratory rhythm, try to slow down the respiratory rhythm and increase the depth of breathing, which will reduce nausea, and if there is saliva can flow out automatically. The patient should not eat until 2 hours after the examination to avoid asphyxia caused by inadvertent aspiration into the trachea.
Thirty, what is congenital heart disease cardiac catheterization and cardiovascular angiography
Cardiac catheterization is the insertion of various functional catheters from the peripheral blood vessels to reach the heart and large vessels for pressure measurement, blood sampling to obtain information, and calculations to make an accurate physiological diagnosis. Cardiovascular angiography is performed by sending a cardiac catheter into some important heart chambers and blood vessels and injecting a contrast courser to make a more accurate anatomical diagnosis of the heart. Although the development of imaging technology such as echocardiography has made it possible to directly confirm the diagnosis of some simple precardial diseases, cardiac catheterization and cardiovascular angiography are still the final method to decide the diagnosis for infants and complex precardial diseases.
What are the indications for cardiac catheterization and cardiovascular angiography?
1.Complex precordial disease requires accurate anatomical and physiological evaluation.
2.Left-to-right shunt preconditioning with pulmonary hypertension, to understand pulmonary artery pressure and resistance.
3.Aortic arch lesions to clarify the length and extent of the lesion.
4.Evaluation of peripheral vascular lesions: such as pulmonary artery branches, aortic side branches, pulmonary veins and coronary arteries.
5.Evaluation of postoperative efficacy of new surgical methods for precordial disease.
Thirty-two, what is pulmonary hypertension?
Pulmonary hypertension is a progressive increase in pulmonary artery pressure, with mean pulmonary artery pressure exceeding 20 mmHg at rest and 30 mmHg during exercise, and mean small pulmonary artery pressure below 15 mmHg. Pulmonary hypertension is diagnosed as pulmonary artery systolic pressure greater than 40 mmHg when pulmonary artery pressure is estimated by echocardiography.
Patients with definite diagnosis of pulmonary hypertension, if not combined with precordial disease, tend to develop progressive hypoxia, right heart failure and death within a few months to a few years. Half of the patients die 2.8 years after definitive diagnosis, and the mortality rate is closely related to the cardiac function class. patients with NYHA cardiac function class I-II have an average survival rate of 6 years, patients with cardiac function class III have an average survival rate of 2.5 years, and patients with cardiac function class IV have an average survival rate of only 6 months.
The congenital heart disease that is not treated in time often develops into pulmonary hypertension, and about 28% of foreign patients with congenital heart disease have combined pulmonary hypertension, and the incidence of ventricular septal defect and arteriovenous ductus arteriosus is high. The incidence of pulmonary hypertension is higher in China, where medical resources are unbalanced and the best time has passed when congenital heart disease is diagnosed and treated. The 5-year or 10-year survival rate of pulmonary hypertension secondary to precocious heart disease is high. When pulmonary hypertension develops to the point of bruising of the lips and mouth, it is called Eisenmenger syndrome, which has the highest mortality rate of about 20.6%.
Can severe pulmonary hypertension in combination with precordial disease be treated?
It was thought that severe pulmonary hypertension was difficult to treat, and in the past, it mainly relied on clinical experience and applied some drugs for the symptomatic treatment of heart failure, but not interventional or surgical treatment. At present, after continuous efforts, three kinds of drugs have been developed for the treatment of pulmonary artery pressure, such as oral, intravenous, and nebulized inhalation drugs, such as iloprost nebulized and intravenous preparations, oral endothelin receptor antagonists, and oral 5-phosphodiesterase inhibitors. At present, the above three drugs have been introduced in China, and after the pulmonary artery pressure is reduced by regular treatment, the precordial disease can be treated by intervention or surgery. Many patients in our hospital have completed the interventional treatment of precordial disease after applying the above drugs.