Congenital heart disease
Congenital heart disease is congenital heart disease. Congenital heart disease is the most common type of congenital malformation, accounting for about 28% of all kinds of congenital malformations, referring to the anatomical structure abnormalities caused by the formation disorders or abnormal development of the heart and large blood vessels during embryonic development, or the failure to close channels that should be automatically closed after birth (normal in the fetus). The incidence of congenital heart disease is not to be underestimated, accounting for 0.4% to 1% of births, which means that there are 150,000 to 200,000 new congenital heart disease patients in China every year. The spectrum of congenital heart disease is particularly broad, including hundreds of specific subtypes, some patients can be combined with a variety of malformations, the symptoms vary widely, the least can be asymptomatic for life, the most serious patients are born with serious symptoms such as hypoxia, shock and even premature death. According to the hemodynamic and pathophysiological changes, congenital heart disease can be classified as cyanotic or non-cyanotic, and can also be divided into three categories according to the presence or absence of shunts: no shunt (e.g. pulmonary stenosis, aortic constriction), left-to-right shunt (e.g. atrial septal defect, ventricular septal defect, patent ductus arteriosus) and right-to-left shunt (e.g. tetralogy of Fallot, large vessel dislocation).
A small number of congenital heart diseases have a chance of self-healing before the age of 5 years, and a small number of patients have mild malformations that do not significantly affect circulatory function and do not require any treatment, but most patients require surgical treatment to correct the malformations. With the rapid development of medical technology, the effect of surgery has been greatly improved. Currently, most patients can recover as normal with timely surgery, and their growth and development will not be affected, and they will be able to perform their ordinary work, study and life needs.
Premature heart disease – etiology
It is generally believed that early pregnancy (5-8 weeks) is the most important period of fetal heart development, and there are many causes of congenital heart disease, genetic factors only account for about 8%, while the majority of 92% are caused by 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 sharply increase the risk of congenital heart disease in children.
Congenital heart disease – clinical manifestations
There are many types of congenital heart disease, and their clinical manifestations depend mainly on the size and complexity of the malformation. Complex and severe malformations can present with serious and even life-threatening symptoms soon after birth. It should be noted that some simple malformations such as ventricular septal defect and patent ductus arteriosus 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 losing the opportunity for surgery. The main symptoms are.
1. frequent colds, recurrent respiratory infections and susceptibility to pneumonia.
2. poor growth, wasting and excessive sweating
3, weak sucking during breastfeeding, difficulty in breastfeeding, or infants refusing to eat, choking and coughing, and shortness of breath in general.
4. children complaining of easy fatigue and poor stamina
5. bruising of the lips and nails or bruising after crying or activity, pestle-shaped fingers and toes (nail bed raised like a hammer).
6, preference for squatting, fainting, hemoptysis.
7. auscultation reveals a heart murmur.
Precordial disease – diagnosis
The diagnosis is usually made by symptoms, signs, electrocardiogram, X-ray and echocardiogram, 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 extent, type and scope of the lesions, make a clear diagnosis and guide the formulation of treatment plans according to the situation.
Congenital heart disease – treatment
1. In general, only a few types of congenital heart disease can recover naturally, while others will gradually increase in complications and worsen with age.
The choice of treatment and the right timing of surgery depends on the extent and degree of congenital heart malformation. Simple and mild anomalies such as atrial septal defect and simple pulmonary valve stenosis, if the diameter of the defect is small, have no significant hemodynamic impact and can be treated without any treatment for life. Severe congenital heart disease such as complete transposition of the great arteries or hypoplastic left heart syndrome must be operated immediately after birth, otherwise the child will not survive.
2. Cases of congenital heart disease under conservative observation.
(1) Secondary foramen ovale defect with small diameter and no tendency of pulmonary hypertension can be observed until 3 to 5 years of age before surgery.
(2) Membranous ventricular septal defect less than 4 mm in diameter has a mild effect on cardiac function and has the possibility of automatic closure, so it can also be observed until 3 to 5 years of age, and surgery should be considered if the ventricular defect still fails to close. Since small ventricular defects have the potential to induce bacterial endocarditis, and the safety of surgical procedures is currently very high, it is not recommended to wait for a longer period of time.
(3) Aortic valve with transvalvular pressure difference less than 40 mmHg and pulmonary valve stenosis less than 60 mmHg. The prerequisite for conservative treatment in these cases is that cardiac ultrasound must be performed more than twice in a hospital with a high level of precordial surgery, and that regular follow-up observations and necessary examinations are required during the observation period to avoid misdiagnosis and delayed treatment.
3. Choosing the right time for surgery is the key to successful surgery and good prognosis for precordial disease.
At present, there are several major factors in determining the timing of surgery.
(1) the pathological characteristics of the preconditioning itself and the degree of impact on hemodynamics Generally speaking, the more complex the malformation, the greater the impact on hemodynamics, and the more early surgery should be performed.
(2) Progression of secondary pathological changes
In the case of left-to-right shunt preconditioning, surgical correction should be sought before the development of obstructive pulmonary vascular changes. Cyanotic and obstructive congenital heart disease should strive for surgery before the occurrence of severe myocardial hypertrophy and fibrous degeneration.
4. Treatment methods of congenital heart disease.
There are various kinds of surgical treatment, interventional treatment and drug treatment. The choice of treatment and the most appropriate time for surgery should be based on the condition and recommended by the cardiologist according to the specific situation of the child. The non-shunt or left-to-right shunt category has a good outcome and a good prognosis after timely surgery. For those with right-to-left shunt or compound malformation, the surgery is complicated and difficult in more severe cases, and some patients cannot be completely corrected due to imperfect development of certain cardiac structures, so only palliative surgery can be performed to alleviate symptoms and improve the quality of life.
Interventional treatment is broadly divided into two categories: one is the use of balloon dilation to release the stenosis of blood vessels and valves, such as aortic stenosis, pulmonary stenosis, aortic constriction, etc.; the other is the use of a variety of special blockers made of memory metal to close the undesirable defects, such as atrial septal defect, ventricular septal defect, arterial catheter closure, etc. Due to the progress of medical technology and the continuous research and improvement of materials and processes, interventional treatment is now further developed in domestic and international clinical applications, which not only can avoid the risks and trauma of open-heart surgery, but also has short hospitalization time and fast recovery, and is a very effective treatment method. Interventional therapy has partially replaced but not completely replaced surgical open-heart surgery, and there are strict indications for this technology.
The surgical methods for precardiac disease are determined by a combination of factors such as the type of heart malformation and the degree of pathophysiological changes, and can be divided into three categories: radical surgery, palliative surgery, and heart transplantation.
(1) Radical surgery It allows the patient’s heart anatomy to return to a normal human structure.
(2) Palliative surgery
(2) palliative surgery can only improve the symptoms but not the root effect, mainly used for complex precardiac diseases for which there is no cure, such as modified Glenn and Fontan surgery, or as a preparatory surgery to promote the growth and development of the original undeveloped structures, creating conditions for the root surgery, such as body-lung bypass.
(3) Heart transplantation is mainly used for end-stage heart disease and complex precardiac diseases that cannot be treated by current surgical methods.
Pre-heart disease – prevention
1.Marriage and childbirth at the right age
Medical science has proven that the risk of fetal genetic abnormalities increases significantly in pregnant women over the age of 35. 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 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 early pregnancy actively prevent rubella, influenza and other rubella viral diseases. Pregnant women should try to avoid taking drugs, if they must be used, it must be done 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.