The most common heart defects. Congenital heart defects in adults

What is meant by congenital heart disease? As a rule, these are defects in any anatomical structure of the heart - the septum, valves, great vessels (aorta and pulmonary artery). More than a hundred varieties of congenital heart disease are now known, as well as many of their combinations. Some heart defects are quite common, while others are relatively rare.

Why does congenital heart disease occur?

In the second or third week of pregnancy, the fetus begins to develop various systems, including the heart and great vessels. By the 4th week, when the fetus measures only a few millimeters, its heart already begins to beat. Complete formation of the heart and large vessels of the fetus is completed by the 8th week of pregnancy. The entire cardiovascular system begins to function properly. The occurrence of congenital heart disease is possible if, in the early stages of pregnancy, under the influence of some negative factor, a violation of the correct formation of organs occurs. The following can be considered as such agents that damage the fetus:

chemicals: varnishes, paints and others
some medications
infectious agents (viruses, etc.)
bad habits of a pregnant woman (smoking, alcohol, substance abuse and drug addiction)
unfavorable environmental conditions (industrial emissions, exhaust gases, radiation, polluted atmosphere)

Particular attention should be paid to the rubella virus. Its affinity for embryonic tissue is well known, which leads to the formation of not only heart defects, but also other congenital anomalies.

It has been reliably determined that in large industrial centers with unfavorable environmental conditions and operating chemical plants, the birth of children with congenital pathologies is higher than, for example, in rural areas.

Hereditary history of cardiovascular pathology and the presence of heart defects in other family members can also play a role.

Sometimes a child is born with a congenital defect, but the cause cannot be determined.

Classification of congenital heart disease

All congenital heart defects, depending on the color of the skin, can be divided into two large groups:

Blue type, occurring with cyanosis.
White type, occurring without cyanosis.

Cyanosis (blueness of the skin) is a symptom that occurs due to the mixing of venous and arterial blood.

In relation to the pulmonary circulation, which passes through the lungs, congenital heart diseases are divided into:

with small circle overload
with small circle depletion
without hemodynamic disturbances in the pulmonary circle

Depending on the violation of the anatomical integrity of a particular cardiac structure, congenital heart diseases can be:

valve
septal
combined

With valvular defects, there are abnormalities of the valves. Septal defects imply septal defects; combined congenital defects may include both valve pathology and septal defects or other anomalies.

Main symptoms

Most often, congenital heart disease is diagnosed in the maternity hospital.

The main symptoms are:

dyspnea
tachycardia
heart murmur heard by a doctor
possible cyanosis or pale skin
sluggish sucking

With mild congenital heart disease, these manifestations may not occur or they may appear in the child at an older age.

What else might cause concern?

Children with congenital heart disease are often born low birth weight. Sometimes such a child has normal body weight at birth, but then gains weight poorly, developmental delay and malnutrition occurs. Children with congenital heart disease with enrichment of the pulmonary circulation more often suffer from colds, which can be protracted or recurrent; a common acute respiratory infection in them can turn into bronchitis or pneumonia. It is especially worth being wary when a child often gets sick at an early age and does not attend preschool institutions.

And another cause for concern is the presence of pathological pulsations and the development of deformation of the chest in the area of the heart, the appearance of the so-called cardiac hump.

School-age children suffering from congenital heart disease may complain of poor health, weakness, headaches, dizziness, and pain in the heart.

The course of any congenital heart disease is assessed by signs of circulatory failure. These include:

dyspnea
tachycardia
liver enlargement
swelling
decreased exercise tolerance

The more pronounced the complex of these manifestations, the greater the degree of circulatory failure and the more severe the defect.

Diagnosis of pathology

Complaints and objective examination data will already allow one to suspect congenital heart disease.

An electrocardiogram will give an idea of the enlargement and overload of certain parts of the heart.

A chest x-ray will show the state of blood flow in the pulmonary circulation, an increase in the shadow of the heart and large vessels.

ECHO-CG (ultrasound of the heart) will determine the specific topic of congenital heart disease, identifying defects in the septa and valves, and assessing the condition of the great vessels.

The most common congenital heart diseases

The most common congenital heart defects are septal defects.

ASD– atrial septal defect, in which there is a pathological communication between the right or left atria, and blood is discharged through it. This is a white type of congenital heart disease with enrichment of the pulmonary circulation. Large atrial septal defects occur with enlargement of the right chambers of the heart, and pulmonary hypertension may develop. Children with ASD are usually born at term, with normal body weight. The systolic heart murmur with this defect is very low-intensity, not rough, and resembles a functional one. Therefore, the diagnosis of the defect is often made after the first year of a child’s life. Children with ASD may often suffer from colds and lag behind in physical development. Atrial septal defects usually require surgical correction. The defect is sutured, large defects are closed with autopericardial or synthetic patches, and endovascular closure using an occluder is increasingly used.

VSD– a defect of the interventricular septum, in which there is a communication between the right and left ventricles with pathological discharge of blood through it. This is a pale type congenital heart disease with enrichment of the pulmonary circulation. There are two varieties of this defect:

muscle defect
membranous defect

The muscular defect of the interventricular septum is usually small in size, proceeds favorably, and often tends to spontaneously close. But even if it persists, it does not require surgical correction.

Membranous defects are less favorable. Diagnosed already in the maternity hospital, from 2-3 days of the child’s life a rough blowing systolic murmur in the heart begins to be heard. Children with such defects may lag behind in physical development and often suffer from bronchitis and pneumonia. Large membranous defects require surgical repair. Most often, open heart surgery is performed and a patch is applied to the defect site.

OAP– patent ductus arteriosus (ductus arteriosus). Also very common is congenital heart disease. The ductus botallus during the prenatal period is a normal communication in the fetus and connects the aorta to the pulmonary artery. Patent ductus arteriosus is a vessel through which pathological communication between the aorta and pulmonary artery remains after birth. This is a pale type congenital heart disease with enrichment of the pulmonary circulation. The clinical picture of the defect will depend on the size of the functioning duct. For small sizes it is minimal. With large, wide PDA, it manifests itself at an early age - with audible noise, signs of circulatory failure, the development of malnutrition, and recurrent acute respiratory diseases. The defect is eliminated promptly. The duct is ligated. Now they often resort to an endovascular technique, when an occluder is inserted into the duct to block it.

COARCTATION OF THE AORTA– a congenital pathology of narrowing of the lumen of the aorta of varying severity anywhere, most often in the area of its isthmus. This heart defect can cause difficulties in diagnosis, since it does not have such a symptom of congenital heart disease as a heart murmur. Sometimes the noise will be heard in the interscapular space from the back. With coarctation of the aorta, the pulsation of peripheral vessels - femoral, popliteal, and dorsum of the foot vessels - is not detected. Symptomatic arterial hypertension develops. Older children have complaints of headaches, nosebleeds, hypertensive crises with high blood pressure, and chilliness of the lower extremities. They have a disproportionate development: a well-developed upper shoulder girdle and poorly developed lower limbs. This congenital heart disorder always requires prompt elimination.

AORTIC STENOSIS– white congenital heart disease without hemodynamic disturbances in the pulmonary circulation, when there is an obstruction to the blood flow from the left ventricle to the aorta. There are three types of stenosis: valvular, subvalvular and supravalvular. Valvular aortic stenosis is most common when there is valve deformation. Subvalvular stenosis is characterized by the presence of a membrane or cord narrowing the outflow tract of the left ventricle. Supravalvular stenosis occurs as a result of an obstruction - a fold above the aortic valve. Severe aortic stenosis is eliminated at an early age; small stenoses can be observed conservatively for a long time.

PULMONARY ARTERY STENOSIS– white congenital heart disease with depletion of the pulmonary circulation, when there is an obstruction to the flow of blood from the right ventricle to the pulmonary artery. There are two types of defect: valvular and infundibular. With valvular stenosis of the pulmonary artery, fusion of the valve leaflets occurs; infundibular stenosis occurs due to hypertrophy of the outflow tract of the right ventricle or the presence of a septum there. Severe pulmonary artery stenoses are eliminated surgically, minor ones are observed conservatively.

Tetralogy of Fallot– the most common blue heart defect, occurring with the appearance of cyanosis after three months of a child’s life. The tetrad includes four characteristic signs: narrowing of the outflow tract of the right ventricle, ventricular septal defect, dextraposition of the aorta (displacement to the right) and hypertrophy of the wall of the right ventricle. Tetralogy of Fallot is eliminated promptly. If previously a series of sequential operations was required, now Tetralogy of Fallot is operated on with one radical surgical intervention.

TRANSPOSITION OF THE GREAT VESSELS, COMMON ARTERIAL TRUNK– severe blue congenital heart disease, manifested by cyanosis from the first hours of the child’s life and requiring emergency cardiac surgery.

Currently, complex, combined congenital heart disease is not uncommon. This is hypoplasia of the left heart, a single ventricle and others.

Treatment methods

The presence of congenital heart disease in a child, as a rule, requires its surgical removal. And it is better to carry out the operation before complications develop: enlargement of the heart, increasing signs of circulatory failure, development of pulmonary hypertension and heart rhythm disturbances. Only a number of defects can be observed conservatively. These include a small muscular defect of the interventricular septum, minor stenosis of the aorta and pulmonary artery.

Some congenital heart defects (they are called critical) must be operated on for health reasons literally in the first days of a newborn’s life. Such congenital heart defects include transposition of the great vessels, common truncus arteriosus, and pronounced coarctation of the aorta.

Other congenital defects can be operated on in the first years of a child’s life, for example, septal defects, patent ductus arteriosus.

Complex heart defects can be operated on in stages, when a palliative (auxiliary) operation is first performed, and then, when the child’s condition is stabilized, a radical correction of congenital heart disease is performed.

Operations can be performed:

under conditions of artificial circulation on an open heart
endovascular method

Endovascular methods for correcting congenital heart disease are now increasingly used. They are performed without an incision in the chest, therefore they are less traumatic and lead to a quick postoperative recovery of the child. These techniques are applicable to the elimination of the most common heart defects, such as atrial septal defect and patent ductus arteriosus.

Prevention of congenital heart disease

Prevention of this pathology in a newborn is aimed, first of all, at eliminating harmful factors. Therefore, we can recommend the following:

maintaining a healthy lifestyle for a pregnant woman
rejection of bad habits
avoid contact with infectious patients, attending public events during epidemics, rubella vaccination
avoid occupational hazards for pregnant women and adverse environmental factors (radiation, vibration, chemical agents, etc.)
taking any medications during pregnancy only in consultation with your doctor
taking folic acid during pregnancy planning and in its early stages
genetic counseling for high risk of hereditary pathology, history of miscarriages, late pregnancies

Thus, compliance with these simple measures, observation and consultation with a doctor, careful attitude towards yourself, avoidance of harmful factors, especially during the formation of fetal organs and systems, is the key to the birth of a healthy child.

But if a child was born with congenital heart disease, this does not mean a death sentence. Now even the most complex and severe forms are operated on. Pediatric cardiac surgery does not stand still; new techniques are being introduced that spare access to the heart. A timely diagnosis and a successful operation not only save the child, but also return him to a fully fulfilling life!

The unknown is always, at a minimum, alarming or people begin to fear it, and fear paralyzes a person. On a negative wave, wrong and hasty decisions are made, their consequences worsen the situation. Then again fear and again wrong decisions. In medicine, this “loop” situation is called circulus mortum, a vicious circle. How to get out of it? Let shallow but correct knowledge of the basics of the problem help solve it adequately and on time.

What is a heart defect?

Each organ of our body is designed to function rationally in the system for which it is intended. The heart belongs to circulatory system, helps the blood move and saturate it with oxygen (O2) and carbon dioxide (CO2). As it fills and contracts, it “pushes” the blood further into large and then small vessels. If the usual (normal) structure of the heart and its large vessels is disturbed - either before birth, or after birth as a complication of the disease, then we can talk about a defect. That is, a heart defect is a deviation from the norm that interferes with the movement of blood or changes its filling with oxygen and carbon dioxide. Of course, as a result, problems arise for the whole organism, more or less pronounced and of varying degrees of danger.

A little about the physiology of blood circulation

The human heart, like that of all mammals, is divided into two parts by a dense septum. The left one pumps arterial blood, it is bright red and rich in oxygen. The right one is venous blood, it is darker and saturated with carbon dioxide. Normally, the septum (called interventricular) has no holes, and the blood is in the cavities of the heart ( atria And ventricles) does not mix.

Venous blood from the whole body enters the right atrium and ventricle, then into the lungs, where it gives off CO2 and receives O2. There she turns into arterial, passes through the left atrium and ventricle, reaches the organs through the vascular system, gives them oxygen and takes in carbon dioxide, turning into a venous system. Then - again to the right side of the heart and so on.

The circulatory system is closed, which is why it is called “ circulation" There are two such circles, both involve the heart. The circle “right ventricle – lungs – left atrium” is called small, or pulmonary: in the lungs, venous blood becomes arterial and is transmitted further. The circle “left ventricle – organs – right atrium” is called big, passing along its route, the blood from arterial again turns into venous.

Functionally left atrium And ventricle experience a high load, because the large circle is “longer” than the small one. Therefore, on the left, the normal muscular wall of the heart is always somewhat thicker than on the right. The large vessels entering the heart are called veins. Outgoing – arteries. Normally, they do not communicate with each other at all, isolating the flow of venous and arterial blood.

Valves hearts are located between atria And ventricles, and at the border of the entrance and exit of large vessels. The most common problems are with mitral valve (bicuspid, between the left atrium and the ventricle), in second place - aortic(at the point where the aorta exits the left ventricle), then tricuspid(tricuspid, between the right atrium and ventricle), and in the “outsiders” - pulmonary valve, at its exit from the right ventricle. The valves are mainly involved in the manifestations of acquired heart defects.

Video: principles of blood circulation and heart function. (Important for understanding hemodynamics with defects)

What are heart defects?

Let's consider the classification, adapted for patients.

Congenital and acquired - changes in normal structure And position hearts and his large vessels appeared either before or after birth.
Isolated and combined - changes are either single or multiple.
C (so-called “blue”) – the skin changes its normal color to a bluish tint, or without cyanosis. Distinguish generalized cyanosis(general) and acrocyanosis(fingers and toes, lips and tip of the nose, ears).

I. Congenital heart defects (CHD)

Disturbances in the anatomical structure of the child’s heart are formed in utero(during pregnancy), but appear only after birth. To get a more complete picture of the problem, see pictures of heart defects.

For convenience, they were classified based on blood flow through the lungs, that is small circle.

CHD with increased pulmonary blood flow – with cyanosis and without it;
CHD with normal pulmonary blood flow;
CHD with reduced blood flow through the lungs – with cyanosis and without it.

Ventricular septal defect (VSD)

Depending on the degree of defect and disruption of blood flow, the concepts were introduced compensated(due to thickening of the walls of the heart and increased contractions, blood flows in normal volumes) and decompensated(the heart enlarges too much, the muscle fibers do not receive the necessary nutrition, the strength of contractions decreases) acquired defects.

Mitral valve insufficiency

Function of healthy (top) and damaged (bottom) valves

Incomplete closure of the valves is the result of their inflammation and consequences in the form of sclerosis(replacing “working” elastic fabrics with rigid connective fibers). Blood during contraction left ventricle is thrown in the opposite direction, into left atrium. As a result, a greater force of contraction is needed to “return” the blood flow to the side aorta, And hypertrophies(thickens) the entire left side of the heart. Gradually developing failure in a small circle, and then - a violation of the outflow venous blood from the systemic circulation, the so-called.

Signs: mitral flush(pinkish-blue color of lips and cheeks). Trembling of the chest, felt even by the hand - it is called cat purring, And acrocyanosis(bluish tint of hands and toes, nose, ears and lips). Such picturesque symptoms are possible only with decompensated vice, and with compensated they don't exist.

Treatment and prognosis: in advanced cases, for prevention , required . Patients live a long time, many do not even suspect the disease, if it is in compensation stages. It is important to treat all inflammatory diseases in a timely manner.

picture: mitral valve replacement

Mitral stenosis (narrowing of the valve between the left atrium and ventricle)

Signs: if the vice decompensated, when measuring blood pressure bottom digit ( diastolic pressure) can drop to almost zero. Patients complain of dizziness if the body position changes quickly (lying down and standing up), and attacks of suffocation at night. The skin is pale, the pulsation of the arteries in the neck is visible ( carotid dance) and shaking the head. Pupils eyes and capillaries under the nails (visible when pressing on nail plate) also pulsate.

Treatment: preventive – for compensated defect, radical - artificial is sewn in aortic valve.

Forecast: isolated vice in about 30% they are found by chance during a routine examination. If the defect valve small and not pronounced, people do not even suspect about the vice and live a full life.

The consequence of aortic disease is heart failure, stagnation of blood in the ventricle

Aortic stenosis, isolated defect

It is difficult for blood to escape from left ventricle V aorta: This requires more effort and the muscular walls of the heart thicken. The less aortic orifice, the more pronounced hypertrophy left ventricle.

Signs: associated with a decrease in income arterial blood to the brain and other organs. Paleness, dizziness and fainting, heart hump(if the defect developed in childhood), attacks of pain in the heart ().

Treatment: we reduce physical activity, carry out restorative treatment - if there is no pronounced circulatory failure. In severe cases - only surgery, valve replacement or dissection of its valves ( commissurotomy).

Combined aortic disease

Two in one: failure valves+ narrowing aortic orifice. Such aortic disease heart is much more common than isolated. Signs are the same as for aortic stenosis, just less noticeable. In severe variants, stagnation begins in small circle, accompanied cardiac asthma And pulmonary edema.

Treatment: symptomatic and preventive - in mild cases, in severe cases - surgery, replacement aortic valve or dissection of its “fused” valves. The prognosis for life is favorable, with adequate and timely treatment.

Video: causes, diagnosis and treatment of aortic stenosis

Tricuspid (three leaflet) valve insufficiency

Due to loose closure valve,blood from right ventricle thrown back into right atrium. His ability compensate for the vice low, so it starts quickly venous blood stagnation V big circle.

Signs: cyanosis, veins necks are full and throbbing, arterial pressure slightly lowered. In severe cases - swelling and ascites(fluid accumulation in abdominal cavity). Treatment is conservative, mainly to eliminate venous stagnation. The prognosis depends on the severity of the condition.

Stenosis of the right atrioventricular (between the right atrium and ventricle) opening

Obstructed blood flow from right atrium V right ventricle. Venous stagnation quickly spreads to liver, it increases, then develops cardiac fibrosis of the liver– active tissue is replaced connecting(scar). Appears ascites, are common swelling.

Signs: pain and feeling of heaviness in hypochondrium on right, cyanosis with a yellow tint, always - pulsation neck veins Arterial pressure reduced; liver enlarged and pulsating.

Treatment: is aimed at reducing swelling, but it is better not to delay the operation.

Forecast: Normal well-being is possible with moderate physical activity. activity. If appeared and cyanosis- quickly see a heart surgeon.

Summary: purchased- mostly rheumatic heart defects. Their treatment is aimed both at the underlying disease and at reducing the consequences of the defect. In case of severe circulatory decompensation, only surgery is effective.

Important! Treatment for heart defects may have a better chance of success if people see their doctor on time. Moreover, malaise as a reason for going to the doctor is not at all necessary: you can simply ask for advice and, if necessary, undergo basic examinations. A smart doctor does not allow his patients to get sick. An important note: the age of the doctor does not really matter. What is really important is his professional level, ability to analyze and synthesize, and intuition.

Congenital heart defect is an anomaly in the structure of the heart or large vessels.

Information Pathology of the cardiovascular system is very common (about 1% of all newborns). Children with such diseases are characterized by high mortality in the absence of timely treatment: up to 70% of patients die in the first year of life.

According to statistical data, if we take into account the entire set of defects, there is a greater prevalence of anomalies of the cardiovascular system in boys, but some types of congenital heart defects are more common in girls.

There are three groups of congenital heart defects according to the frequency of occurrence in males or females:

"Male" vices: coarctation of the aorta (often in combination with a patent ductus arteriosus), transposition of the main vessels, aortic stenosis, etc.;
"Women's" vices: open arterial defect, atrial septal defect, Fallot's triad, etc.;
Neutral vices(occurs with equal frequency in boys and girls): atrioventricular septal defect, aortopulmonary septal defect, etc.

Causes of birth defects

The formation of congenital malformations of the heart and large vessels occurs in the first 8 weeks of pregnancy under the influence of various factors:

Chromosomal abnormalities;
Bad habits of the mother (smoking, alcoholism, drug addiction);
Unreasonable use of medications;
Infectious diseases of the mother (rubella, herpes infection, etc.);
Hereditary factors (the presence of heart disease in parents and close relatives significantly increases the risk of abnormalities of the cardiovascular system in the child);
Age of parents (man over 45 years old, woman over 35 years old);
Adverse effects of chemical compounds (gasoline, acetone, etc.);
Radiation exposure.

Classifications

At the moment, there are many classifications of congenital anomalies of the cardiovascular system.

The International Nomenclature of Congenital Heart Defects was adopted in 2000.:

Hypoplasia of the right or left heart(underdevelopment of one of the ventricles). It is rare, but is the most severe form of defects (most children do not survive to surgery);
Obstruction defects(narrowing or complete closure of the heart valves and large vessels): aortic valve stenosis, pulmonary valve stenosis, bicuspid valve stenosis;
Partition defects: atrial septal defect, ventricular septal defect;
Blue vices(leading to skin cyanosis): tetralogy of Fallot, transposition of the main vessels, tricuspid valve stenosis, etc.

Also in practicing medicine the following classification is often used:

Congenital heart defect

Congenital heart disease is a heart defect of congenital origin. Basically, this pathology affects the septum of the heart, affects the artery that delivers venous blood to the lungs or one of the main vessels of the arterial system - the aorta, and also the duct of Botallova (PDA) does not heal. With congenital heart disease, the movement of blood in the systemic circulation (BCC) and small circulation (PCC) is disrupted.

Heart defects are a term that combines certain heart diseases, the main feature of which is a change in the anatomical structure of the heart valve apparatus or its largest vessels, as well as non-fusion of the partitions between the atria or ventricles of the heart.

Congenital heart defect causes

The main causes of congenital heart disease are chromosomal abnormalities - this accounts for almost 5%; gene mutation (2–3%); various factors such as parental alcoholism and drug addiction; infectious diseases suffered in the first third of pregnancy (rubella, hepatitis), taking medications (1–2%), as well as hereditary predisposition (90%).

With various distortions of chromosomes, their mutations appear in quantitative and structural form. If large or medium-sized chromosome aberrations occur, this is generally fatal. But when distortions occur with compatibility for life, then it is then that various types of congenital diseases appear. When a third chromosome appears in the chromosome set, defects occur between the valve flaps of the atrial and ventricular septa or their combination.

Congenital heart defects with changes in sex chromosomes are much less common than with autosomal trisomy.

Mutations of one gene lead not only to congenital heart disease, but also to the development of anomalies of other organs. Malformations of the cardiovascular system (cardiovascular system) are associated with the syndrome of autosomal dominant type and autosomal recessive type. These syndromes are characterized by a pattern of system damage of mild or severe severity.

The formation of congenital heart disease can be facilitated by various environmental factors that damage the cardiovascular system. Among them are x-rays that a woman could receive during the first half of pregnancy; radiation from ionized particles; some types of medications; infectious diseases and viral infections; alcohol, drugs, etc. Therefore, heart defects that formed under the influence of these factors are called embryopathies.

Under the influence of alcohol, VSD (ventricular septal defect), PDA (patent ductus arteriosus), and pathology of the interatrial septum are most often formed. For example, anticonvulsants lead to the development of pulmonary artery and aortic stenosis, coartation of the aorta, and PDA.

Ethyl alcohol ranks first among toxic substances, which contributes to the appearance of congenital heart defects. A child born under the influence of alcohol will have fetal alcohol syndrome. Mothers who suffer from alcoholism give birth to almost 40% of children with congenital heart disease. Alcohol is especially dangerous in the first third of pregnancy - this is one of the most critical periods of fetal development.

It is very dangerous for the unborn child if a pregnant woman has suffered from rubella. This disease causes a number of pathologies. And congenital heart pathology is no exception. The incidence of congenital heart disease after rubella is 1 to 2.4%. Among the heart defects, the most common in practice are: PDA, VVC, tetralogy of Fallot, VSD, pulmonary stenosis.

Experimental data indicate that almost all congenital heart defects are fundamentally genetic in origin, which is consistent with multifactorial inheritance. Of course, there is genetic heterozygosity and some forms of congenital heart disease are associated with mutations of a single gene.

In addition to etiological factors that cause congenital heart disease, there is also a risk group that includes older women; having disorders of the endocrine system; with toxicosis of the first three months of pregnancy; who have a history of stillborn children, as well as existing children with congenital heart disease.

Congenital heart defect symptoms

The clinical picture of congenital heart disease is characterized by the structural features of the defect, the recovery process and complications arising from various etiologies. First of all, the symptoms of congenital heart disease include shortness of breath, which occurs against the background of slight physical activity, increased heartbeat, periodic weakness, pallor or cyanosis of the face, heart pain, swelling and fainting.

Congenital heart defects can occur periodically, which is why there are three main phases.

In the primary phase, adaptation, the patient’s body tries to adapt to disturbances in the circulatory system that are caused by a developmental defect. As a result, the symptoms of the disease are usually mild. But during severe hemodynamic disturbances, cardiac decompensation quickly develops. If patients with congenital heart disease do not die during the first phase of the disease, then after approximately 2–3 years improvements in health and development occur.

In the second phase, relative compensation and improvement in general condition are noted. And after the second, the third inevitably comes, when all the adaptive capabilities of the body are exhausted, dystrophic and degenerative changes in the heart muscle and various organs develop. Basically, the terminal phase leads to the death of the patient.

Among the most pronounced symptoms of congenital heart disease are heart murmur, cyanosis and heart failure.

A heart murmur of a systolic nature and varying intensity is observed in almost all types of defects. But sometimes they can be completely absent or appear inconsistent. As a rule, murmurs of best audibility are localized in the left upper part of the sternum or close to the pulmonary artery. Even a slight increase in the shape of the heart makes it possible to listen to a heart murmur.

During pulmonary artery stenosis and TMS (transposition of the great vessels), cyanosis sharply manifests itself. And with other types of defect it may be completely absent or small. Cyanosis is sometimes permanent or appears during screaming or crying, that is, with frequency. This symptom may be accompanied by changes in the terminal phalanges of the fingers and nails. Sometimes this symptom is expressed by the pallor of a patient with congenital heart disease.

With some types of defects, cardiac dullness may change. And its increase will depend on the localization of changes in the heart. To make an accurate diagnosis, in order to ascertain the shape of the heart and the cardiac hump, they resort to an x-ray, using simultaneously antiography and kymography.

In heart failure, peripheral vascular spasm may develop, which is characterized by paleness, coldness of the extremities and the tip of the nose. The spasm manifests itself as an adaptation of the patient’s body to heart failure.

Congenital heart disease in newborns

Infants have a fairly large heart, which has significant reserve capacity. Congenital heart defects usually form between 2 and 8 weeks of pregnancy. The cause of its appearance in the child is considered to be various diseases of the mother, infectious and viral in nature; the expectant mother’s work in hazardous work and, of course, the hereditary factor.

Approximately 1% of newborns have cardiovascular disorders. Now, accurately diagnosing congenital heart disease at an early stage is not difficult. Thus, it helps save the lives of many children through medical and surgical treatment.

Congenital heart disease is most often diagnosed in male children. And different defects are characterized by a certain gender predisposition. For example, PDA and VSD predominate in women, and aortic stenosis, congenital aneurysm, coarctation of the aorta, tetralogy of Fallot and TMA predominate in men.

One of the most common changes in the heart of children is considered to be a devital septum - this is an abnormal opening. These are mainly VSDs, which are located between the upper chambers of the heart. During the entire period of the baby’s first year of life, some minor defects in the septum may close spontaneously and not negatively affect the further development of the child. Well, for major pathologies, surgical intervention is indicated.

The cardiovascular system of the fetus before birth is a blood circulation that bypasses the lungs, that is, the blood does not enter there, but circulates through the ductus arteriosus. When a baby is born, this duct usually closes within a few weeks. But if this does not happen, then the child is given a PDA. This creates a certain load on the heart.

The cause of severe cyanosis in children is the transposition of two large arteries, when the pulmonary artery connects to the left ventricle, and the aorta to the right. This is considered a pathology. Without surgical intervention, newborns die immediately during the first days of life. In addition, heart attacks are very rare in children with severe congenital heart defects.

Characteristic signs of congenital heart disease in children are poor weight gain, fatigue and pale skin.

Congenital heart disease treatment

Congenital heart defects can sometimes have a different clinical picture. Therefore, treatment and care methods will largely depend on the severity and complexity of the clinical manifestations of the disease. Basically, when the patient has complete compensation for the defect, his lifestyle is absolutely normal, like that of healthy people. As a rule, such patients do not need medical consultations. They may be given recommendations aimed at keeping the defect in a compensatory state.

First of all, a patient suffering from congenital heart disease must limit heavy physical labor. It is advisable to change the work that will adversely affect the patient’s well-being to another type of activity.

A person with a history of congenital heart disease should avoid engaging in challenging sports and participating in competitions. To reduce the load on the heart, the patient should sleep for about eight hours.

Proper nutrition should accompany patients with congenital heart disease for life. Food must be taken 3 times a day so that large meals do not lead to stress on the cardiovascular system. All food should not contain salt, and if heart failure occurs, salt should not exceed five grams. It should be borne in mind that only boiled foods should be consumed, as they are easier to digest and significantly reduce the load on all digestive organs. Smoking and drinking alcoholic beverages are strictly forbidden, so as not to provoke the cardiovascular system.

One of the methods of treating congenital heart disease is medication, when it is necessary to increase the contractile function of the heart, regulate water-salt metabolism and remove excess fluid from the body, as well as combat altered rhythms in the heart and improve metabolic processes in the myocardium.

Treatment for congenital heart disease sometimes varies depending on the nature and severity of the defect. The patient's age and general health are also always taken into account. For example, sometimes children with minor forms of heart defects do not require treatment. And in some cases, surgical intervention is immediately necessary in infancy.

Almost 25% of children with congenital heart disease require urgent early surgery. To determine the location of the defect and its severity, a catheter is placed in the heart in the first days of life.

The main surgical method for treating congenital heart disease is the method of deep hypertension, which uses extreme cold. This type of surgery is performed on babies who have a heart the size of a walnut. Using this method for operations on the heart of infants, the surgeon has the opportunity to perform a complex operation to restore the heart, as a result of its complete relaxation.

At the moment, other radical methods of treating congenital heart defects are also widely used. Among them are commissurotomy, where dissection of fused valves and prosthetics are used, when the altered mitral or tricuspid atrioventricular valve is removed, and then a valve prosthesis is sewn in. After such surgical interventions, especially mitral commissurotomy, the prognosis for surgical treatment is positive.

Mostly, after surgery, patients return to their normal lifestyle and are able to work. Children do not limit themselves in physical capabilities. However, anyone who has had heart surgery should still be seen by their primary care physician. A defect that has a rheumatic etiology requires repeated prevention.

84. Congenital heart defects.

Congenital heart defects arise as a result of disruption of the formation of the heart and the vessels extending from it. Most defects disrupt the flow of blood inside the heart or through the large (BCC) and pulmonary circulation (MPC) circles. Heart defects are the most common birth defect and are the leading cause of childhood death from birth defects.

Etiology. Congenital heart disease can be caused by genetic or environmental factors, but is usually a combination of both. The most well-known causes of congenital heart defects are point gene changes, or chromosomal mutations in the form of deletion or duplication of DNA segments. Major chromosomal mutations such as trisomies 21, 13 and 18 cause about 5-8% of cases of congenital heart disease. Genetic mutations occur due to the action of three main mutagens:

Physical mutagens (mainly ionizing radiation).

Chemical mutagens (phenols of varnishes, paints; nitrates; benzpyrene from smoking; alcohol consumption; hydantoin; lithium; thalidomide; teratogenic medications - antibiotics and CTP, NSAIDs, etc.).

Biological mutagens (mainly the rubella virus in the mother’s body, leading to congenital rubella with Greg’s characteristic triad - congenital heart disease, cataracts, deafness, as well as diabetes mellitus, phenylketonuria and systemic lupus erythematosus in the mother).

Pathogenesis. There are two leading mechanisms.

1. Impaired cardiac hemodynamics → overload of the heart parts by volume (defects such as valve insufficiency) or resistance (defects such as stenosis of the orifices or vessels) → depletion of the involved compensatory mechanisms → development of hypertrophy and dilatation of the heart parts → development of heart failure (and, accordingly, disorders systemic hemodynamics).

2. Disturbance of systemic hemodynamics (plethora/anemia of MCC and BCC) → development of systemic hypoxia (mainly circulatory with white defects, hemic with blue defects, although with the development of acute left ventricular HF, for example, both ventilation and diffusion hypoxia occur) .

CHDs are conventionally divided into 2 groups:

1. White(pale, with left-to-right shunting, without mixing of arterial and venous blood). Includes 4 groups:

With enrichment of the pulmonary circulation (patent ductus arteriosus, atrial septal defect, ventricular septal defect, AV communication, etc.).

With depletion of the pulmonary circulation (isolated pulmonary stenosis, etc.).

With depletion of the systemic circulation (isolated aortic stenosis, coarctation of the aorta, etc.)

Without a significant disturbance of systemic hemodynamics (heart dispositions - dextro-, sinistro-, mesocardia; cardiac dystopia - cervical, thoracic, abdominal).

2. Blue(with right-left discharge of blood, with mixing of arterial and venous blood). Includes 2 groups:

With enrichment of the pulmonary circulation (complete transposition of the great vessels, Eisenmenger complex, etc.).

With depletion of the pulmonary circulation (tetralogy of Fallot, Ebstein's anomaly, etc.).

Clinical manifestations of congenital heart disease can be combined into 4 syndromes:

Cardiac syndrome(complaints of pain in the heart, shortness of breath, palpitations, interruptions in cardiac function; upon examination - pallor or cyanosis, swelling and pulsation of the vessels of the neck, deformation of the chest like a cardiac hump; palpation - changes in blood pressure and characteristics of the peripheral pulse, changes in the characteristics of the apical impulse with hypertrophy/dilatation of the left ventricle, the appearance of a cardiac impulse with hypertrophy/dilatation of the right ventricle, systolic/diastolic cat purr with stenosis; percussion - expansion of the boundaries of the heart according to the expanded sections; auscultation - changes in rhythm, strength, timbre, monolithic tones, the appearance of characteristic each noise defect, etc.).

Heart failure syndrome(acute or chronic, right or left ventricular, dyspnea-cyanotic attacks, etc.).

Chronic systemic hypoxia syndrome(growth and development delays, symptoms of drumsticks and watch glasses, etc.)

Respiratory distress syndrome(mainly with congenital heart disease with enrichment of the pulmonary circulation).

Heart failure (occurs in almost all congenital heart diseases).

Bacterial endocarditis (more often observed with cyanotic congenital heart disease).

Early prolonged pneumonia against the background of stagnation in the pulmonary circulation.

High pulmonary hypertension or Eisenmenger syndrome (characteristic of congenital heart disease with enrichment of the pulmonary circulation).

Syncope due to small output syndrome up to the development of cerebrovascular accident

Angina syndrome and myocardial infarction (most typical for aortic stenosis, anomalous origin of the left coronary artery).

Dyspnea-cyanotic attacks (occur in tetralogy of Fallot with infundibular stenosis of the pulmonary artery, transposition of the great arteries, etc.).

Relative anemia - with cyanotic congenital heart disease.

Pathological anatomy. With congenital heart defects, the process of myocardial hypertrophy in children in the first 3 months of life involves not only an increase in the volume of muscle fibers with hyperplasia of their ultrastructures, but also true hyperplasia of cardiomyocytes. At the same time, hyperplasia of reticulin argyrophilic fibers of the cardiac stroma develops. Subsequent dystrophic changes in the myocardium and stroma, up to the development of micronecrosis, lead to the gradual proliferation of connective tissue and the occurrence of diffuse and focal cardiosclerosis.

Compensatory restructuring of the vascular bed of a hypertrophied heart is accompanied by an increase in intramural vessels, arteriovenous anastomoses, and smallest veins (the so-called vessels of Viessen-Tebezia) of the heart. Due to sclerotic changes in the myocardium, as well as increased blood flow in its cavities, thickening of the endocardium appears due to the growth of elastic and collagen fibers in it. Restructuring of the vascular bed also develops in the lungs. Children with congenital heart defects experience retardation of general physical development.

Death occurs in the first days of life from hypoxia with particularly severe forms of defects or later from the development of heart failure. Depending on the degree of hypoxia, caused by a decrease in blood flow in the pulmonary circulation and the direction of blood flow through abnormal pathways between the pulmonary and systemic circulation, heart defects can be divided into two main types - blue and white. With blue type defects, there is a decrease in blood flow in the pulmonary circulation, hypoxia and the direction of blood flow along an abnormal path - from right to left. With white type defects, there is no hypoxia, the direction of blood flow is from left to right. However, this division is schematic and not always applicable to all types of congenital heart defects.

Congenital defects with impaired division of the heart cavities. Ventricular septal defects are common and depend on the growth retardation of one of the structures that form the septum, resulting in abnormal communication between the ventricles. More often, a defect is observed in the upper connective tissue (membranous) part of the septum. Blood flow through the defect is from left to right, so cyanosis and hypoxia are not observed (white type of defect). The degree of the defect can vary, up to the complete absence of the septum. With a significant defect, hypertrophy of the right ventricle of the heart develops, with a minor defect, no significant changes in hemodynamics occur.

The septum primum defect appears as a hole located directly above the ventricular valves; with a defect of the secondary septum, there is a wide open oval foramen, devoid of a valve. In both cases, blood flow occurs from left to right, hypoxia and cyanosis do not occur (white type of defect). Overflow of blood to the right half of the heart is accompanied by hypertrophy of the right ventricle and expansion of the trunk and branches of the pulmonary artery. The complete absence of the interventricular or interatrial septum leads to the development three-chambered heart- a severe defect, in which, however, during the period of compensation, complete mixing of arterial and venous blood is not observed, since the main flow of one or the other blood retains its direction and therefore the degree of hypoxia increases as decompensation progresses.

Congenital heart defects with impaired division of the truncus arteriosus. A common truncus arteriosus in the complete absence of division of the truncus arteriosus is rare. With this defect, one common arterial trunk originates from both ventricles, at the exit there are 4 semilunar valves or less; the defect is often combined with a ventricular septal defect. The pulmonary arteries depart from the common trunk not far from the valves, before the branches of the large vessels of the head and neck; they may be completely absent and then the lungs receive blood from the dilated bronchial arteries. With this defect, severe hypoxia and cyanosis are observed (blue type of defect), children are not viable.

Pulmonary artery stenosis and atresia observed when the septum of the arterial trunk is displaced to the right, often combined with a ventricular septal defect and other defects. When the pulmonary artery is significantly narrowed, blood enters the lungs through the ductus arteriosus and the dilating bronchial arteries. The defect is accompanied by hypoxia and severe cyanosis (blue type of defect).

Aortic stenosis and atresia are a consequence of displacement of the septum of the arterial trunk to the left. They are less common than septal displacement to the right and are often accompanied by hypoplasia of the left ventricle of the heart. In this case, a sharp degree of hypertrophy of the right ventricle of the heart, dilatation of the right atrium and a sharp general cyanosis are observed. Children are not viable.

Narrowing of the aortic isthmus (coarctation), up to its atresia, is compensated by the development of collateral circulation through the intercostal arteries, arteries of the chest and sharp hypertrophy of the left ventricle of the heart.

Patchy ductus arteriosus can be considered a defect if it is present with simultaneous expansion in children older than 3 months of life. The blood flow is from left to right (white type of defect). An isolated defect lends itself well to surgical correction.

Combined congenital heart defects. Among the combined defects, the triad, tetralogy and pentade of Fallot are more common. Triad of Fallot has 3 signs: ventricular septal defect, pulmonary artery stenosis and, as a consequence, right ventricular hypertrophy. Tetralogy of Fallot has 4 signs: ventricular septal defect, narrowing of the pulmonary artery, dextraposition of the aorta (displacement of the aortic mouth to the right) and hypertrophy of the right ventricle of the heart. Pentade of Fallot In addition to these four, it includes a 5th sign - atrial septal defect. Tetralogy of Fallot is the most common (40-50% of all congenital heart defects). With all defects of the Fallot type, blood flow from right to left, a decrease in blood flow in the pulmonary circulation, hypoxia and cyanosis (blue type of defects) are noted. More rare combined congenital defects include ventricular septal defect with stenosis of the left atrioventricular orifice ( Lutambashe disease), ventricular septal defect and aortic dextraposition ( Eisenmenger's disease) and a branch of the left coronary artery from the pulmonary trunk (Bland-White-Garland syndrome), primary pulmonary hypertension ( Aerz's disease), depending on the hypertrophy of the muscular layer of the lung vessels (small arteries, veins and venules), etc.

Heart defects in children

Heart defects in a child, children

Heart defects are a common pathology in children. The frequency of defects in children has been increasing in recent years. Consultation and examination by a pediatric cardiologist - children's clinic "Markushka".

Congenital heart defects in children, child

Frequency congenital heart defects(CHD) in newborns is 0.8%, they vary widely in anatomical features and severity. The clinical manifestations of congenital heart disease in children are varied and are determined by three main factors: the anatomical features of the defect, the degree of compensation and the complications that arise.

CHD in a child can be suspected if he has: cyanosis or severe pallor, malnutrition, frequent colds, insufficient tolerance to age-appropriate physical activity (fatigue during breastfeeding, during outdoor play, shortness of breath when climbing even one flight of stairs and etc.), an increase in heart size, a change in heart sounds, the appearance of a heart murmur, a change in the pulse in the arms, a weak or absent pulse in the femoral artery, a change in arterial blood pressure, chest deformation, heart rhythm disturbances, any pathological ECG changes, unusual changes detected on a chest x-ray, etc.

Congenital heart defects with enrichment of the pulmonary circulation

Atrial septal defect(ASD) is one of the common congenital diseases. In 10-20% of cases, ASD is combined with mitral valve prolapse.

Hemodynamics in ASD are determined by the discharge of arterial blood from left to right, which leads to an increase in the minute volume of the pulmonary circulation. In the formation of a shunt, the difference in pressure between the right and left atria, the higher position of the latter, the greater distensibility of the right ventricle and the area of the right atrioventricular orifice, resistance, and the volume of the vascular bed of the lung are important. The development of pulmonary hypertension and damage to the vascular bed of the lungs lead to reverse shunting of the blood and the appearance of cyanosis. With primary defects, mitral insufficiency is often observed.

Unlike ventricular septal defects, in which significant shunt leads to volume overload in both ventricles, with ASD the shunt is smaller and affects only the right side of the heart.

With severe weight loss, patients experience weight loss and a tendency to recurrent respiratory diseases and pneumonia in the first years of life. As a rule, in these cases there are complaints of shortness of breath, fatigue, and heart pain.

Ventricular septal defect(VSD) is one of the most common congenital heart defects. It accounts for 17 to 30% of cases of cardiac anomalies.

Stand out three types of development VSD depending on the hemodynamic characteristics of the defect (the size of the left-right shunt), which determine the clinical manifestations and prognosis of the disease.

First type- there is a small defect in the septum (less than 0.5 cm2/m2), small blood discharge (More

What is congenital heart disease and can it be cured?

Congenital heart disease sometimes requires medical attention already at the time the baby is born. But there are many other defects that do not manifest themselves for a long time. In an adult, they are detected at any age.

Heart disease in a child is detected by characteristic signs that parents need to know. After all, timely surgery not only saves the child’s life. After surgical treatment, children are no different from healthy peers.

What are congenital heart defects

Among the defects of embryonic development, anomalies of the heart valves and blood vessels are the most common. For every 1000 births, there are 6-8 babies with the defect. This heart pathology is responsible for the high mortality rate of newborns and infants.

Congenital heart defects (CHD) are a group of diseases formed before birth that combine a disorder of the structure of valves or blood vessels. The anomaly occurs in isolation or in combination with other pathologies. More than 150 variants of anomalies are described in the literature.

Complex defects are detected immediately after the baby is born. Others do not manifest themselves for a long time and can be detected in an adult at any period of life.

Causes of birth defects

The main reasons lie in the conditions of the embryonic development of the child. The main factors influencing the formation of the fetus during the period of organ formation - the first trimester of the mother's pregnancy - have been identified:

viral diseases of women - rubella, influenza, hepatitis C;
taking medications with teratogenic side effects;
exposure to ionizing radiation;
alcoholism;
smoking;
CHD occurs from drug use;
early toxicosis in the mother;
threat of miscarriage in the first trimester;
history of stillborn children;
mother's age after 40 years;
endocrine diseases;
maternal heart pathology;
obesity of a pregnant woman.

All these factors determine the formation and appearance of the defect after the birth of the baby. The health of the father and mother matters in the development of pathology. Partial importance is given to genetic etiology.

By the way! During pregnancy planning, it is recommended to seek medical and biological consultation for those parents whose relatives have children with congenital heart disease or stillborn babies. A geneticist will determine the risk level of the birth defect.

Classification

There are many types of congenital defects, which are also combined in the same or different valves. Therefore, a unified systematization of diseases has not yet been developed. Several classifications of congenital heart defects (CHD) are considered. In Russia, they use the one created at the Scientific Research Center for Surgery named after. A. N. Bakuleva.

with blood discharge from left to right

Ventricular septal defect (VSD).

Atrial septal defect (ASD).

with venous-arterial ejection of blood from right to left

Transposition of the great vessels.

Pulmonary atresia.

with difficulty releasing both ventricles

Pulmonary artery stenosis.

Types of birth defects

CHDs are characterized by a variety of heart and blood vessel defects. Some of them appear in childhood immediately after birth. Others occur hidden and are discovered in old age. There are many vices in various combinations. They can be isolated or combined. The severity of the pathology is related to the degree of hemodynamic impairment. Congenital defects are divided into the following clinical syndromes.

The most common defect is an atrial septal defect (ASD). The anomaly is a hole in the wall between the two chambers that did not close after birth. Oxygen-rich blood flows from the right atrium to the left side of the heart. This is a normal phenomenon during the prenatal period. Soon after birth the hole closes. The defect leads to increased pressure in the blood vessels of the lungs.

Attention! The most pronounced symptoms of the defect appear at a young age, when the heart rhythm is disturbed.

Since the hole does not close on its own, surgery is required, which is best done between the ages of 3 and 6 years.

A ventricular septal defect is found in 20% of children with heart defects. With a developmental anomaly, an incompletely closed hole remains in the septum. As a result, blood under increased pressure during contraction penetrates from the left to the right ventricle.

Attention! The defect threatens pulmonary hypertension. This complication makes the operation impossible. Therefore, parents of children with VSD need to promptly consult a cardiac surgeon. Children after valve correction lead a normal life.

Tetralogy of Fallot

Tetralogy of Fallot (TF) is a blue defect. The pathology affects four structures of the heart - the pulmonary valve, the septum between the ventricles, the aorta, and the muscle of the right myocardium. Immediately after birth, no changes in the baby's condition are observed. But after a few days, anxiety and shortness of breath during sucking are noticeable. When screaming, the skin turns blue.

Attention! Sometimes there are no clear signs of the disease, but the defect is indicated by a decrease in the level of hemoglobin and red blood cells.

Severe attacks of cyanosis appear in the second half of life. For such a complex defect, treatment is only surgical.

Pathology of the Botallian duct

Patent ductus arteriosus (PDA). Normally, it closes within a few hours after the baby is born. But in this case, the defect remains open. As a result, there is a pathological communication between the pulmonary trunk and the aorta.

The defect is classified as a white defect and is manifested by attacks of shortness of breath during sucking. With a small diameter, the duct can eliminate itself. Large defects are accompanied by severe shortness of breath. In acute cases, emergency duct ligation surgery is required.

Attention! After surgical treatment, the child recovers completely without consequences.

Pulmonary valve stenosis

The heart anomaly is caused by damage to the valves. Due to adhesions, the valve does not open completely, which makes it difficult for blood to pass into the lungs. The muscle of the right ventricle has to exert great effort, so it hypertrophies.

Narrowing of a segment of the aorta

Coarctation of the aorta is a pathology of a large vessel. Although the heart itself works normally, the narrowing of the aortic isthmus is accompanied by impaired hemodynamics. The left ventricle places a heavy load on itself to push blood through the narrow section of the aortic arch. In the vessels of the upper body (head, neck, arms) the pressure is constantly increased, and in the lower parts (legs, abdomen) it is decreased.

Aortic stenosis

The anomaly is a partial fusion of the aortic valve leaflets. Since pumping blood is difficult, part of it remains in the left ventricle. The increased volume of fluid leads to hypertrophy of his muscles. Over the years, the compensatory capabilities of the myocardium are depleted, which causes overload of the left atrium with the development of pulmonary hypertension. Gradually, in adults, signs of insufficient pumping function of the heart appear - shortness of breath, swelling of the extremities.

Aortic valve disease

Bicuspid aortic valve is a congenital anomaly. Due to the disrupted structure of the valves, blood from the aorta partially passes back into the left ventricle. Aortic valve insufficiency develops, which a person may not know about for many years. Symptoms appear in old age.

Signs of congenital heart disease

The diagnosis of the disease can be suspected by clinical manifestations. Some defects are recognized immediately after the baby is born. In other newborns, the anomaly is detected after a few months. Some pathologies are found in adults at different periods of life.

Common symptoms of birth defects in babies:

Changes in skin temperature. Parents notice cold feet and hands. The baby's skin is pale or gray-whitish in color.
Cyanosis. With severe defects, a decrease in oxygen in the blood causes a bluish tint to the skin. After birth, blue discoloration of the nasolabial triangle is noted. During feeding, the baby's ears turn purple.

Heart rate increases to 150 or decreases to 110 per minute.

Child's restlessness during sucking.
Increased breathing.

In addition to these signs, parents notice that the baby quickly gets tired while sucking and often spits up. During crying, cyanosis of the skin increases. The legs and arms are swollen, and the abdomen increases in size due to the accumulation of fluid and enlargement of the liver.

If congenital heart disease is suspected, newborns undergo an ultrasound examination. Modern diagnostic methods make it possible to detect the defect at any age.

Important! Fetal echocardiography (ultrasound) detects the presence of a defect in the child at the 16th week of the mother's pregnancy. Already at 21-22 weeks the type of defect is determined.

Signs of congenital heart disease throughout life

Heart defects that are not detected in newborns manifest themselves at different periods of life. Children are pale, prone to frequent colds, and complain of tingling in the heart. Some children experience bluishness of the nasolabial triangle or ears.

Teenagers in physical education classes quickly get tired and complain of shortness of breath. Over time, there is a noticeable lag in mental and physical development.

Changes in body structure gradually form. The chest sinks in the lower part, while the enlarged abdomen protrudes. In other cases, a cardiac hump forms in the area of the heart. There is such a sign of congenital heart disease as thickening of the fingers in the form of drumsticks or protruding nails in the shape of watch glasses.

Any such signs require the attention of parents at any age of children. First you need to do a cardiogram and contact a cardiologist.

Complications

The most common consequence of congenital heart disease is heart failure. With severe defects, it develops immediately after birth. With some defects it appears at the age of 10.

The damaged structure of the valves does not allow the heart to perform its pumping function in full. Hemodynamic deterioration increases at 6 months of age. Children are developmentally delayed, prone to frequent colds, and get tired quickly. Children with defects constitute a risk group for the incidence of endocarditis, pneumonia, and heart rhythm disturbances.

Treatment

For congenital heart defects, operations are often performed on newborns, as well as children in the first year of life. According to statistics, 72% of babies need it. Surgical intervention is performed under artificial circulation using a machine. Congenital defects can and should be treated surgically. After radical surgery for congenital heart disease, children live full lives.

But not all defects require surgery immediately after diagnosis. For minor changes or severe pathology, surgical treatment is not indicated.

Severe defects in newborn babies are discovered by doctors in maternity hospitals. If necessary, a team of cardiac surgeons is called for emergency surgery. Some heart defects detected by ultrasound require only observation. Based on a number of the described signs, parents may notice a deterioration in the baby’s condition and consult a doctor in a timely manner.

Heart defects are anomalies and deformations of individual functional parts of the heart: valves, septa, openings between vessels and chambers. Due to their improper functioning, blood circulation is disrupted, and the heart ceases to fully perform its main function - supplying oxygen to all organs and tissues.

As a result, a condition develops, which in medicine is called “hypoxia” or “oxygen starvation.” It will gradually increase. If qualified medical care is not provided in a timely manner, this will lead to disability or even death. It is important to know the main causes and symptoms in order to notice the development of pathology in time.

In the majority of all clinical situations, heart defects are formed in humans due to deformations and anomalies of the aortic or mitral valve, which connect the largest vessels in the heart. Many people who hear such a terrible diagnosis immediately ask the question: “How many live with such vices?” There is no definite answer to this question, since all people are different and clinical situations are different. They live as long as their heart can work after conservative or surgical treatment.

Classification

In medicine, all heart defects are divided based on the mechanism of their formation into: congenital and acquired.

Acquired vice can form in a person from any age group. The main reason for its development today is hypertension. This disease occurs in people of working age and the elderly. More than 50% of all clinical cases involve damage to the mitral valve and only about 20% to the semilunar valve. The following types of anomalies also occur:

prolapse. The valve protrudes or swells greatly, with the valves everting into the heart cavity;
stenosis. Develops as a result of post-inflammatory cicatricial adhesions of the valve leaflets, which significantly reduce the lumen of the opening;
failure. This condition develops due to sclerosis of the valves. They are shortened.

Heart failure defines a clinical syndrome in which the pumping function of the heart is disrupted. Heart failure, the symptoms of which can manifest themselves in a variety of ways, is also characterized by the fact that it is characterized by constant progression, against the background of which patients gradually lose adequate ability to work, and also face a significant deterioration in the quality of their life.

A defect or anatomical abnormality of the heart and vascular system that occurs primarily during fetal development or at the birth of a child is called congenital heart disease or congenital heart disease. The name congenital heart defect is a diagnosis that doctors diagnose in almost 1.7% of newborns. Types of congenital heart disease Causes Symptoms Diagnosis Treatment The disease itself is an anomaly in the development of the heart and the structure of its blood vessels. The danger of the disease lies in the fact that in almost 90% of cases newborns do not live to see one month. Statistics also show that in 5% of cases, children with congenital heart disease die before the age of 15 years. Congenital heart defects have many types of cardiac abnormalities that lead to changes in intracardiac and systemic hemodynamics. With the development of congenital heart disease, disturbances in the blood flow of the greater and lesser circles, as well as blood circulation in the myocardium, are observed. The disease occupies one of the leading positions found in children. Due to the fact that congenital heart disease is dangerous and fatal for children, it is worth analyzing the disease in more detail and finding out all the important points, which this material will tell you about.

Pulmonary failure is a condition characterized by the inability of the pulmonary system to maintain normal blood gas composition, or it is stabilized due to severe overstrain of the compensatory mechanisms of the external respiration apparatus. The basis of this pathological process is a violation of gas exchange in the pulmonary system. Because of this, the required volume of oxygen does not enter the human body, and the level of carbon dioxide constantly increases. All this causes oxygen starvation of organs.

Lecture

"Pathology of the cardiovascular system"

The circulatory system is one of the integrating systems of the body, which normally optimally provides the blood supply needs of organs and tissues.

A condition in which the cardiovascular system does not meet the needs of tissues and organs for the delivery of oxygen and nutrients to them through the blood, as well as the transport of carbon dioxide and metabolites from the tissues to maintain normal tissue metabolism, is called circulatory failure (CI).

Main causes of NC:

– heart pathology;

– disturbances in the tone of the walls of blood vessels;

– changes in the mass of circulating blood and/or its rheological properties.

According to the severity of development and the nature of the course, acute and chronic NC are distinguished.

Acute NK develops within hours or days (the causes are: acute myocardial infarction, some types of arrhythmia, shocks)

Chronic NK develops over several months or years due to chronic inflammatory heart diseases, cardiosclerosis, heart defects, hyper- and hypotensive conditions, and anemia.

NC clinically manifests itself in the form of: shortness of breath, cyanosis, tachycardia.

According to the severity of signs of NK, 3 stages are distinguished:

Stage I – signs of NK appear only during physical activity

Stage II – signs of NK are detected both at rest and during physical activity

Stage III – there are significant disturbances in cardiac activity and hemodynamics at rest, pronounced dystrophic and structural changes develop in organs and tissues.

Coronary insufficiency blood circulation is caused by changes in the basic properties of the heart muscle: automaticity, excitability, conductivity and contractility.

Automatism- the ability to perform automatic activity under the influence of impulses originating in these tissues themselves. In various pathological conditions it can occur tachy- or bradycardia.

Excitability- the ability to generate an electrical impulse in response to stimulation. Impaired myocardial excitability may manifest itself extrasystole – a sudden contraction of the heart caused by an extraordinary impulse from some automatic unit. Extrasystoles are:

– by localization – supraventricular (sinus, atrial, atrioventricular) and ventricular ;

– according to the clinic - extrasystole, paroxysmal tachycardia, fibrillation and flutter of the atria or ventricles, accelerated ectopic rhythms.

Conductivity- the ability of the conduction system to ensure the propagation of excitation waves throughout the heart. Conduction disorder is called blockade heart, which can be partial or complete.

According to localization they distinguish:

– sinoatrial blockade, causing loss of contraction after 1, 2, 3 or more cardiac cycles;

– atrioventricular: the atria contract normally, and the ventricles contract slowly (30‑40 per minute);

– intraventricular (conduction disturbance below the bifurcation of the His bundle into branches), characterized by unequal strength of ventricular contractions.

Contractility- the ability of the heart muscle to perform mechanical work.

The reasons for the weakening of myocardial contractile function are usually:

– overload of the heart with an increased volume of blood (heart defects, arterial hypertension);

– myocardial damage (infections, including rheumatism and intoxication); c) coronary circulatory disorders (CHD).

Vascular insufficiency blood circulation is caused, first of all, by changes in blood pressure (BP).

Changes in blood pressure are usually the result of disturbances in the following factors:

– the amount of blood entering the vascular system per unit of time - cardiac output;

– the value of peripheral vascular resistance;

– changes in elastic stress and other mechanical properties of the walls of the aorta and its large branches;

– changes in blood viscosity, disrupting blood flow in the vessels.

Factors causing cardiac and vascular forms of circulatory failure underlie the etiology, patho- and morphogenesis of a number of diseases (hypertension, atherosclerosis, coronary heart disease, consequences of rheumatism, heart defects, etc.).

Heart defects– structural irreversible abnormalities of valves, openings or septa in the chambers of the heart and/or in the mouths of large vessels extending from it, impairing its function. Heart defects may be congenital And acquired.

Congenital heart defects are formed as a result of disturbances in one of the phases of prenatal development.

Etiology they are multifactorial: most are inherited, and often combined with anomalies and malformations of other organs. Serious importance is attached to alcoholism and syphilis of parents, viral diseases of the mother (mumps, rubella, influenza) suffered in the third trimester of pregnancy, exposure to chemicals, radiation, temperature fluctuations, and vitamin deficiencies.

Pathological anatomy. Congenital heart defects are of the “blue” type (there is hypoxia due to decreased blood circulation in the pulmonary circle due to blood flow from the right half of the heart to the left) and the “white” type (there is no hypoxia, because the blood flow is directed from the left half of the heart to the right).

The most common congenital heart defects