home Adviсe Types of heart surgeries in children: their advantages and disadvantages. Three types of UPS operations according to deadlines. How physical activity is restored

Types of heart surgeries in children: their advantages and disadvantages. Three types of UPS operations according to deadlines. How physical activity is restored

After diagnosis, when can surgery be scheduled, and who makes the decision?

Major congenital cardiovascular diseases can be divided into:

Diseases of the pulmonary-cardiac vessels without abnormal connections between arteries and veins.
So-called “white” congenital heart defects.
So-called “blue” congenital heart pathologies.

"White" heart defects It is customary to call such pathological conditions when venous blood does not enter the systemic circulation. Or, due to structural defects, blood flows from the left half of the heart to the right.

“White” congenital defects include:

Patent ductus arteriosus.
Narrowing of the aortic mouth.
Pulmonary stenosis.
Structural defect interventricular septum.
Anomaly in the structure of the interatrial septum.
Segmental narrowing of the aortic lumen (coarctation).

"Blue" VPS are characterized by pronounced cyanosis of newborns. This symptom indicates a lack of oxygen in the blood, which in turn threatens the normal functioning and development of the patient’s brain.

“Blue” congenital heart defects include:

Abnormal prolapse of the pulmonary veins.
Underdevelopment of the tricuspid valve.
Fallot's disease in all its forms.
Abnormal location (transposition) of the main great vessels - the aorta and pulmonary trunk.
The connection of the aorta and pulmonary artery into the common arterial trunk.

The decision on the method of treating a congenital heart defect is made after an accurate diagnosis is made using modern methods for diagnosing congenital heart defects.

In some cases, such a diagnosis can be made in utero. In this case, the pregnant woman is examined by both gynecologists and cardiologists. The woman is explained the severity of the pathology existing in the baby.

There are situations when a newborn needs to undergo heart surgery immediately after birth. The mother gives her consent in principle to this even before the birth, then it is necessary to properly prepare the child and his parents for heart surgery.

Unfortunately, not all congenital cardiac anomalies can be diagnosed in utero. In most babies, the presence of heart pathology is detected only after birth.

In case of severe “blue” defects that threaten the baby’s life, it can be performed emergency surgery VPS according to vital indications.

If such urgent surgical intervention is not required, the operation is postponed until the child is three to five years old so that his body is prepared for the use of anesthesia. During preparation, the child is prescribed maintenance therapy.

Three main categories of operations for congenital heart defects

All types of surgical intervention for cardiac pathology are divided into:

Closed operations.
Open surgical interventions.
X-ray surgical operations.

Closed operations represent such actions of the surgeon in which the human heart is not directly affected and there is no need to open the heart cavity. All surgical operations occur outside the cardiac zone. When carrying out this type of operation there is no need for special specialized equipment.

In particular, such a surgical intervention as a closed commissurotomy consists of dividing the fused leaflets of the left atrioventricular orifice if they have existing stenosis.

The surgeon enters the heart cavity through the left atrial appendage, onto which a purse-string suture is first applied. Before performing this manipulation, doctors make sure that there are no blood clots.

Then, a digital inspection of the condition of the mitral valve is performed, and the degree of its stenosis is determined. The surgeon restores the loosened constrictions with his fingers to normal size.

If there are dense adhesions, a special instrument is inserted to remove them.

For open surgical procedures the surgeon needs to open the heart cavity to carry out the necessary surgical procedures in it. Such operations involve temporary shutdown of cardiac and pulmonary activity and are performed under general anesthesia.

Therefore, the patient must be connected to a special artificial blood circulation machine during the operation. Thanks to the operation of this device, the operating surgeon has the opportunity to work on the so-called “dry” heart.

The patient’s venous blood enters the device, where it passes through an oxygenator, which replaces the work of the lung. In the oxygenator, the blood is converted into arterial blood, enriched with oxygen and freed from carbon dioxide. The blood that has become arterial, with the help of a special pump, enters the patient’s aorta.

X-ray surgery for congenital heart defects are a fairly new type of cardiac surgery. To date, they have already proven their success and efficiency. These operations are carried out as follows:

The surgeon uses a very thin catheter, at the ends of which tubes or special balloons folded like an umbrella are securely attached.
The catheter is placed into the lumen of the vessel or inserted through the vessels into the cavity of the heart.
Then the balloon expands using pressure and, depending on the defect, enlarges the narrowed lumen of the heart septum or ruptures the valve affected by stenosis. Or a completely missing hole is created in the septum. If umbrella tubes are inserted into the heart cavity using a catheter, they are used as a patch. The umbrella, which opens under pressure, covers the pathological hole.

The entire progress of the operation is monitored by doctors on the monitor screen. This type of surgery is much less traumatic and safe for the patient than abdominal surgery.

X-ray surgery can be used as an independent operation, not for all cardiac defects. In some cases, it is used as an auxiliary to the main one, facilitating the latter.

Three types of UPS operations by deadlines

Congenital heart defects (CHD)

Congenital heart defects (CHD)- an extensive and heterogeneous group of diseases associated with anatomical defects of the heart and great vessels. These diseases are dealt with by pediatric cardiology. The most common defects: septal defects (“holes” between the atria of the heart - atrial septal defect, between the ventricles of the heart - ventricular septal defect), patent ductus arteriosus (PDA, which normally should close during the first weeks after birth), vasoconstriction ( aortic stenosis, pulmonary artery stenosis).

Congenital heart disease occurs with a frequency of 6-8 per 1000 children born. Recently, this figure has been increasing, mainly due to improved diagnostics. The predisposing factors of the study are: unfavorable environmental factors, diseases suffered by the pregnant woman, genetic predisposition. Moreover, some congenital defects can be combined (for example, septal defect and patent ductus arteriosus), or combined with other developmental anomalies (for example, Down syndrome).

Congenital heart defects are treated mainly surgically, meaning heart surgery is required. The essence of surgical treatment is the correction of anatomical defects of the heart and blood vessels. Until relatively recently, only abdominal operations on the heart were performed, i.e. with a cut into the chest open heart. Now many defects (but, unfortunately, not all) can be corrected “without an incision”: special instruments are passed through the vessels to the heart, with the help of which the holes or the vessel are closed, or, conversely, the lumen of the vessel is expanded. These are so-called endovascular operations. To close the atrial septal defect and ventricular septal defect, occluders are used, for patent ductus arteriosus - occluders or spirals (depending on the size of the defect), for vascular stenosis - balloons and stents.

The cost of a set of medical instruments for the correction of congenital heart disease is: for closing a PDA - from 30,000 to 100,000 rubles. for closure of ASD and VSD - from 150,000 to 220,000 rubles, for correction of stenoses - from 30,000 to 120,000 rubles. depending on the specific heart defect, model, manufacturer, and the presence of combined defects.

Currently, we provide assistance in purchasing medical instruments for endovascular operations to correct congenital heart defects for children undergoing treatment in more than 50 Russian clinics, their list is constantly expanding.

Heart disease

Heart disease is a unique series of structural anomalies and deformations of valves, septa, openings between the heart chambers and vessels, which disrupt blood circulation through the internal heart vessels and predispose to the formation of acute and chronic form insufficient circulatory function. According to etiological factors, heart disease can be of congenital origin or acquired.

Heart defects with a congenital etiology are divided into defects that are an anomaly of the embryonic formation of the S.S.S. and for heart defects that develop as a consequence of endocardial pathologies during fetal development. Taking into account the morphological lesions, this category of heart defect occurs with anomalies in the location of the heart, in the pathological structure of the septa, both between the ventricles and between the atria.

There are also defects of the ductus arteriosus, valvular apparatus of the heart, aorta and movements of significant vessels. Heart defects with acquired etiology typically develop against the background of rheumatic carditis, atherosclerosis, and sometimes after trauma and syphilis.

Heart defect causes

The formation of heart defects of congenital etiology can be influenced by gene mutations, various infectious processes, endogenous, as well as exogenous intoxications during pregnancy. In addition, this category of heart defects is characterized by various abnormalities in the chromosome set.

Among the characteristic changes, trisomy 21 is noted in Down syndrome. Almost 50% of patients with such a genetic pathology are born with congenital heart disease (congenital heart disease), namely, ventricular septal or atrioventricular defects. Sometimes mutations occur in several genes at once, contributing to the development of heart disease. Mutations such as those in TBX 5 are detected in many patients diagnosed with Holt-Oram syndrome, which is an autosomal disease with septal defects. The cause of the development of supravalvular aortic stenosis is mutations occurring in the elastin gene, but changes in NKX lead to the development of the heart defect Tetralogy of Fallot.

In addition, heart disease can occur as a result of various pathological processes occurring in the body. For example, in 85% of cases the development of mitral stenosis and in 26% of aortic valve damage is influenced by rheumatism. It can also contribute to the formation of various combinations of insufficient functioning of some valves and stenosis. Sepsis, infectious endocarditis, trauma, and atherosclerosis can lead to the formation of heart defects acquired throughout life. and in some cases – Libman-Sachs endocarditis, rheumatoid arthritis. causing visceral lesions and scleroderma.

Sometimes different degenerative changes become the cause of the development of isolated mitral and aortic insufficiency, aortic stenosis, which are characterized by non-rheumatic origin.

Heart defect symptoms

Any organic lesions of the heart valves or its structures that cause characteristic abnormalities are in a general group called “heart disease.”

The characteristic signs of these anomalies are the main indicators with which it is possible to diagnose a certain heart defect, as well as at what stage of development it is located. At the same time, there are symptoms with a congenital etiology, which are determined almost immediately from the moment of birth, but acquired cardiac anomalies are characterized by a meager clinical picture, especially in the compensatory stage of the disease.

As a rule, the clinical symptoms of heart disease can be divided into general signs of the disease and specific ones. Some disorders in the structure of the heart or blood vessels are characterized by a certain specificity of symptoms, but general symptoms are characteristic of many diseases of the entire circulatory system. Therefore, heart disease, for example, in infants has more nonspecific symptoms, in contrast to the symptoms of a certain type of disorder in the blood flow system.

Children's heart defects are differentiated by color types skin. When the skin color is cyanotic, blue defects are considered, and white defects are characterized by a pale tint. With white heart defects, venous blood does not enter the ventricle located on the left side of the heart or its outlet narrows, as well as the aorta parallel to the arch. And with blue defects, mixing of blood or transposition of blood vessels is noted. It is very rare to observe the appearance of rapidly developing cyanosis of the skin in a child, which makes it possible to assume an existing heart defect, not in the singular. To confirm this diagnosis, additional examination is required.

The symptoms of general manifestations include the appearance of signs in the form of dizziness, rapid heartbeat, increased or decreased blood pressure, shortness of breath, cyanosis of the skin, pulmonary edema, muscle weakness, fainting, etc. All these symptoms cannot accurately indicate an existing heart defect, so an accurate diagnosis of the disease is possible after a thorough examination. For example, an acquired heart defect can be identified after listening, especially if the patient has a history of disorders characteristic of this. The mechanism of hemodynamic disorders makes it possible to immediately reliably and quickly determine the type of heart defect, but the stage of development is much more difficult to identify. This can be done if signs of a nonspecific disease appear. Largest quantity clinical symptoms characteristic of heart defects in combination or combined form.

In the subjective assessment of congenital heart defects, a slight intensity is noted symptomatic manifestations, while acquired ones are characterized by severity in such stages as decompensation and subcompensation.

The clinical symptoms of stenosis are more pronounced than valve insufficiency. Mitral stenosis manifests itself in the form of diastolic cat purring, delayed pulse in the artery of the left arm as a result of compression of the subclavian artery on the left, acrocyanosis, in the form of a cardiac hump, cyanosis in the area of the nasolabial triangle.

In the subcompensation and decompensation stages, PH develops, leading to difficulty breathing, the appearance of a dry cough with scanty white sputum. These symptoms increase each time and lead to the progression of the disease, which causes deterioration and weakness in the body.

With absolute decompensation of the heart defect, patients develop edema in some parts of the body and pulmonary edema. For a first-degree stenotic defect affecting the mitral valve, when performing physical activity, shortness of breath with a sensation of heartbeat and a dry cough is characteristic. Valve deformation is observed on both the aortic and tricuspid valves. With aortic damage, a systolic murmur is detected in the form of purring, palpation of a weak pulse with the presence of a cardiac hump between the fourth and fifth ribs. With an abnormality of the tricuspid valve, edema and heaviness in the liver appear, which is a sign of complete filling of the vessels. Sometimes the veins in the lower extremities dilate.

Symptoms of insufficient functioning of the aortic valve consist of changes in pulse and blood pressure. In this case, the pulse is very tense, the size of the pupil changes in diastole and systole, and an Quincke pulse of capillary origin is observed. During the period of decompensation, the pressure is at low levels. In addition, this heart defect is characterized by its progression, and the changes that occur in the myocardium very quickly become the cause of HF (heart failure).

In patients at a younger age, as well as among children with heart defects of congenital etiology or early acquired, the formation of a cardiac hump is observed as a result of high blood pressure enlarged and altered myocardium of the left part of the ventricle onto the anterior wall of the chest.

With a congenital cardiac anomaly, there is a rapid beating of the heart and efficient circulation of blood, which are characteristic from birth. Very often with such defects cyanosis is detected. caused by a septal defect between the atrium or between the ventricle, transposition of the aorta, stenosis of the entrance to the right ventricle and its hypertrophy. All these symptomatic signs also have a heart defect such as tetralogy of Fallot, which very often develops in newborns.

Heart disease in children

Cardiac pathology, which is characterized by defects in the valve apparatus, as well as in its walls, is called heart disease. In the future, it leads to the development of cardiovascular failure.

In children, heart defects can be of congenital etiology or can be acquired during life. The reasons for the formation of congenital defects in the form of defects in the heart and adjacent vessels are considered to be disturbances in the processes of embryogenesis. Such heart defects include: defects between the septa, both between the ventricles and between the atria; a defect in the form of an open ductus arteriosus; aortic stenosis; tetralogy of Fallot; isolated pulmonary artery stenosis; coarctation of the aorta. All these cardiac pathologies in the form of heart defects are formed during the prenatal period, which can be detected using ultrasound of the heart, and early stages development using electrocardiography or Doppler.

The main causes of heart disease in children include: hereditary factor, smoking and drinking alcohol during pregnancy, an environmentally unfavorable area, a woman’s history of miscarriages or stillborn children, as well as an infectious disease such as rubella during pregnancy.

Acquired cardiac defects are characterized by abnormalities in the valve area, in the form of stenosis or insufficient heart function. These heart defects are childhood develop as a result of certain diseases. These include infective endocarditis, mitral valve prolapse and rheumatism.

To determine a heart defect in a child, first of all, pay attention to murmurs during auscultation of the heart. Existing organic murmurs indicate a suspected heart defect. A child with this diagnosis gains very little weight every month, about 400 grams. he has shortness of breath and gets tired quickly. As a rule, these symptoms appear during feeding. At the same time, heart disease is characterized by tachycardia and cyanosis of the skin.

There is generally no clear answer to the treatment of childhood heart disease. Many factors play a role in the choice of therapeutic treatment method. This includes the nature of the disease, the age of the child and his condition. It is also important to take into account that heart disease in children can go away on its own after reaching fifteen or sixteen years of age. All this applies to heart defects with congenital etiology. Very often, treatment is initially started for the disease that caused the development of heart disease in children or contributed to its progression. In this case, preventive and drug treatment is used. But acquired cardiac pathology often ends in surgery. In this case, it is a commissurotomy, which is performed for isolated mitral stenosis.

Surgical intervention in the presence of mitral regurgitation is prescribed in cases of complications or deterioration of the child’s well-being. The operation is performed to replace the valve with an artificial one. To carry out therapeutic therapy for heart disease, appropriate protein diet with restriction of water and salt, various general hygienic measures, as well as constant exercise physical therapy. A child with a heart defect is taught to perform certain physical activities that constantly train the heart muscle. First of all, this is walking, which helps increase blood circulation and prepares the muscles for the next activity. Then they perform a set of exercises that straighten the spine and chest. Of course, an integral part of the training is exercises for the respiratory system.

Heart disease in newborns

In newborns, heart disease may be based on certain genetic causes, as well as environment can greatly influence its formation, especially in the first trimester of pregnancy.

Moreover, if future mom used some medicines, drugs, alcohol, smoked or had certain viral or bacterial etiology, then there is huge probability development of heart disease first in the fetus and then in the newborn. Some types of heart defects develop due to hereditary etiology. All these pathologies can be identified even when examining pregnant women with an ultrasound, and sometimes with late diagnosis, but then heart defects manifest themselves at different ages.

In newborns, heart defects are a common pathology and a very serious problem. They are divided into heart defects characterized by shunting and without shunting. Clinical symptoms are most pronounced in the first type of heart disease, when there is a defect between the atrial septa. In this case, blood without oxygen enrichment enters such a circulatory system as the systemic circulation, which is why the newborn develops cyanosis or a bluish coloration of the skin. A characteristic blueness is visible on the lips, which is why the medical term “blue baby” exists. Cyanosis also appears with a defect in the septum between the ventricles. This is explained by a defect, as a result of which the heart and small circle are overloaded due to pressure in different parts of the heart.

For heart defects of congenital origin, but without bleeding, coartation of the aorta is more typical. In this case, a cyanotic tint does not appear on the skin, but when at different levels development of the defect, cyanosis may form.

The most common malformations of newborns are tetralogy of Fallot and coartation of the aorta. But the most common defects are defects of the atrial and ventricular septa.

Tetralogy of Fallot is formed in the fourth to sixth weeks of pregnancy as a consequence of disturbances in the development of the heart. Heredity plays a significant role, but risk factors also play an important role. Most often, this defect occurs in newborns with Down syndrome. Tetralogy of Fallot is characterized by a defect in the septum between the ventricles, the position of the aorta changes, the pulmonary aorta narrows and the right ventricle enlarges. In this case, a rustling sound is heard in the heart, shortness of breath is noted, and the lips and fingers also turn blue.

Coartation of the aorta in newborns is characterized by narrowing of the aorta itself. Depending on this narrowing, there are two types: postductal and preductal. The last cardiac type refers to a very severe pathology incompatible with life. In this case, surgical intervention is necessary, as this heart defect leads to blue discoloration of the lower body.

Heart valve defects of congenital origin are presented in the form of protruding parts of the endocardium that lines the inner part hearts. With such defects, blood circulates in only one direction. The most common heart defects in this category are aortic and pulmonary. The symptoms of this pathology consist of a certain heart rustling, difficulty breathing, swelling of the limbs, chest pain, lethargy and loss of consciousness. To clarify the diagnosis, electrocardiography is used, and one of possible methods The treatment is considered to be surgery.

Diagnosing heart defects in newborns involves identifying this pathology even before birth, that is, using the prenatal diagnostic method. There are invasive and non-invasive examinations. The first diagnostic method includes cordocentesis, chorionic villus biopsy and amniocentesis. The second method of examination includes a blood test for a biopsy from the mother, an ultrasound of the pregnant woman in the first half of pregnancy, and to clarify the diagnosis - a repeat ultrasound examination.

A certain group of heart defects in infants is in some cases simply life-threatening, so in this case emergency surgery is prescribed. For example, with a heart defect such as coartation of the aorta, the narrowed area is surgically removed. In other cases, surgery is postponed for a certain period of time, if this is possible without surgery.

Acquired heart defects

This pathology in the structure and functioning of the heart valves, which are formed throughout a person’s life under the influence of certain factors, leads to disturbances in the functioning of the heart. The formation of acquired heart defects is influenced by infectious lesions or various inflammatory processes, as well as certain overloads of the heart chambers.

A heart defect that a person acquires during life is also called valvular heart disease. It is characterized by stenosis or insufficient functioning of the valve, and at some points it manifests itself as a combined heart defect. When making this diagnosis, a disturbance in the functioning of the mitral valve is identified, which is unable to regulate blood flow and causes stagnation in both circulation circles. And overload of some cardiac parts leads to their hypertrophy, and this, in turn, changes the entire structure of the heart.

Acquired heart defects are rarely subject to timely diagnosis, which distinguishes them from UPS. Very often people suffer many infectious diseases“on your feet,” and this can cause rheumatism or myocarditis. Heart defects with acquired etiology can also be caused by improperly prescribed treatment.

In addition, this category of cardiac pathology is classified according to etiological criteria into heart defects of syphilitic origin, atherosclerotic, rheumatic, and also as a consequence of bacterial endocarditis.

Acquired heart defects are characterized by a high or moderate degree of hemodynamic disturbance inside the heart; there are also defects that are absolutely not affected by these dynamics. Depending on this hemodynamics, several types of acquired defects are distinguished, namely compensated, decompensated and subcompensated.

An important point To diagnose the type of defect, its location is taken into account. Heart defects such as monovalve include mitral heart defect, aortic and tricuspid. In this case, only one valve is subject to deformation. If both are affected, they speak of combined valvular heart disease. This category includes mitral-tricuspid, mitral-aortic, aortic-mitral-tricuspid defects, etc.

With minor heart defects, the symptoms of the disease may not manifest themselves for a long time. But hemodynamically significant acquired heart defects are characterized by shortness of breath, cyanosis, edema, rapid heartbeat, pain in this area and cough. A characteristic clinical sign of any type of defect is a heart murmur. For a more accurate diagnosis, a consultation is prescribed with a cardiologist, who conducts an examination using palpation, percussion, and auscultation, which makes it possible to listen to a clearer heart rhythm and the murmur present in the heart. In addition, ECHO-cardioscopy and Dopplerography methods are used. All this will help to assess how severe a certain heart defect is, as well as its degree of decompensation.

Making a diagnosis such as heart disease requires a person to take greater responsibility for their health. First of all, it is necessary to limit the performance of heavy physical activity, especially in professional sports. It is also important to comply correct image life with rational nutrition and daily routine, regularly carry out the prevention of endocarditis, cardiac arrhythmias and poor circulatory function, since in this category of patients there are prerequisites for the formation of defects. In addition, timely treatment of infectious diseases with the prevention of rheumatism and endocarditis of bacterial etiology can prevent the development of acquired heart defects.

Today, two methods are used to treat the acquired category of this cardiac pathology. These include surgical treatment and medication. Sometimes this anomaly becomes completely compensated, which allows the patient to forget about his diagnosis of an acquired heart defect. However, for this, the important point remains timely diagnosis of the disease and correctly prescribed treatment.

Therapeutic treatment methods include stopping the process of inflammation in the heart, then surgery is performed to eliminate the heart defect. As a rule, surgery is performed on an open heart and the effectiveness of the operation largely depends on the early timing of its implementation. But such complications of heart defects as insufficient circulatory function or disturbed heart rhythm can be eliminated without surgery.

Aortic heart disease

This disease is divided into aortic stenosis and aortic insufficiency. Today, aortic stenosis, among acquired heart defects, is most often detected in North America and Europe. About 7% are diagnosed with calcifying aortic stenosis in people over 65 years of age and mainly among the male half of the population. Only 11% is accounted for by such an etiological factor as rheumatism in the formation of aortic stenosis. In the most developed countries, the cause of the development of this heart defect is almost 82% due to the degenerative calcifying process occurring on the aortic valve.

One third of patients suffer from bicuspid aortic valve disease, where leaflet fibrosis progresses as a result of damage to the valve tissues themselves and atherogenic processes accelerate, and this is what causes the formation of aortic defect in the form of stenosis. And provoking factors such as smoking, dyslipidemia, the patient’s age, and significantly increased cholesterol levels can accelerate fibrotic processes and the formation of aortic disease in the heart.

Depending on the severity of the disease, several degrees are distinguished. These include: aortic stenosis with slight narrowing, moderate and severe.

The symptomatic picture of aortic heart disease depends on anatomical changes aortic valve. With minor lesions, most patients live and work for a long time in their usual rhythm of life and do not present certain complaints that would indicate an aortic defect. In some cases, the first symptom of aortic disease is heart failure (HF). Hemodynamic disorders present increased fatigue, which is associated with centralization of blood flow. All this causes dizziness and fainting in patients. Almost 35% of patients experience pain characterized by angina pectoris. When the defect is decompensated, shortness of breath appears after any physical activity. But as a result of inadequate physical activity, pulmonary edema can occur. Signs such as cardiac-type asthma and angina attacks are unfavorable prognoses of the disease.

Visually, during examination of the patient, pallor is noted, and with severe stenosis, the pulse is small and slow in filling, and the systole pressure and pulse are reduced. The cardiac impulse at the apex is heard in the form of a powerful tone, diffuse, rising with a shift to the left and down. When you place your palm on the manubrium of the sternum, a pronounced systole tremor is felt. During percussion, the border of cardiac dullness is noted with a displacement in left side and down almost 20 mm, and sometimes more. During auscultation, a weakened second tone is heard between the ribs, as well as a systolic murmur, which is carried out to all parts of the heart, to the back and cervical vessels. Sometimes a murmur can be heard remotely by auscultation. And when the second sound of the aorta disappears, we can speak with complete confidence about severe aortic stenosis.

Aortic heart disease is characterized by five stages.

The first stage is absolute compensation. The patients do not present any characteristic complaints; the defect is detected by auscultation. Using echocardiography, a slight gradient of systole pressure on the aortic valve is determined (about 40 mm Hg). Surgical treatment is not performed.

The second stage of the disease is a hidden insufficient work of the heart. Here fatigue, shortness of breath due to physical exertion, and dizziness appear. In addition to signs of aortic stenosis during auscultation, a characteristic sign of left ventricular hypertrophy is detected using X-ray and electrocardiographic studies. When conducting echocardiography, it is possible to determine moderate systolic pressure on the aortic valve (about 70 mm Hg) and here surgery is simply necessary.

The third stage is characterized by relative coronary insufficiency, which is manifested by pain resembling angina pectoris; shortness of breath progresses; Fainting and dizziness become more frequent due to minor physical exertion. The borders of the heart are clearly enlarged due to the ventricle on the left. The electrocardiogram shows all the signs of an enlarged ventricle in the left side of the heart and hypoxia of the heart muscle. With echocardiography, systole pressure increases to a maximum above 60 mmHg. Art. In this condition, emergency surgery is prescribed.

At the fourth stage of aortic heart disease, left ventricular failure is pronounced. The complaints of patients are the same as in the third stage of the disease, but pain and other sensations are much stronger. Sometimes attacks of paroxysmal shortness of breath appear periodically and mainly at night; cardiac asthma; the liver enlarges and pulmonary edema occurs. The electrocardiogram shows all abnormalities associated with coronary circulation and atrial fibrillation. And an echocardiographic study reveals calcification of the aortic valve. An X-ray reveals an enlarged ventricle on the left side of the heart, as well as congestion in the lungs. Recommendations of bed rest and the prescription of conservative methods of therapy temporarily improve general state some patients. In this case, surgical treatment is generally simply impossible. Everything is decided on an individual basis.

AND last stage aortic heart disease is terminal. It is characterized by progression of RV and LV failure. At this stage, all the signs of the disease are quite pronounced. The patients are in extreme in serious condition, therefore, treatment in this case is no longer effective and surgical operations are also not performed.

Aortic insufficiency refers to one of the types of aortic defects. The frequency of its detection, as a rule, is directly dependent on the methods of diagnostic studies. The prevalence of this type of defect increases with a person’s age, and all clinical signs severe form deficiencies are much more common in males.

One of the common causes of the formation of this pathology is aortic aneurysm of the ascending part, as well as the bicuspid aortic valve. In some cases, the cause of the pathology is almost 50% due to degenerative disorders of the aortic valve. In 15%, the etiological factor is rheumatism and atherosclerosis, and in 8%, endocarditis of infectious origin.

As with aortic stenosis, there are three degrees of severity of aortic heart disease: initial, moderate and severe.

The symptoms of aortic insufficiency depend on the rate of formation and size of valve defects. In the compensatory phase there are no subjective signs of the disease. The development of aortic heart disease proceeds calmly, even with a significant amount of aortic regurgitation.

With the rapid formation of extensive defects, the symptoms progress, and this becomes the cause of insufficient heart function (HF). A certain number of patients experience dizziness and feel their heart beating. In addition, almost half of patients diagnosed with aortic insufficiency, the causes of which are atherosclerosis or syphilis. The main symptom of the disease is angina.

Attacks of difficulty breathing develop initially pathological process with increased physical activity, and with the formation of left ventricular failure, shortness of breath appears at rest and is characterized by symptoms of cardiac asthma. Sometimes everything is complicated by the addition of pulmonary edema. In addition, patients are very pale, their carotid, brachial and temporal arteries pulsate strongly, and Musset, Landolfi, Müller and Quincke symptoms are observed. On examination, Corrigan's pulse is observed; upon auscultation, a very strong and somewhat diffuse impulse is heard at the apex of the heart, and its boundaries are significantly enlarged to the left side and downwards. Over large vessels, a double Traube sound is noted, and when pressing on the area of the iliac artery, a Durosier noise appears. Systolic pressure rises to 170 mm Hg. Art. and diastolic pressure indicators are characterized by a decrease to almost 40 mm Hg. Art.

This pathology develops from the appearance of the first signs until the patient’s death, on average it takes about seven years. Very quickly, insufficient work of the heart occurs in the process of tearing off the leaflet or quite severe damage to the valve due to endocarditis. Such patients live a little more than a year. A more favorable prognosis is characterized by aortic heart disease against the background of atherosclerotic origin, which rarely leads to significant changes in the valves.

Mitral heart disease

This category of diseases includes stenosis and insufficient function of the mitral valve. In the first case, stenosis is considered a common rheumatic heart disease, the cause of which is long-term rheumatic endocarditis. As a rule, this type of cardiac pathology occurs more among the younger generation and in 80% of cases affects the female half of the population. Very rarely, the mitral orifice becomes narrowed as a result of carcinoid syndrome, rheumatoid arthritis, and lupus erythematosus. And 13% of cases are due to degenerative valve changes.

Mitral stenosis can be minor, moderate or significant.

All clinical symptoms of mitral heart disease in the form of stenosis have a certain dependence on the stage of this pathology and the state of the blood circulation. With a small area of the hole, the defect does not manifest itself clinically, but this only applies to a state of rest. But with an increase in pressure in such a circle of blood circulation as the pulmonary circulation, shortness of breath appears, and patients complain of a strong heartbeat when performing minor physical exertion. In cases of a sharp increase in capillary pressure, cardiac asthma, dry cough, and sometimes with sputum production and even hemoptysis develop.

With PH (pulmonary hypertension), patients become weak and get tired quickly. With severe symptoms of stenosis, signs of mitral blush in the cheeks with a pale complexion, cyanosis on the lips, tip of the nose and ears are observed.

During a visual examination with mitral heart disease, a strong protrusion of the sternum is noted lower section and pulsation as a result of the formation of a hump of the heart, which is a consequence of increased impacts of the RV on the chest wall in front. In the area of the cardiac apex, diastole tremor is detected in the form of a cat's purr. During auscultation, an increase in the first sound in the upper part of the heart is heard and a click when the mitral valve opens.

Mitral stenosis can occur in several stages. The first is full compensation, in which you can do without the use of surgical treatment. The second is stagnation in the LH (pulmonary artery). In this case, surgical treatment is performed strictly according to indications. The third is insufficient work of the pancreas. Absolute indicators for surgical intervention are noted. The fourth stage is characterized by dystrophic changes. With the use of drug therapy, it is possible to achieve a slight, short-term effect. At this stage, operations can be performed, however, briefly increasing the life expectancy of patients. For the last, terminal stage, any treatment does not provide any effectiveness, neither medication nor surgery.

The second type of mitral heart disease is considered to be insufficient functioning of the mitral valve. Today, in the modern world, 61% of this disease accounts for degenerative mitral regurgitation and only 14% is rheumatic pathology. Other reasons for the development of this heart defect include systemic scleroderma and lupus erythematosus. endocarditis of infectious etiology and ischemic heart disease.

This disease is classified into initial degree severity, moderate and severe.

In compensation, this type of heart defect is accidentally detected during a medical examination. With reduced activity of LV contractions, attacks of difficulty breathing when performing certain work and heart palpitations develop. Then swelling occurs in the legs, pain in the hypochondrium on the right side, cardiac asthma and even shortness of breath in a state of absolute bye.

Many patients are diagnosed with aching, stabbing, pressing pain in the heart, which can appear without physical activity. With significant processes of regurgitation in the left part of the sternum, the formation of a cardiac hump is noted in patients; a push in the upper part of the heart of an intensified and diffuse nature is heard, which is localized under the fifth rib. On auscultation, the first heart sound is completely absent, the second heart sound is very often split above the LA and a dull third sound is heard at the apex.

With mitral insufficiency, five stages of the disease are also distinguished. The first is the compensation stage, without indications for surgical methods treatment. The second is the subcompensatory stage, which requires surgical intervention. The third stage of mitral regurgitation occurs with decompensation of the pancreas. The operation is also scheduled here. The fourth is dystrophic changes in the heart. In this case, surgical interventions are still possible. The fifth stage is terminal, in which surgical treatment is no longer performed.

Prognostic parameters of poor results include the age of patients, the presence of certain symptoms and atrial fibrillation, progressive processes of PH and low fraction ejection

Heart disease treatment

Typically, treatment for heart disease is divided into medicinal methods and surgical. In the compensation phase of heart defects, it is not prescribed special treatment. It is recommended to reduce physical activity and mental fatigue. An important point remains the implementation of exercises in the LF group. But during the decompensation period, antihypertensive drugs are prescribed to prevent pulmonary hemorrhages; beta-adrenergic receptor blockers and Endothelin, which reduces the resulting functional heart failure, which also allows you to endure physical activity. Anticoagulants are used for the development of fibrillation and atrial flutter.

For decompensated heart disease, such as mitral valve disease, digitalis preparations are used; for aortic defects - Strophanthin. But generally, when conservative treatment methods are ineffective, they resort to surgical operations for various heart defects.

In order to prevent the development of acquired heart defects, it is necessary to promptly and thoroughly treat diseases such as atherosclerosis, rheumatism, syphilis, and eliminate infectious foci in the oral cavity and pharynx, and also not to overwork and avoid nervous overload. In addition, it is important to observe sanitary and hygienic rules in everyday life and work, and to combat dampness and hypothermia.

To prevent heart disease from going into the stage of decompensation, it is necessary not to overeat, rationally distribute work and rest time with sufficient time for sleep. Various heavy types of work are completely contraindicated for people with heart defects. Such patients are constantly registered with cardiologists.

Heart defect surgery

In certain cardiac surgery clinics, various surgical methods are used to treat heart defects. In case of insufficient functioning of the valves, in some cases organ-preserving operations are resorted to. In this case, the adhesions are cut or fused. And with minor narrowings it produces a partial expansion. This is done using a probe and the method is referred to as endovasal surgery.

For more severe cases, a technique is used to completely replace the heart valves with artificial ones. In large forms of aortic stenosis and when it is not possible to expand the aorta, resection is performed and a certain section of the aorta is replaced using a synthetic Dacron prosthesis.

When diagnosing coronary circulatory insufficiency, the method of bypassing arteries that have lesions is simultaneously used.

There is also a modern method of surgical treatment of heart disease, which has been developed and widely used in Israel. This is a rotablater method, which is characterized by the use of a small drill to restore the lumen of blood vessels. Very often, heart defects are accompanied by rhythm disturbances, i.e. blockades are formed. Thus, an operation involving valve replacement is always accompanied by the implantation of artificial control and regulation of the heart rhythm.

After any surgical operation for heart defects, patients are in rehabilitation centers until they complete the entire course of therapeutic rehabilitation therapy with the prevention of thrombosis, improvement of myocardial nutrition and treatment of atherosclerosis.

After discharge, patients undergo periodic examinations as prescribed by a cardiologist or cardiac surgeon with preventive treatment twice a year.

Congenital heart defects (VPS) - the most common birth defects, occurring in approximately 6 to 8 out of 1000 live births. Considering modern results operations to eliminate congenital heart disease, most patients will undergo surgery and reach adulthood.

The population of patients undergoing surgery for congenital heart disease is expected to increase by approximately 5% per year. An increasing number of children with congenital heart disease, considered fatal just a few years ago, are surviving thanks to advances in medical and surgical treatment. At the same time, no operation on the cardiovascular system can be performed without a certain degree of risk, even if its “success” is postoperative period confirmed by normal anatomical, physiological and electrocardiographic data.

The doctor is obliged to predict the long-term results of the operation in terms of physical and social status, educational and professional abilities. In this case, it is necessary to take into account all possible outcomes, including the occurrence of possible complications both in the immediate postoperative period and in subsequent life. In this review, we will try to analyze the problems that may arise in patients after surgical treatment of congenital heart disease in order to help the pediatrician anticipate and recognize them.

CHD without cyanosis more often manifests itself as symptoms of pulmonary circulation overload or congestion with difficulty in systemic cardiac output. Cyanotic defects are manifested by progressive hypoxemia. In years past, surgery was often delayed until the patient's symptoms worsened and the risk of death increased due to natural progression congenital disease vice. Over the past decade, early correction began to replace palliative operations and began to be performed more often during the first months of life. Early surgical correction prevents complications of congenital heart disease. Despite significant improvements in the results of surgery for congenital heart disease, some problems may remain.

Friedli suggested classification of types of correction of congenital heart disease based on the likelihood that the patient will require further subsequent surgery:

True complete correction results in restoration of normal cardiac anatomy and function and is usually possible for secondary atrial septal defects (ASDs), ventricular septal defects (VSDs), patent ductus arteriosus(PDA), coarctation of the aorta (CoA). Although late complications sometimes occur in some patients, most children lead normal lives without further surgery.
Anatomical correction with residual effects can be performed in patients with tetralogy of Fallot (TF), atrioventricular septal defects (AVS), and valvular obstructions treated by valvotomy or valve repair. These patients experience resolution of symptoms and abnormal physiology, but retain residual defects such as valve regurgitation or arrhythmias that may require further intervention.
Correction using prosthetic materials is used in patients who require an anastomosis between the right ventricle and the pulmonary artery (pulmonary atresia with VSD, truncus arteriosus). Due to somatic growth and degeneration of the prosthetic material, this category of patients will require repeated surgery to replace the prosthesis.
Physiological correction (surgeries Senning And Mustard for transposition of the great arteries (TMA), Fontan operation in patients with a three-chamber heart) eliminates disorders of cardiovascular physiology, but does not eliminate anatomical disorders. Such patients almost always develop late complications requiring surgical or conservative intervention.

This classification is very useful for pediatricians and pediatric cardiologists to use in practice in order to predict the likelihood of problems in the operated patient and plan further observation.

The number of patients who have undergone surgical correction of congenital heart disease is growing at a rate that far exceeds the growth in the number and workload of pediatric cardiologists. As a result, the local pediatrician will be forced to take on an increasing role in the management of this complex group of patients. The pediatrician must be aware of all remaining disorders and potential complications that may develop in order to promptly refer the patient to a specialist.

COMMON POSTOPERATIVE PROBLEMS

Despite significant advances in the surgical correction of congenital heart defects, most patients retain some residual anatomical and/or physiological abnormalities after surgery. Let's look at the most common problems that some patients may experience after heart surgery. These problems can be divided into three main groups: residual defects, consequences of surgery and its complications.

The term " residual defect" is used to identify anatomical and hemodynamic disorders that are either part of the defect or arose as a result of it. In the future, with the development of diagnostic and surgical technologies, these problems may be prevented during surgery. On the other hand, the nature of the defect may be that residual pathology cannot be corrected or radical surgery is not justified due to the high risk.Sometimes a defect can persist even after an impeccably performed operation, which ensures success in most cases, and it is not possible to predict such an outcome.

The term " consequences of operations" is used in relation to anatomical and hemodynamic conditions arising as a result of surgery, which cannot be avoided at the present level of our knowledge. If the solution to these problems becomes known, then their occurrence is already classified as complications. Some of the consequences are not directly related to the operation, but they lead to certain problems or increase the possibility of their occurrence.Some of these consequences pose a greater threat than the circulatory disorders for which the operation was performed.

"Complications" are conditions that arise unexpectedly after surgery, although their occurrence in some cases may be unprecedented. The occurrence of complications does not necessarily imply an error in decision-making, procedure or lack of skill of the cardiologist, anesthesiologist, nurse or surgeon, although errors in the work of the staff do one of the reasons.In some cases, the occurrence of complications is unpredictable and inevitable.

HEART PROBLEMS

In the postoperative period, the patient often exhibits abnormalities during physical examination, which require the exclusion of complications. At the first postoperative examination, the doctor conducts a thorough analysis of diagnostic studies, information about the operation and the discharge summary. The doctor should evaluate the pulse to identify any arrhythmia. Blood pressure measurements in the right arm and either leg are necessary at each examination to exclude hypertension and a gradient between the upper and lower extremities that may occur with recurrent aortic coarctation. When auscultating the heart, abnormal sounds and the presence of murmurs should be recorded.

Deviations are often detected in patients in the postoperative period and are not always pathological in nature. Soft systolic flow murmurs at the base of the heart are often heard after closure of an ASD or VSD and represent turbulent flow in the dilated pulmonary artery. A metallic click is expected in a patient with a prosthetic valve, and its absence should be a cause for alarm. Hard or rough noises usually indicate a residual defect. Auscultation assesses the nature of breathing and the presence of continuous noises that can be heard on artificial aortopulmonary shunts or native aortopulmonary collateral vessels.

Decreased or nonconducted breathing may indicate pleural effusion, which often occurs after a Fontan procedure and is confirmed by a chest x-ray. At follow-up visits, the parent (or patient) should be asked about any changes in appetite, exercise tolerance, or behavior. The dynamics of physical development are assessed in order to record its improvement, which is expected after surgical correction of most congenital heart defects.

A pulse, blood pressure, heart, lung and liver size examination are performed. The ordering of laboratory tests such as electrolytes and complete blood counts should be determined by clinical indications, such as long-term treatment diuretics, residual defect, changes in physical examination findings. A chest x-ray, electrocardiogram and echocardiogram should be ordered, since routine studies usually have low informativeness. If necessary, Holter monitoring and exercise testing are prescribed.

Residual and recurrent defects

Children with congenital heart disease often have residual defects that are minor and do not affect the long-term outcome of surgical correction. A number of patients have more severe residual defects either due to planned staged surgical correction or due to incomplete success of the initial operation. Recurrence of defects such as valve stenosis or regurgitation, anastomotic obstruction, or recurrence of aortic coarctation may occur. Residual or recurrent defects increase the patient's risk of endocarditis.

Residual defects
Currently, the most common reason for the presence of residual cardiac defects in a patient in the postoperative period is staged surgical correction. Examples include repair of a three-chamber heart, ultimately leading to a Fontan procedure, or operations that require implantation of a prosthesis (homograft anastomosis for correction of tetralogy of Fallot with pulmonary atresia). Children with such defects initially undergo palliative procedures to ensure adequate pulmonary blood flow to allow adequate somatic growth without excessive cardiac work or pulmonary hypervolemia. Residual defects occur in less than 5% of cases when most defects are corrected. The physiological consequences and therefore symptoms of residual cardiac disease in the patient are determined by the presence of intracardiac shunts and decreased pulmonary or systemic blood flow.

Patients with a residual left-to-right shunt (patients with a residual VSD after incomplete surgical closure) will exhibit symptoms of pulmonary hypervolemia (tachypnea, weight loss, pulmonary congestion) depending on the size of the residual defect and the presence or absence of any obstruction to pulmonary blood flow . A patient with tricuspid atresia will have a mandatory right-to-left shunt at the level of the atrium (via the ASD) and a left-to-right shunt at the ventricular level (via the VSD) or at the level of the great arteries (via the PDA), or a surgically created aortopulmonary shunt to provide pulmonary blood flow. These shunts will determine the pulmonary blood flow and therefore the degree of cyanosis in the patient. This balance is dynamic in nature, changing with the patient's somatic growth and physical activity.

Recurrent defects
Recurrence of an anatomical defect will lead to return initial symptoms. Some congenital heart defects recur more frequently. For example, the prevalence of recurrent CoA is approximately 10% after correction in a young child. Aortic valve stenosis after balloon valvotomy or open surgical valvuloplasty is rarely permanent, with complication-free survival reported in less than 50% of patients after 10 years of follow-up. In the early stages of recurrence of the defect, there are usually no symptoms.

Subtle but significant changes during physical examination of the patient (an increase in the gradient between the blood pressure of the upper and lower extremities in a patient after surgery for coarctation of the aorta, a new or louder murmur in a patient with aortic stenosis) are the first clinical signs of a change in the patient's status. Targeted echocardiography with Doppler pressure gradient studies at the site of coarctation repair will help quantify the extent of recoarctation and determine the need and timing of further research and intervention.

Arrhythmias

Arrhythmias- most common problem, which occurs in children in the postoperative period. The actual prevalence of arrhythmias is unknown because they are sometimes asymptomatic. In the postoperative period, the patient or his parents may report a feeling of palpitations. Symptoms of a significant arrhythmia may include changes in general health, decreased appetite, vomiting, or decreased exercise tolerance. Often, arrhythmia is first detected during a routine physical examination and confirmed on an ECG.

Arrhythmia in a postoperative patient may be caused by an anatomical defect (eg, Ebstein's anomaly), the result of surgical correction (eg, ventriculotomy or atrial suture), the result of conservative therapy (eg, hypokalemia due to diuretics, digoxin overdose), or a combination these factors. When evaluating a patient with postoperative arrhythmia, the physician should carefully consider the underlying heart defect, surgical repair, the patient's current medications, and any recent health problems (eg, electrolyte imbalance due to vomiting or diarrhea) that may help differentiate the type of arrhythmia. its cause and determine treatment tactics.

Supraventricular arrhythmias
Supraventricular arrhythmias are the most common type of arrhythmias in the postoperative patient and range from benign to potentially life-threatening (persistent atrial flutter in a patient following a Fontan procedure). The causes of arrhythmias may be scars after atriotomy, increased intraatrial pressure due to obstruction of the atrioventricular valve (mitral stenosis) or inelastic ventricular chamber (TF, aortic stenosis). After some surgical operations (Fontan operation for a three-chamber heart or Senning and Mustard operation for TMS), residual structural and physiological changes persist, which can lead to supraventricular arrhythmias. These operations require long intraatrial sutures, creating conditions for the spontaneous occurrence of reentry circuit. ASD closure and correction of abnormal pulmonary venous drainage are less likely to be complicated by arrhythmia.

Episodic arrhythmias can be difficult to detect due to their short duration; they are better diagnosed with Holter monitoring. Persistent supraventricular arrhythmias (atrial flutter, atrial fibrillation and junctional tachycardia) require prompt identification. For a clinically stable patient, treatment begins with correction of disorders that are arrhythmogenic (electrolyte disturbances, drug-induced arrhythmia).
Drug treatment is effective in less than 40% of cases. It may be complicated by proarrhythmic effects and other side effects of some drugs, emphasizing the need for management of arrhythmias experienced specialist. Hemodynamically unstable patients may require more aggressive therapy, including electrical cardioversion. Refractory arrhythmias may require more complex interventions, including radiofrequency ablation arrhythmogenic focus or installation of an antitachycardia pacemaker.

The clinical significance of bradycardias is often underestimated, since their symptoms may be absent or mild. Inappropriate heart rhythm may be due to sick sinus syndrome, which is often observed in patients after Mustard and Senning operations (only 20-40% of them have sinus rhythm 5-10 years after surgery). Approximately 20% of patients require antiarrhythmic therapy or a pacemaker 5-10 years after Fontan surgery. Treatment of bradycardia may require adjustment of medications that can cause or worsen bradycardia (digoxin, beta blockers or calcium channel blockers). Often a permanent pacemaker is required.

Ventricular arrhythmias
Ventricular arrhythmias in postoperative patients are less common than supraventricular arrhythmias, but are often more significant due to serious hemodynamic disturbances and the possibility of sudden death. Causes of such arrhythmias include scarring caused by ventriculotomy during surgical correction, increased intraventricular pressure (in severe pulmonary or aortic valve stenosis, cardiomyopathic ventricles with elevated end-diastolic blood pressure), and ischemic lesions associated with the lesion. coronary arteries or inadequate myocardial protection during surgery. Earlier surgical correction, resulting in less severe ventricular hypertrophy and fibrosis, reduces the risk of late ventricular arrhythmias.

Persistent ventricular tachycardia may be well tolerated in the short term by some patients. More often, with these arrhythmias, there is a threat of syncope, seizures or sudden death. Immediate cardioversion is necessary in patients with persistent ventricular tachycardia. In many cases, electrophysiological testing is required to confirm the type and sites of origin of the arrhythmia. Based on these data, ablation therapy or implantation of an automatic defibrillator/pacemaker system can be used.

Sudden cardiac death

Certain types of uncorrected congenital heart disease with increased ventricular pressure (aortic stenosis, pulmonary stenosis), hypertrophic cardiomyopathy and coronary anomalies are associated with an increased risk of sudden cardiac death. Its prevalence reaches 5 per 1000 patients per year. In this group of patients, half had previously undergone corrective heart surgery. A small group of patients had a history of ventricular tachycardia, and 75% had dysfunction of one or both ventricles. The majority of sudden deaths are caused by malignant arrhythmias, which once again emphasizes the need for their timely detection and treatment.

PROBLEMS CAUSED BY VALVES AND PROSTHETICS

Let's look at problems common to most patients who have had heart valve surgery or who have had a prosthesis used as a component of the surgical procedure.

Valvotomy

After pulmonary valvotomy, the complication-free survival rate is 75-80% after 5 years for both surgical and balloon valvotomy in young children. Early results of aortic valvotomy by balloon or open surgical technique are quite successful in children, although residual aortic stenosis is more common after balloon valvotomy and aortic regurgitation after surgical valvotomy.

The complication-free survival rate is only 50% at 10 years and less than 33% at 15 years of follow-up in older patients after surgical valvotomy. Late complications include recurrent aortic valve stenosis, clinically significant aortic regurgitation, endocarditis, and the need for reoperation. Long-term results of interventions on the mitral and tricuspid valves are more variable due to wide range correctable congenital defects.

Prosthetic valves

Generally, valve replacement is avoided in children if an alternative to reconstruction is available, due to the disadvantages of all valve replacement options in the growing child. Each category of valve prostheses (bioprostheses, mechanical valves, homografts, autografts) has significant disadvantages:

Prosthetic conduits and patches

Conduits used for reconstruction of the UHL create many common problems, described in detail above regarding prosthetic valves. Conduits between the ventricles and large arteries or used to correct coarctation of the aorta do not grow, and the patient outgrows them within several years. Due to pseudointimal formation, valve calcification, and stenosis, less than 50% of cases do not require conduit replacement within the first 10 years.

Due to their low durability, homograft conduits, consisting of a portion of the pulmonary artery and the pulmonary valve or a segment of the aorta and the aortic valve, have replaced Dacron valve conduits. These channels are more durable, but still degenerate over time. Conduit stenosis due to conduit degeneration or somatic growth can be easily identified by a change or appearance of a new systolic heart murmur or ECG signs of ventricular hypertrophy. Intracardiac and extracardiac patches are usually made from autologous or heterologous pericardium, Dacron. Pericardial patches may shrink over time or become aneurysmal if exposed to excess pressure. Dacron patches when used in cameras low pressure(interatrial septum), tend to develop pseudointima, and can cause obstruction. When using Dacron in high-pressure chambers (for VSD), minimal development of pseudointima is noted.

Ventricular dysfunction

CHDs cause subclinical changes in the heart that can progress and cause abnormalities in ventricular function. Earlier surgical correction of defects leads to a lower incidence of ventricular dysfunction. There are several potential causes of ventricular dysfunction:

Chronic hemodynamic overload. Chronic pressure and volume overload due to defects such as stenosis or insufficiency of the aortic or pulmonary valve cause ventricular hypertrophy. Over time, chronic hypertrophy leads to myocardial fibrosis, which causes irreversible changes in myocardial systolic and diastolic function.
Chronic cyanosis. Chronic cyanosis also leads to myocardial fibrosis due to an imbalance in oxygen requirements determined by the work of the heart and the oxygen content in the desaturated arterial blood. This problem most often occurs in conditions of a hypertrophied ventricle (for example, with tetralogy of Fallot).
Complications of surgical correction. Open heart surgery requires stopping the heart for an extended period of time. Inadequate myocardial protection during this period usually manifests itself as early postoperative myocardial dysfunction.

Late consequences of myocardial ischemic injury include myocardial systolic dysfunction and fibrosis. Ventricular incisions may also alter myocardial function due to coronary artery disease. Chronic deviations from normal hemodynamic physiology, such as the morphological functioning of the right ventricle as a pump for systemic circulation during TMS, often lead to a gradual deterioration of systemic ventricular function. Finally, arrhythmias, including complete heart block, reduce cardiac efficiency by reducing atrial ventricular preload.

Subclinical ventricular dysfunction is usually detected only by additional studies (cardiomegaly on a radiograph) and is confirmed by a decrease in ventricular function on an echocardiogram. However, a number of weakly expressed clinical signs(intolerance to new exercise, fatigue or increased sleepiness, growth retardation, general decrease in well-being, new noise mitral regurgitation or hepatomegaly) the doctor can detect during examination.

Endocarditis

Infective endocarditis poses a persistent, serious risk for patients with unrepaired congenital heart disease and, to a lesser extent, for patients with repaired defects. Physician and patient education regarding endocarditis can have a significant impact on reducing both early and late morbidity and mortality in patients after surgery for congenital heart disease.

In patients with a prosthetic heart valve, the prevalence of both early and late endocarditis ranges from 0.3% to 1.0% per patient per year. In patients with unrepaired congenital heart disease, the overall risk of endocarditis ranges from 0.1 to 0.2% per patient per year and decreases 10-fold to 0.02% after correction. The risk of endocarditis varies depending on the type of defect. Blue-type complex heart defects pose the highest risk, estimated at 1.5% per patient per year. Patients operated on for TF remain at increased risk of endocarditis (0.9% per patient per year) due to the relatively common prevalence of residual VSD and right ventricular outflow obstruction. Patients with a surgically closed VSD or bicuspid aortic valve after surgical valvotomy are at moderate risk. Patients with repaired ASD, VSD, PDA, aortic coarctation or pulmonary stenosis and those who have had pacemaker implantation are at low risk of endocarditis.

The microorganisms that cause endocarditis, and therefore the antibiotics used for prevention and treatment, vary according to the portal of entry of the infection. Streptococcus viridans is the most common organism following dental and upper respiratory tract procedures, whereas Enterococcus fae-calis is the most common organism associated with gastrointestinal or genitourinary bacteremia. Staphylococcus aureus and Staphylococcus epidermidis are the most common pathogens resulting from skin and soft tissue infections.

It is important to recognize that failures even with appropriate prophylaxis do occur, and therefore endocarditis cannot be safely ruled out even if prophylaxis is prescribed. Intravenous antibiotics have not been found to be superior to oral antibiotics when an appropriate oral regimen is followed, taking into account frequency of administration and dosage. Endocarditis can often be difficult to diagnose, so it is important for the physician to place endocarditis at the top of the list of diseases in the differential diagnosis and keep high level alertness when a patient with congenital heart disease develops symptoms of infection.

PROBLEMS NOT RELATED TO THE HEART

Growth and development

Retarded physical development is one of the symptoms of congenital heart disease, which causes the greatest concern among parents. Several studies have shown a correlation between the degree of growth retardation and the type of congenital heart disease. In children with large left-to-right shunts (VSD, complete atrioventricular septal defect, etc.), the degree of growth retardation corresponds to the size of the shunt and the degree of congestive heart failure. In contrast, in patients with blue congenital heart disease, growth retardation is more often associated with the specific defect present, rather than with the degree of cyanosis. Surgical correction of congenital heart disease improves weight gain and linear growth. Although patients catch up (in terms of growth) in different ways, this is influenced by associated causes, for example, Down syndrome, renal disorders.

There is strong evidence that earlier surgical correction of congenital heart disease improves growth by early stage. It is important for the pediatrician to know the patient's reasonable growth expectations postoperatively: patients with complete anatomical correction will have a normal growth rate, whereas patients with incomplete or staged correction are likely to grow worse. A patient with a delayed growth curve should be evaluated for possible complications of surgery, including unrecognized residual or recurrent defects. Concomitant metabolic and non-cardiac causes of poor weight gain should also be excluded. Finally, it is necessary to provide the child with normal nutrition.

Neuropsychic development in the majority of patients who have undergone surgery for congenital heart disease is normal, although some have either pre-existing disorders or acquired as a result of complications in the preoperative period and during the operation. Sometimes the causes of developmental delay are intrauterine infections, Down syndrome and other syndromes associated with mental retardation. Patients with blue defects have a reduced intelligence quotient (IQ) and development quotient (DQ) compared to healthy children. Such changes can be detected during the first six months of life. The duration of cyanosis affects the degree of developmental delay, which indicates the advantage of early correction of these defects. Congestive heart failure in congenital heart failure with left-to-right shunts causes developmental delay, but to a lesser extent than that observed in patients with cyanosis.

Patients undergoing open heart surgery are exposed to a number of influences that can have a profound impact on their subsequent neurological and intellectual development.

Chronic brain syndromes such as choreoathetosis have been associated with the use of deep hypothermia. There are few data regarding late outcome in patients who undergo cardiac surgery during childhood. However, their school performance, success at work, and marriage rates are lower than those of adults of the same age without congenital heart disease. This may be influenced by restrictions from parents and doctors during childhood.

Parents should be encouraged to place their child in an environment that will stimulate development. Restrictions should only be used in situations where physical activity and strain may be contraindicated due to residual hemodynamic abnormalities. The fundamental goal of treating patients with congenital heart disease is to place as few restrictions on them as possible to enable them to lead as normal a life as possible. Physical activity is an important part of the lifestyle of children and adolescents, and restrictions should be applied in case of residual defects, physiological abnormalities or individual characteristics of the patients. Parents, school and local doctors should be advised to avoid unnecessary restrictions.

A heart defect is considered organic lesion heart valves, septum, myocardium, which leads to persistent disruption of pumping blood mass. During decompensation, these changes cause stagnation in the veins, tissues, organs, and severe oxygen depletion (hypoxia).

Cardiac pathology also includes defects of large vessels (for example, stenosis of the aortic isthmus, patent ductus botallus, and others), although some scientists believe that there are no sufficient grounds for this.

The problem of how to treat a heart defect is always associated with determining the type of defect, its main cause, the degree of compensatory capabilities of the myocardium, the presence and prognosis of complications.

There is a division of diseases into 2 large groups of pathology:

acquired,
congenital.

Vices have different reasons. Acquired ones develop over the years and are diagnosed closer to adolescence and adulthood, while congenital ones are detected in newborns (6–8 cases per 1000). The mechanism of heart damage is the same.

What is damaged in the heart when there is a defect?

The most common acquired defects are:

Lesions of the valve apparatus (cusps and structures involved in closing the chambers of the heart), with rheumatism, mitral and tricuspid defects are formed in young people 10–30 years old, with syphilis, insufficiency of the aortic valves upon reaching 40 years of age and older, in the case of severe atherosclerosis defects develop in elderly and senile people.
Narrowing or widening of the openings between the chambers of the heart through which blood flows (narrowing of the aortic orifice, narrowing of the right atrioventricular opening).
Pathology of the cardiac membranes (epicardium, myocardium and endocardium) against the background of severe inflammatory diseases such as rheumatism, sepsis, severe forms of childhood infections lead to the participation of the heart wall in the formation of the defect.

With congenital defects, the pathology is formed during the formation of organs in the embryonic period. As a result, the newborn is determined to have:

, open foramen ovale;
the ductus botallus remains unopened;
stenosis of the aortic isthmus or pulmonary artery is formed;
the localization of the main drainage vessels changes dramatically;
underdevelopment (hypoplasia) of one of the ventricles.

How to determine the type of defect?

It is customary to classify defects into 3 types:

simple - one of the valves or hole is damaged;
complex - there is a combination of narrowing or widening of the holes with valve changes;
combined - multiple structural abnormalities, most typical of congenital defects.

The number of types of heart defects exceeds a hundred. For early diagnosis, all newborns are examined by a neonatologist; at the modern level, ultrasonic methods, magnetic resonance and computed tomography, angiography.

Determining the type of defect is important for choosing a treatment method. In addition, the cardiologist needs to know how disrupted the compensatory adaptive mechanisms of the patient’s heart are. If the structural disorder is mild and does not lead to a disruption in the blood supply to organs and tissues (for example, with), then the patient is observed and treated conservatively.

What influences the decompensation of the defect?

In the case of acquired defects, it is impossible to cure cardiac pathology without preventive measures in relation to the underlying causes. The following is required:

prevention of rheumatic attacks, since the defect increases each time;
treatment of infectious complications after acute illnesses, injuries, sore throats;
carrying out therapy for hypertension and atherosclerosis in adults suffering from these diseases;
complete cure of syphilis before deregistration with a venereologist.

The development of decompensation of cardiac activity is determined by disruption of the structures. Due to insufficient closure of the valves, the blood that came out during systole from one part of the heart to another or into the vessels partially returns. Together with the next portion, it overfills the chamber and causes stagnation in the afferent vessels.

When the opening is narrowed, similar difficulties are created for the functioning of the heart: through the narrowed opening, blood passes with difficulty into the next section and accumulates with the portion received during diastole, causing expansion and hypertrophy. After a certain time, the performance of the stretched heart muscle is lost. Myocardial cells do not have enough energy to push the required volume of blood. This is how oxygen starvation caused by heart failure begins to manifest itself.

The goal of conservative treatment is to maintain the energy balance of the myocardium and combat tissue hypoxia.

What is used to treat heart disease?

Acquired defects require the prescription of special medications depending on the specific disease: antibiotics, steroid hormones, antihypertensive drugs.

It is impossible to correct organic pathology and the damaged structure of the heart using conservative methods. Treatment is limited to providing assistance and preventing attacks of acute heart failure.

Drugs used:

groups of cardiac glycosides;
diuretics;
containing potassium and magnesium;
anabolic hormonal agents;
vitamins B, C, E to provide antioxidant activity and support immunity;
if necessary, antiarrhythmic drugs are prescribed;
during an attack, oxygen inhalation is necessary;
According to indications, drugs that reduce blood clotting are prescribed.

Balneological treatment with oxygen baths is used in sanatorium conditions

Conservative therapy is indicated during preparation for elective surgery and in the postoperative period. Patients are recommended to undergo annual treatment in a specialized center, cardiology hospital, or sanatorium.

Here, attention is necessarily paid to the regimen, feasible physical activity, and dietary nutrition. To prevent hypoxia, oxygen baths, cocktails, and inhalations are prescribed. Walking in a coniferous forest helps improve breathing and provides the patient with phytoncides.

Why is surgery needed?

If an adult is responsible for his own health and the consequences of refusing the proposed type of treatment, then parents and close relatives should worry about children. Observation by a cardiologist with annual monitoring of the development of the defect in a growing baby is an important ongoing responsibility of the mother and father.

You shouldn’t hope that “everything will go away on its own.” Statistics show rather disappointing information: there are very few birth defects among the adult population, because 60% occur in children under 14 years of age. Of these, without timely surgical treatment, up to 70% die in the first year of life.

Identification of life-threatening defects requires urgent surgical treatment in infancy

Depending on the severity of the defect, surgery may be delayed until an older age, when the baby has developed sufficient immunity and a willingness to deal with the consequences of surgery.

In cardiac surgery, there are phases of primary adaptation and compensation, when the child’s condition is stable and most suitable for surgery. In addition, the timing is determined by the state of blood circulation in the pulmonary circle.

The phase of irreversible changes (terminal) is expressed in degeneration of internal organs and the heart, and the addition of severe complications.

What complications are possible if you refuse surgery?

Possible complications concern the heart itself and the organs most interested in sufficient blood supply - the lungs and brain.

From the side of the heart the following are observed:

attacks of heart failure;
various arrhythmias and conduction disorders;
septic endocarditis;
continuously sluggish rheumatic carditis.

The respiratory organs react:

frequent colds;
chronic bronchitis;
prolonged cases of pneumonia.

In the central nervous system there are:

circulatory disorders with areas of ischemia or hemorrhage in the cerebral cortex;
abscesses in brain tissue;
thromboembolism.

Types of surgical interventions

The specific operation is selected by the cardiac surgeon depending on the type of defect and the degree of defects in the heart chambers and large vessels. Currently, cardiology centers have been organized with special equipment that makes it possible to operate on a stopped heart with connection to artificial circulation, and to use hypothermia (lowering body temperature).

If the ductus arteriosus is open, ligation and intersection of the unnecessary vessel are performed.
A defect of the interventricular or interatrial septum requires suturing, plastic surgery of the septal tissue with the application of a “patch” to completely stop communication between the atria or ventricles.
If possible, narrowed vessels are widened with stents or a narrow section is removed (for stenosis of the aortic mouth).
If the position of the efferent arteries is disturbed, it is necessary to correct the localization with movement of the vessels.
Valve defects are eliminated by installing artificial analogues or a homograft.
When there is stenosis of the valves and atrioventricular orifice, commissurotomy and dilation are performed with the installation of a ring to prevent re-union.

The surgeon literally holds the patient's heart in his hands

There are no ideal valves yet. They are divided into 2 types:

mechanical - made of metal, synthetic fabrics, single- or double-leaf, designed for up to 50 years, require constant use of anticoagulants;
biological - made from human or pig tissue, after 12 years they may lose elasticity and require replacement. Indicated in old age and when it is impossible to take anticoagulants.

If artificial valves were used, the patient must take blood thinning medications for the rest of his life. When using homografts, cytostatics are needed to prevent tissue rejection.

Complex, combined defects may require repeated interventions with breaks from several months to a year.

Treatment in the postoperative period

In the intensive care unit, hemodynamic monitoring is carried out after surgery. The patient is connected to a continuous monitor and heart rate, blood pressure, and respiration are monitored.

Analgesics are administered for pain relief. An oxygen mask for breathing must be used. A nutrient solution, vitamins, and antibacterial drugs to prevent pneumonia.

For interventions on valves, sutures are removed after 7–10 days

When installing a mechanical type of artificial valve, anticoagulants are prescribed from the first days indirect action(Phenilin, Warfarin). The dosage is selected based on the results of determining the prothrombin index. It is maintained at 35–45%.

After discharge from the hospital, prothrombin will have to be checked at least once a month. In addition, it is necessary to exclude foods rich in vitamin K from food, since it increases coagulation and reduces the effect of anticoagulants.

These products include:

How is physical activity restored?

The recovery period for different operations is 3–6 months, depending on the condition of the heart before the intervention. During the first 3 months, the bone tissue of the sternum grows together, so it is not recommended to lift weights of more than 5 kg, pull heavy objects with your hand, or push with your shoulder.
It is quite possible to do light housework. It is recommended to start driving a car 3 months after the operation.

Women wishing to have a baby should notify their doctor. The fact is that regular use of anticoagulants can provoke uterine bleeding. This poses a threat to the mother and promotes miscarriage. The resulting pregnancy is observed simultaneously by a gynecologist and a cardiac surgeon. Delivery only by surgery.

Forecast

Repeated attacks of rheumatism in childhood and adolescence significantly worsen the patient's prognosis.

Untreated sore throat causes rheumatism

If surgical treatment is delayed, the child becomes disabled at an early age. Inaccessible to him quick games, you can't study hard.

Against the backdrop of advances in cardiac surgery postoperative mortality still amounts to 3% when ligating the ductus botallus. A successful operation allows the patient to live and work fully.

After radical complex interventions in the stage of decompensation, up to 30% of patients cannot be saved. Therefore, the timing of surgical treatment is so important.

Parents should think in advance about the health of their future children. Factors such as alcohol intake, smoking, infectious diseases suffered by the expectant mother in the early stages of pregnancy significantly affect proper development fetus

In childhood, a child must be protected from colds, dressed according to the season, and sore throats treated. Strengthening the immune system helps overcome possible diseases.

A significant number of heart defects require inevitable surgical treatment. Parents who face many hours of exhausting waiting should have an idea of what is happening and how.
On the eve of surgery, the child will be examined by an anesthesiologist - a specialist in anesthesia, operational monitoring and resuscitation measures, after which he will contact you and conduct a detailed survey, and also explain the essence of his actions. During the operation, the anesthesiologist not only “turns off” the patient, but also monitors all vital functions.
Next you will have to communicate with the surgeon. It is he who will outline the course of the operation in detail and in acceptable detail, inform about the degree of risk and possible complications. If during the conversation you have any questions, ask them immediately; you must be fully informed about the upcoming intervention.
In the morning, about half an hour before the operation, the nurse will give the child an injection. This is just a sedative that precedes anesthesia. After he is taken to the operating room, you will face the most painful and difficult time - waiting. Heart operations are quite long, so for the first two hours you don’t have to trample the floor in the stairwell or in the waiting room; receiving news is unlikely. No one will reassure you completely, but in order not to make wild and ridiculous assumptions, it is better to know WHAT exactly is happening behind the doors of the operating unit.
From the outside, the environment in the operating room looks a little otherworldly - people in masks move from one place to another, perform some actions, utter incomprehensible words, and all this is accompanied by “technical” sounds. Standard medical composition in a cardiac surgery operating room it looks like this - the chief operating surgeon (who is subordinate to the rest of the team), two assistant surgeons, an operating nurse, an anesthesiologist, a specialist responsible for the work of the artificial blood circulation machine (heart-lung machine) and an orderly.
Any operation, even the longest one, is completed. One of the surgeons will definitely come to you and “report the situation.” You will definitely want to see your baby; as a rule, this is not allowed for reasons of sterility, but sometimes parents may be allowed into the intensive care ward. If you are allowed to enter, remain calm and do not panic. The initial reaction is almost always the same – horror. Tubes and wires extend from the patient, the mouth is covered with a mask of the device artificial ventilation lungs, glowing cardiac monitors are visible all around and the squeak of operating devices can be heard. Staff move from one bed to another, and the whole situation resembles the process of a hasty evacuation. There is no need to give free rein to your emotions, grab nurses by the coats and demand increased attention to your child - everything happens as it should be. Work in intensive care wards occurs with several patients at the same time, and around the clock, and therefore apparent external fussiness is normal. After you have seen everything, it is better to just leave the room, anyway, now you will not be able to do ANYTHING. Wait for the resuscitator on duty to appear and explain the situation in detail.
It is also worth remembering that only a specialist, such as the surgeon who performed the operation, an anesthesiologist, or the doctor on duty, can inform you in full about your child’s condition. You should not listen to anyone who may be nearby at this moment, stories like: “... but this happened with this child” can only do harm, and the most important thing for you at the moment is to maintain calm and composure.
After you have found out everything, taken a breath and calmed down a little, it is better to leave the hospital. In the morning you will have more specific information; by that time the child will be completely taken out of anesthesia and disconnected from some of the equipment. If there are no possible complications, your child will spend one or two, sometimes three days in intensive care. This is followed by a return to the department, and it is then that your participation and effective help will be in demand and necessary. The operation is over, and discharge will follow in about two weeks.

Heart defects in children and adults: essence, signs, treatment, consequences

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, 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 designed. The heart belongs to circulatory system, helps the blood move and saturate it with oxygen (O2) and carbon dioxide (CO2). Filling and contracting, it “pushes” the blood further into the 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” - valve pulmonary artery , 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

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 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(heart enlarges too much, 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: V 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. At 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.