Warm secrets. Heart diseases Congenital heart diseases at kids occur at children of
seldom and can externally not be shown first in any way. Therefore pediatricians and parents sometimes do not pay due attention to this pathology which, meanwhile, often demands the urgent help. It is necessary to know about congenital heart diseases in time to help the baby.
Congenital heart diseases are arisen vnutriutrobno, till the child`s birth, anatomic defects of heart, its valvate device or vessels. They meet frequency of 6 - 8 cases on each one thousand childbirth and win first place on mortality of newborns and children of the first year of life.
It is sad, but the fact that even at careful supervision over pregnancy doctors often pass congenital heart diseases. It is connected not only with lack of sufficient qualification of experts in the field (pathology rare - experience a little) and the imperfect equipment, but also with feature of a blood-groove of a fruit.by
Therefore even if pregnancy proceeded favorably and took place all necessary inspections, it is necessary to check a heart of the kid after the birth. Unfortunately, within medical examination only the electrocardiography enters a range of obligatory screening methods of inspection in 1 month. However on the electrocardiogram at this age of changes can not be even at difficult congenital heart diseases. Besides, not in all policlinics there are personnel which are trained to remove an electrocardiogram film at babies. For 100% it is possible to exclude existence of congenital heart disease, having resorted to such research as an echocardiography, or ultrasonic research of heart. But under one condition: if it is executed by the skilled doctor. Not in all policlinics there are such device and the highly qualified specialist. At suspicions on congenital heart disease the pediatrician sends the child for performance of this research to other policlinic or the cardiac center. However some congenital heart diseases in the first months of life happen asymptomatic, i.e. have no manifestations, or they are very insignificant. To be sure in health of the kid, parents can make this research without the direction, for a fee in the medical center.
What can guard the doctor and parents?
- of Noise in heart. it is revealed by the doctor when listening heart of the kid. Carrying out an echocardiography in this case is obligatory. Noise happen organic which are connected with heart disease, and inorganic, or functional.
Functional noise at children is a norm. As a rule, they are connected with growth of chambers and vessels of heart, and also with existence of an additional chord or trabecula in a cavity of the left ventricle (a heart chamber). The chord or a trabecula is tyazh which reaches from one wall of a ventricle for another, around it the turbulent stream of blood is created, listening of characteristic noise is a consequence of what. In this case it is possible to tell:“ Much ado about nothing“, as this feature is not congenital heart disease and does not lead to heart diseases.
- Bad increase of body weight. If in the first months of life the kid adds less than 400 g, it is an occasion to address the children`s cardiologist for carrying out careful inspection as many heart diseases prove a delay of physical development of the child.
- Short wind (violation of frequency and depth of breath) and increased fatigue. to See moderate short wind is a prerogative of the doctor as sufficient experience is for this purpose necessary. Mother can notice fatigue of the kid during sucking, the baby eats Pomala and is frequent, the respite is necessary for it to collect the strength.
- Tachycardia (tachycardia).
- Cyanosis (cyanosis of integuments). It is characteristic of difficult, so-called “blue“ heart diseases. It is in most cases connected with the fact that in the arterial blood rich with oxygen (it is bright - red), which runs on vessels to skin and other bodies, the blue blood poor in oxygen is added owing to defect (dark, is closer to violet color), which has to get into lungs for enrichment by oxygen. Cyanosis can be expressed slightly, then it is difficult to notice it even to the doctor, and can be intensive. At moderate cyanosis of a lip get a violet shade, become blue there is skin under the child`s marigold, patches become blue.
is Very important to debug in time. And it is possible to make it still vnutriutrobno by means of ultrasonic research of a fruit. On early terms (11 - 14 weeks) for the expert it is easier to reveal congenital heart disease at transvaginal (chrezvlagalishchny) ultrasonography. However some pathologies of heart and vessels come to light in later terms therefore at suspicion on them it is necessary to make transabdominal (through a forward belly wall) ultrasonography of heart of a fruit in 20 - 24 weeks. First of all those women who had spontaneous abortions and still births need to think of it, there are children with congenital malformations, including congenital heart diseases, and also arrhythmias (violations of a rhythm of heart). Besides, enter into risk group:
- of the woman, had a viral infection on early terms of pregnancy, especially in the first two months when the main structures of heart are formed;
- of a family in which congenital heart disease was also diagnosed for future parents or the immediate family;
- of the woman, medicine having diabetes and other chronic diseases, taking during pregnancy;
- future mothers are more senior than 37 years;
- of the woman, the using drugs during pregnancy;
- of the woman, living in ecologically adverse areas.
Wants to add what in the presence of heart disease can not be any of these signs or they will be expressed very slightly in the first months of life of the child therefore performance of an echocardiography is desirable for all children. It is impossible to tell about all congenital heart diseases in one article, their about 100. Let`s stop on the most often meeting. The open arterial channel, defect of an interventricular partition concern to them.
the Open arterial channel
is the vessel connecting an aorta (the big vessel departing from heart and bearing arterial blood) and a pulmonary artery (the vessel departing from the right ventricle and bearing a blue blood in lungs).the open arterial channel Is normal of
exists in the pre-natal period and has to be closed within the first two weeks of life. If it does not occur, speak about existence of heart disease. Existence or lack of external manifestations (short wind, tachycardia etc.) depends on the extent of defect and its form. The external manifestations noticeable for mother, can not be also at the one-year-old kid even with big channels (6 - 7 mm).the Frequency of breath and warm reductions at children is normal of
|Age||Number of respiratory movements in a minute||Pulse in a minute|
|Newborn||40 - 60||140 - 160|
|Chest age (to 1 year)||30 - 40||100 - 120|
|the Preschool age (from 1 year to 6 years)||20 - 25||80 - 120|
the Open arterial channel has sound symptomatology, and the doctor, as a rule, without effort listens to noise in heart. Degree of its intensity depends on diameter of a channel (the more the channel, the is louder noise), and also on age of the child. In the first days of life even big channels it is badly heard as during this period pressure in a pulmonary artery is normal at children high and, therefore, there is no big dumping of blood from an aorta in a pulmonary artery (which defines noise) as a difference of pressure of blood between vessels small. Further pressure in a pulmonary artery decreases and becomes 4 - 5 times less, than in an aorta, dumping of blood increases, amplifies also noise. Therefore, doctors in maternity hospital can not hear noise, it will appear later.
So, as a result of functioning of an open arterial channel gets to vessels of lungs of blood more, than normal, from the raised loading over time of their wall it is irreversible change, become less pliable, more dense, their gleam is narrowed that leads to formation of pulmonary hypertensia (a state at which pressure in vessels of lungs increases). In initial stages of this disease when changes in vessels of lungs are still reversible, it is possible to help the patient, having executed operation. People with the last stages of pulmonary hypertensia have small life expectancy and its bad quality (short wind, increased fatigue, sharp restriction of physical activity, frequent inflammatory a bronchial tube - pulmonary diseases, faints etc.) . Pulmonary hypertensia is formed only at big channels (more than 4 mm), and its irreversible stages - usually to teenage age. At the small size of a channel pulmonary hypertensia is not formed, but there is a risk of developing of a bacterial endocarditis - generally from - for the fact that the blood stream under big pressure “hits“ into a wall of a pulmonary artery which under this influence changes over time and is subject to an inflammation more than healthy fabrics. The bacterial endocarditis is a special type of blood poisoning at which is surprised endokard (an inside layer of heart and vessels) and valves. Prevention of this disease consists in fight against the chronic centers of an infection which treat: carious teeth, chronic tonsillitis (an inflammation of almonds), chronic adenoidit (an inflammation of a nasopharyngeal almond), inflammatory diseases of kidneys, furunkulez etc. Even at such interventions as, for example, removal of tooth, “cover“ by antibiotics is necessary (these preparations the doctor appoints).On the first year of life reduction large and spontaneous closing of small channels is possible
. If business reaches operation, parents appear before the choice. Surgery can be two types. In one case the channel is tied up, opening a thorax with use of artificial ventilation of lungs (that is for the child the device “breathes“). In the second case the channel is closed endovaskulyarno. What does it mean? Through a femoral vessel to an open arterial channel enter the conductor on which end there is a closing device, and fix it in a channel. At small channels (to 3 mm) usually use spirals, at big - okklyuder (they remind in a form a mushroom or the coil, depending on modification). Such operation, as a rule, without artificial ventilation is performed, children for 2 - 3 day after it are written out home, there is even no seam left. And in the first case usually the extract is made on 6 - 8 - y day and there is a seam on a zadnebokovy surface of a back. At all visible advantages endovascular intervention has minuses too: it usually is not carried out to children with very big channels (more than 7 mm), this operation for parents paid as, unlike the first, the Ministry of Health does not pay it, moreover, as well as after any intervention there can be complications, first of all, connected with the fact that through small children`s vessels it is necessary to carry out quite big device in the diameter. The most frequent of them - thromboses (formation of a clot of blood) in a femoral artery.
Defect of a mezhpredserdny partition
Represents the message between two auricles (heart chambers in which blood pressure low). All have such message (an open oval window) vnutriutrobno. After the birth it is closed: more than at a half - on the first week of life, at the others - till 5 - 6 years. But there are people at whom the open oval window remains for the rest of life. If the sizes its small (to 4 - 5 mm), then it does not exert negative impact on work of heart and health of the person. In that case the open oval window is not considered congenital heart disease, does not demand expeditious treatment. If the extent of defect more than 5 - 6 mm, then are already about heart disease - defect of a mezhpredserdny partition. Very often there are no external displays of a disease till 2 - 5 years, and at small defects (to 1,0 cm) - and much longer. Then the child begins to lag behind in physical development, increased fatigue, frequent colds, bronchitis, pneumonia (pneumonia), short wind appears. The disease is connected with the fact that “excess“ blood through defect, but as pressure in both auricles low, and dumping of blood through an opening small comes to vessels of lungs. Pulmonary hypertensia is formed slowly, usually only at adult age (at what age it will occur, first of all, depends on the extent of defect and specific features of the patient). It is important to know that defects of a mezhpredserdny partition can significantly decrease in sizes or be closed spontaneously, especially, if they are less than 7 - 8 mm in the diameter. Then expeditious treatment will manage to be avoided. And, as a rule, people with small defects of a mezhpredserdny partition differ in nothing from healthy faces, the risk of a bacterial endocarditis at them is low - same, as well as at healthy. Expeditious treatment is also possible two types. The first - with artificial blood circulation, cardiac arrest and a vshivaniye of a patch or an ushivaniye of defect of a mezhpredserdny partition. The second - endovascular closing with use of an okklyuder who is entered into a heart cavity by means of the conductor through vessels.
Defect of an interventricular partition
is a message between ventricles (heart chambers) in which, unlike auricles, a high pressure, and in the left ventricle - in 4 - 5 times more, than in right. Existence or lack of clinical manifestations depends on the extent of defect so in what area of an interventricular partition it is located. Loud noise in heart is characteristic of this defect. Pulmonary hypertensia can quickly be created, since the second half of the year of life. It should be noted that during the forming of pulmonary hypertensia and increase of pressure in the right departments of heart noise in heart begins to decrease as dumping through defect becomes less. It is often treated by the doctor as reduction of the extent of defect (its overgrowing), and the child continues to be observed at the place of residence, without sending to specialized institution. When progressing pulmonary hypertensia to its irreversible stages pressure in the right ventricle becomes more, than in left, and the blue blood from the right departments of heart (bearing blood in lungs for enrichment by oxygen) begins to arrive in left (from which blood rich with oxygen goes to all bodies and fabrics). The patient has a cyanosis of integuments (cyanosis), physical activity decreases. With such state the patient can be helped only by a heart transplantation and lungs that in our country at children is not done.
on the other hand, defects of an interventricular partition are inclined to spontaneous closing that withknitted with features of growth of intra warm structures at the kid therefore they are usually not hurried to be eliminated with surgical methods right after the birth. In the presence of heart failure which symptoms are defined by the doctor appoint medicinal therapy for support of work of heart and watch dynamics of development of process, examining the baby each 2 - 3 months and carrying out an echocardiography. If the extent of defect decreases to 4 - 5 mm and less, then such defects, as a rule, do not operate as they do not exert impact on health, do not cause pulmonary hypertensia. If business reaches operation, then close defects of an interventricular partition in most cases with use of artificial blood circulation, cardiac arrest by means of a patch. However 4 - 5 years at the small extent of defect and its certain localization are aged more senior perhaps endovascular closing by means of the okklyuder who is carried out through vessels. It is necessary to notice that it is better to be observed in the center of warmly vascular surgery (at doctors, including at doctors there - ekhokardiografist that it is very important, experience is more). If the extent of defect decreases to 4 - 5 mm and less, then such defects, as a rule, do not operate as they do not exert impact on health, do not cause pulmonary hypertensia.
Heart disease questionable
If at the child suspected heart disease, it is necessary to register as soon as possible with the child in consultations to the children`s cardiologist or the children`s cardiosurgeon, it is desirable - in the center warmly - vascular surgery where will be able to conduct high-quality echocardiographic and electrocardiographic researches and the child the skilled cardiologist will examine. Indications and term of carrying out operation are always established strictly individually. In the period of a neonatality and before half a year the risk of complications after operation at children is higher, than at more advanced age. Therefore if the condition of the child allows, it is given the chance to grow up appointing if necessary medicamentous therapy, to gain weight, during this time become more mature nervous, immune and other systems of an organism, and defects are sometimes closed, and the child it is not necessary to operate any more.
besides, in the presence of congenital heart disease it is necessary to examine the child on existence of anomalies and frustration from other bodies that is often combined. Quite often congenital heart diseases occur at children with genetic and hereditary pathology therefore it is necessary to consult at the geneticist. What it is better known about health of the baby before operation for, the risk of postoperative complications is less.
in conclusion wants to note that if nevertheless the kid with those defects about which we spoke does not manage to avoid surgical treatment, in most cases after operation the child recovers, differs in nothing from peers, well transfers physical activities, it will have no restrictions at work, at school and family life.