No more sentence! Congenital heart defects in children: identify and treat

Congenital heart disease (CHD) is a defect in the structure of the heart and large vessels that occurs before birth.

These defects occur already at the stage of fetal development in the uterus, and the possibility of being born with congenital heart disease among newborns is about 1% (1 in 100 newborns).

Symptoms of congenital heart disease can appear both at birth and during childhood, and sometimes before the patient reaches adulthood. According to statistics, about 500,000 adults have congenital heart disease. Each of them, of course, needs regular examinations by a cardiologist.

General information

Congenital heart disease is the most common congenital anomaly leading to mortality. Occurs in approximately 1% of newborns. Congenital heart defects most often appear in childhood. They can progress and, if not treated correctly, lead to death. Source: JIE Hoffman, S. Kaplan The incidence of congenital heart disease // JACC, 2002, Vol. 39, p.1890—1900

CHD can manifest as single anomalies or a combination of several disorders. It is most dangerous when the disease has no external manifestations and passes hidden. In modern conditions, treatment is usually successful, but timely and accurate diagnosis is vital.

The actions of the mother during pregnancy and of both parents during preparation for it are also important. To assess the risk of having a baby with congenital heart disease, you need to contact a geneticist.

CHD entails a number of complications, including bacterial endocarditis, heart failure, early pneumonia with a prolonged course, short-term fainting, pulmonary hypertension, myocardial infarction, attacks of shortness of breath, and angina syndrome.

No more sentence! Congenital heart defects in children: identify and treat

Perhaps there will always be diseases about the methods of treatment of which one could say something like “If only such diagnosis and treatment existed... years ago.”

This phrase is also true in relation to our topic today. With Candidate of Medical Sciences, pediatric cardiologist at Clinic Expert Smolensk Tatyana Mikhailovna Frolova, we are talking about congenital heart defects.

— Tatyana Mikhailovna, what is congenital heart disease? Is this a separate disease or a group of diseases?

This is a whole group of pathologies - congenital defects in the structure of the heart and large vessels, as well as anomalies in the location of the heart in the chest. These defects disrupt blood flow inside the heart and in large vessels and can lead to the development of heart failure, disability, and in some cases, the death of the child.

Today there are more than 35 types of congenital heart defects

Today there are more than 35 types of such defects.

— Do babies with congenital heart disease always look different from their healthy peers? Or can a heart defect in a child be asymptomatic?

The latter is true. Along with very severe defects, there are also those that are not accompanied by obvious clinical manifestations. Such children may be no different from their peers. It has become possible to identify these defects thanks to the improvement of methods for studying the cardiovascular system. They are often diagnosed accidentally.

— How is it usually discovered that a child has a heart defect?

Modern ultrasound machines make it possible to detect or suspect the presence of fetal heart defects even in the prenatal period.

After birth, a child also undergoes an ultrasound examination of the heart in the first year of life.

“An ultrasound is definitely not enough. The examination must be comprehensive." Quote from the material “Ultrasound of the heart: when is it prescribed and what will it show?”

It is possible that a defect may be accidentally discovered during examination for other reasons (medical examinations, obtaining certificates for sports activities, etc.).

And, finally, situations when a child develops some symptoms or changes are detected on the ECG, which becomes a reason to deepen the diagnostic search and conduct echocardiography.

“What are the types of heart murmurs? Where do they come from? And what to do if such noise is detected? Quote from the material “Heart murmurs in a child: looking for reasons”

— Should a cardiac examination of a baby be carried out only when indicated, or should all newborns undergo special diagnostics to exclude congenital heart defects and other cardiovascular pathologies?

According to the order of the Ministry of Health, ultrasound screening (echocardiography) is mandatory at the end of the neonatal period (the first month of extrauterine life), i.e. when the baby is one month old, during a routine medical examination. All children under one year of age must undergo such a study along with an ECG.

Of course, if a child has any manifestations of trouble, they do not wait for any special time, but consult a doctor immediately.

— How many children in Russia and the world are born with congenital heart defects?

According to statistics, congenital heart defects are considered a fairly common pathology. Their frequency in our country is 8 children per 1000, or 1 per 125 live births. The true incidence is higher if we take into account cases of early stillbirths and cases of spontaneous abortions.

In European countries this figure ranges from 3 to 8 per 1000 children. The highest frequency is in third world countries, in Asian countries.

- Why is a child’s heart so vulnerable? Are heredity and ecology to blame, or are there other reasons for the development of congenital heart defects in babies?

Approximately 90% of heart defects are multifactorial in nature. In other words, the combined influence of both hereditary and environmental factors plays a role in their occurrence.

8% of defects are caused by chromosome abnormalities and “breakdowns” of individual genes.

In our country, 8 children out of 1000 are born with congenital heart defects

2% is due solely to environmental factors that increase the risk of congenital heart defects. These may be physical, chemical factors, hazardous production, or unfavorable environmental conditions.

In addition, the formation of the defect can be facilitated by maternal diseases (in particular, endocrine; infectious pathologies during pregnancy), taking certain medications, smoking, and drinking alcohol by the mother.

— Modern diagnostics make it possible to identify congenital heart defects at the stage of intrauterine development?

Yes, but not in all cases.

— Before birth, can any heart defects in the fetus be detected with 100% accuracy, or is the development of perinatal diagnostics imperfect today?

As I said earlier, reliable diagnosis is not always possible. The success of detecting a defect is influenced by the position of the fetus, its mobility during the examination, the qualifications and experience of the doctor, the class of the apparatus for performing ultrasound, and the severity of circulatory disorders.

Some anatomical features of the heart, such as a patent ductus arteriosus, are normal in the prenatal period and become a defect only if they persist for a long time after birth. In these cases, dynamic monitoring of the child comes first.

Why are pregnant women prescribed MRI? Read here

— Tatyana Mikhailovna, if a fetus is diagnosed with a heart defect, is this an indication for termination of pregnancy or is the decision made individually in each case?

Today this is not a reason to terminate a pregnancy. In Russia, individual operations for intrauterine correction of heart defects have already begun. If there are no indications for surgical treatment during pregnancy, then after the birth of the child and consultation with a cardiac surgeon, the necessary operation is performed either immediately or later.

— Previously, the diagnosis of “congenital heart disease” almost always sounded like a death sentence. Has the situation changed now?

Over the past 10-15 years - dramatically. What has changed? The detection of defects in the prenatal period has improved significantly. Defects began to be diagnosed that do not require urgent surgical intervention and that can be eliminated on their own as the child grows older. If there is a question about surgery, then, if necessary, it can be performed even on the first day after the birth of the child.

“Holter monitoring is also used to examine children.” Quote from the material “Holter (24-hour) ECG monitoring - complete instructions for the patient”

— If a baby is diagnosed with a heart defect after birth, is this always an indication for surgery?

No. All heart defects require dynamic monitoring, since their spontaneous closure is possible, reducing the severity of circulatory disorders, as a result of which there is no need for surgical treatment. With some defects, the child can even engage in certain sports if there are no significant circulatory disorders.

— If necessary, can surgeries in Smolensk help a baby with a congenital heart defect, or are such children sent to large Russian cardiology centers?

Heart surgeries are high-tech and highly specialized medical care. They are performed only in large specialized clinics.

If necessary, the operation can be performed even on the first day after the birth of the child.

Smolensk patients can undergo surgery in Moscow or St. Petersburg, if we talk about regional proximity. In our city, unfortunately, such operations are not carried out.

— It is generally accepted that prevention can save you from many health problems. Is it possible to reduce the risk of having a child with a heart defect?

Yes. It is extremely important to remember the periods of heart development here. Its formation begins at the end of the 2nd week of pregnancy. By the 4th week, a two-chamber heart is formed, and by the 6th week the chambers separate to form a four-chambered heart.

Just thinking about these numbers is enough. Does every woman at two weeks (and even later) know about her pregnancy? No, whereas at this time the heart is laid and formed. If during this period there are unfavorable factors that we talked about earlier, the risk of developing a defect increases. Therefore, the most important prevention is planning and preparation for pregnancy. A woman must be healthy, she needs to lead an appropriate lifestyle.

Pregnant women need to undergo regular screenings, during which some abnormalities in the development of the heart in the fetus may be detected. When they are detected, the question of the method of delivery is decided.

Other materials on topics:

What should a child's blood pressure be?

Are unvaccinated children the healthiest?

Often – how much? A child who is often ill at a pediatrician's appointment

For reference:

Frolova Tatyana Mikhailovna

Graduate of the pediatric faculty of the Orenburg State Medical Academy in 1997.

From 1997 to 1998 she completed an internship in the specialty “Pediatrics”.

In 2014, she underwent professional retraining in pediatric cardiology, and in 2021 - in functional diagnostics. Candidate of Medical Sciences.

Currently, he is a pediatric cardiologist and functional diagnostics doctor at Clinic Expert, Smolensk. Receives at the address: st. 8 March, no. 20.

Phases of the disease

CHD occurs in three phases:

• first phase: during it, a compensatory and adaptive reaction to a failure in the dynamics of blood circulation is observed; in case of a serious violation, myocardial hyperfunction occurs.
• second phase: relative compensation occurs. The child’s motor activity and physiological development improves.
• the third phase is terminal. The body has already exhausted the possibilities of compensation; degenerative, dystrophic pathologies of the heart and nearby blood vessels are developing. If a child is sick, especially with complications, then the terminal phase occurs faster. Its outcome is only fatal. Source: E.E. Chepurnykh, E.G. Grigoriev Congenital heart defects // Siberian Medical Journal (Irkutsk), 2014, No. 3, pp. 121-127

Therefore, the earlier the pathology is detected, the more favorable its prognosis.

2. Symptoms of the disease

Sometimes it happens that the symptoms of heart disease do not appear at all and the disease does not cause any concern. Or, for example, symptoms of the disease appear only in adulthood. As a rule, symptoms of heart disease in adults are expressed in the following forms:

• Dyspnea;
• Labored breathing;
• Rapid fatigue, fatigue;
• Inability to perform activities associated with heavy physical exertion;
• Headache;
• Dizziness;
• Pain in the heart, abdominal area.

Visit our Cardiology page

Causes of pathology

CHD may develop if:

• parents smoke;
• parents drink alcohol;
• the fetus is affected by external factors during the period of development and formation (high background radiation, lack of vitamins, viruses carried by the mother, polluted air, water, a number of chemicals, including heavy metals). Source: L.N. Falyush, V.V. Florensov Risk factors for congenital heart defects // Clinical medicine. Bulletin of the All-Russian Scientific Center SB RAMS, 2010, No. 6(76), p.67-69

Treatment for the diagnosis of congenital heart disease in newborns

Treatment methods depend on the type of heart defect:

• Minimally invasive procedures
• Radical surgery
• Heart transplant
• Drug therapy
• Long-term therapy

If the heart defects are not very serious, minimally invasive procedures can be used. Their essence is that a thin catheter is inserted into the heart through the femoral vein, and the necessary instruments are delivered to the defect inside the catheter.

The most radical but effective method of treating congenital heart disease is surgery. This is a traditional open intervention with opening of the chest and the heart itself. Most of these operations are performed using a heart-lung machine. After heart surgery, a child faces a long and difficult recovery period, but sometimes it is the only possible way to cure.

Heart transplantation is used in the most severe cases, in which traditional surgery is helpless in case of severe congenital heart disease.

Drug therapy is used mainly for auxiliary purposes, improving the functioning of the heart and blood flow.

Long-term therapy involves several consecutive operations on congenital heart disease.

Symptoms of congenital heart disease

They are divided into two large groups according to the color of the child’s skin: “white” and “blue”. A changed skin tone is the first reason for parents and pediatricians to be wary.

"Blue" vices

They usually appear either immediately at birth or a little later. In this case, the ears, lips and body skin are susceptible to cyanosis. Blue discoloration can occur during exertion (screaming, crying of a newborn), during breastfeeding. The “blue” appearance is usually manifested by a mirror arrangement of the great vessels, atresia of the pulmonary artery, and tetralogy of Fallot.

CHD of the “white” variety

Accompanied by pallor and coldness of the extremities. When listening with a stethoscope, noises are heard. They are not direct symptoms, but a heart examination is still required. With “white” pathologies, heart failure is often detected. Changes are detected on x-rays, ECG, ECHO-CG. This type of congenital heart disease is most often a pathology of the interatrial septum and interventricular septum.

Unfortunately, not all types of congenital heart disease occur in newborns. A child can feel well even up to 10 years of age. But sooner or later the vice will appear:

• delay in physiological development;
• pallor or cyanosis;
• shortness of breath during exercise.

Problems associated with congenital heart disease

The most common problems are:

1. Heart valve defects. Narrowing (stenosis) of the valves or their complete closure makes it difficult or impossible for the smooth functioning of the circulatory system. Other valve defects cause them to not close properly and allow blood to flow backwards.
2. Defects of the interatrial and interventricular septa. These defects create a pressure gradient between the ventricles, causing blood to be shunted from left to right.
3. Abnormalities in the heart muscle, which can lead to heart failure.

Treatment methods

Treatment of congenital heart disease is carried out only by surgery . Cardiac surgeons perform complex reconstructive interventions, successfully curing those forms of congenital heart disease that were previously considered inoperable. If the diagnosis is made early and treatment is carried out promptly, heart function can be restored to 100%.

Non-invasive therapy (medication, physiotherapy, etc.) may be prescribed as an auxiliary measure. Such treatment is also carried out in cases where it is possible to postpone the operation to a later time or there is a “white” congenital heart disease that has little impact on the child’s well-being during growth and development.

Heart disease. Treatment without surgery

In some cases this is possible. In these cases, drug therapy is aimed at preventing the development of complications (pulmonary edema, atrial fibrillation, sudden cardiac arrest, etc.), reducing the manifestations of heart and pulmonary failure and improving the quality of life. Diet therapy and physical therapy have a good preventive and supportive effect. Only a specialist can give specific recommendations.

In the pre- and postoperative period, as well as in the absence of indications for surgical intervention, a person can be helped by holistic treatment methods: classical and resonant homeopathy, osteopathy, acupuncture, qigong therapy, herbal medicine.

Make an appointment

We invite you to “SM-Clinic”

Our clinic’s staff includes some of the best specialists in the Northern capital. We employ experienced pediatricians and pediatric cardiologists who will promptly identify the presence of alarming symptoms and prescribe all the necessary examinations. “SM-Clinic” is well equipped; we can conduct all tests for the presence of congenital heart disease.

Make an appointment with us as soon as possible if you notice signs of congenital heart disease in your child. Time plays a huge role in this disease.

Sources:

1. HER. Chepurnykh, E.G. Grigoriev. Congenital heart defects // Siberian Medical Journal (Irkutsk), 2014, No. 3, pp. 121-127.
2. L.N. Falyush, V.V. Florensov. Risk factors for congenital heart defects // Clinical medicine. Bulletin of the All-Russian Scientific Center SB RAMS, 2010, No. 6(76), p.67-69.
3. J. I. Hoffman, S. Kaplan. The incidence of congenital heart disease // JACC, 2002, Vol. 39, p.1890—1900.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

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Diagnosis of congenital heart disease

Congenital heart disease is often discovered when a doctor notices an unusual sound or murmur in the heart during an examination. Depending on the type of noise, your doctor may order laboratory tests.

Among the leading diagnostic methods are:

• echocardiogram or ultrasound of the heart (the main technique that allows you to see the morphology of the defect and determine the functional state of the heart)
• cardiac catheterization
• chest x-ray
• electrocardiogram (ECG)
• magnetic resonance imaging (MRI).