Classification of congenital heart disease
As part of the campaign to help children with heart disease, we continue a series of publications on the topics: What is congenital heart disease (congenital heart disease)? What variants of the Air Force exist or the Air Force classification? What is endovascular treatment (surgery)? And also stories of children with heart defects who will be helped within the action. Today, we will tell you what is endovascular treatment (surgery)?
What are the variants of congenital heart disease or classification of congenital heart disease?
In the formation of heart disease in the newborn due to the incorrect structure of the structures and walls of the heart there is a violation of proper blood circulation in the vascular bed. Conventionally, all heart defects manifested at birth are divided into simple and complex. Among the simplest, the most common are defects or openings of the septa of the heart chambers, resulting in a mixture of enriched (arterial) and depleted (venous) blood, or stenosis (narrowing) of the valves, which disrupt (block) blood flow to the lungs or other organs. . More complex defects are usually a combination of simple heart defects.
Examples of simple Air Force.
Defects in the heart septum .
The septum of the heart is the muscular wall that separates the left and right halves of the heart. It is this septum that prevents the mixing of arterial and venous blood. During its fetal development, the baby’s circulation is structured in such a way that there are several messages between the small and large circulation (oval window between the left and right atria, open duct between the aorta and pulmonary arteries), which close themselves after birth. . These holes are physiological. However, in some cases, the closure of these holes does not occur and defects are formed in the partitions.
Atrial septal defect (atrial septum).
DMPP is an opening located in the part of the septum separating the upper chambers of the heart or atrium. As a result of the formation of this defect, oxygen-enriched blood through this hole comes from the left atrium to the right, which reduces the flow of blood to the left ventricle and reduces the amount of oxygen-enriched blood to organs and tissues. In most cases, DMPP rarely manifests itself clinically and the symptoms of DMPP appear only in the formation of large defects.
DMPP can be small or large. With small DMPPs, only small amounts of blood are mixed between the atria. At the same time there are no serious changes in blood circulation, the gas composition of arterial and venous blood changes little and at the same time special treatment is not required. In addition, with age, some of these defects close on their own. However, with larger atrial septal defects, constant blood flow prevents these openings from closing.
Large DMPPs may require surgical treatment. Recently, there have been options for minimally invasive intravascular (endovascular) treatment of such defects - the installation of various occluders (caps), closing the communication between the atria.
Ventricular septal defect (VLD).
DMZhP is an opening between the lower chambers - ventricles. As a result of the formation of this hole, oxygen-enriched blood flows from the left ventricle to the right, instead of entering the aorta and further to the organs and tissues of the body during contraction.
Like the atrial septal defect, DMJP can be small or large. With a small size, the defect usually closes on its own or requires minimal treatment. Large DMZhP lead to an overload of a left ventricle, increase in intensity of its reduction and increase in arterial pressure in the right departments (chambers) of heart and lungs because of receipt of additional volume of blood. Increased heart rate and wear and tear can lead to heart failure and impaired growth of the child. If the interventricular septal defect is not closed in time, persistent high blood pressure in the lungs or pulmonary hypertension can cause gradual sclerosis and narrowing of the small pulmonary arteries and subsequent pneumosclerosis. Open cardiac surgery is commonly used to correct congenital heart disease such as DMJP.
Congenital pathology of the valves .
Simple UTIs can cause abnormal development of the heart valves, which maintain normal blood circulation between the atria and ventricles, as well as between the ventricles and large vessels (aorta and pulmonary trunk). There is the following congenital valve pathology:
· Valve stenosis. This is a condition in which the heart valve does not open completely, causing additional strain on the heart muscle, which is needed to pump blood through the narrowed valve.
· Atresia of the valve. This is a condition in which the heart valve forms incorrectly, a sharp narrowing occurs at the site of its formation and blood does not pass from one chamber of the heart to another.
· Insufficiency and regurgitation of the valve. This is a condition where the valve does not close completely and the blood "leaks" back, creating an additional burden on the heart.
The most common congenital valvular malformation is pulmonary artery valve stenosis. The degree of such stenosis can vary from moderate to severe. At a moderate stenosis of the pulmonary valve the course of pathology can be absolutely asymptomatic and the defect of the valve can be revealed at auscultation on characteristic noise in heart. Usually, moderate stenosis does not require any treatment.
In a newborn or child with severe pulmonary artery valve stenosis, the right ventricle is overloaded when pumping blood through the pulmonary arteries and lung tissue. As a result, less blood passes through the lungs and, accordingly, arterial blood receives less oxygen than is necessary to maintain proper tissue metabolism. The blood becomes darker and this is manifested by a change in the color of the skin, lips and nails to a bluish color, and the condition itself is called cyanosis.
Older children with pulmonary artery valve stenosis may experience symptoms such as severe fatigue . and intolerance to physical activity. Currently, the method of choice in the treatment of severe pulmonary valve stenosis is intravascular (endovascular) balloon dilatation of the valve using a special balloon catheter.
Examples of complex Air Force.
Complex congenital heart defects are treated mainly through surgery. Modern advances in medicine in the diagnosis and treatment of this category of patients allow surgery even with very complex defects that require the use of high technology.
The most common combined (complex) heart disease is the Fallot tetrad, which is a combination of four defects:
· Pulmonary artery valve stenosis (pulmonary stenosis).
· Major interventricular septal defect (VLC).
· Dextraposition of the aorta - a condition when the aorta departs from the right ventricle or high deviation of the aorta from the left ventricle, then it turns out that with narrowed excretory tract of the pulmonary artery, with contraction of both ventricles blood tract for both ventricles of the heart. As a result, oxygen-poor blood enters only the aorta instead of the pulmonary trunk, causing cyanosis of the skin, so this defect is classified as "blue".
· Hypertrophy of the right ventricle- thickening of the muscular wall of the right ventricle, which occurs during the formation of a constant load on the right heart, necessary for pumping blood into the pulmonary artery.
Newborns and infants with Fallot’s tetrad may develop episodes of cyanosis, sometimes very severe. Previously, this type of heart disease was not operated on after birth or after the first year of life. As adults, such children are severely retarded in development and get tired quickly at the slightest physical exertion. However, in modern conditions, Fallot tetrad is well amenable to surgical treatment and correction at an earlier age, which allows children with this defect to develop on an equal footing with their peers and prevent the symptoms of the defect.
The tactics of the planned surgical treatment for tetrad of Fallot depends on the degree of stenosis of the pulmonary artery valve and always involves open cardiac surgery. At the expressed stenosis of the valve and disturbance of blood circulation of babies operate immediately after a birth, carrying out before that a course of the therapy allowing to compensate and stabilize a condition of the child. At less expressed stenosis of children try to operate within 1 year of life. In any case, after the operation, such children are under the control of a pediatric cardiologist and cardiac surgeon for life.
What are the variants of congenital heart disease or classification of congenital heart disease?
In the formation of heart disease in the newborn due to the incorrect structure of the structures and walls of the heart there is a violation of proper blood circulation in the vascular bed. Conventionally, all heart defects manifested at birth are divided into simple and complex. Among the simplest, the most common are defects or openings of the septa of the heart chambers, resulting in a mixture of enriched (arterial) and depleted (venous) blood, or stenosis (narrowing) of the valves, which disrupt (block) blood flow to the lungs or other organs. . More complex defects are usually a combination of simple heart defects.
Examples of simple Air Force.
Defects in the heart septum .
The septum of the heart is the muscular wall that separates the left and right halves of the heart. It is this septum that prevents the mixing of arterial and venous blood. During its fetal development, the baby’s circulation is structured in such a way that there are several messages between the small and large circulation (oval window between the left and right atria, open duct between the aorta and pulmonary arteries), which close themselves after birth. . These holes are physiological. However, in some cases, the closure of these holes does not occur and defects are formed in the partitions.
Atrial septal defect (atrial septum).
DMPP is an opening located in the part of the septum separating the upper chambers of the heart or atrium. As a result of the formation of this defect, oxygen-enriched blood through this hole comes from the left atrium to the right, which reduces the flow of blood to the left ventricle and reduces the amount of oxygen-enriched blood to organs and tissues. In most cases, DMPP rarely manifests itself clinically and the symptoms of DMPP appear only in the formation of large defects.
DMPP can be small or large. With small DMPPs, only small amounts of blood are mixed between the atria. At the same time there are no serious changes in blood circulation, the gas composition of arterial and venous blood changes little and at the same time special treatment is not required. In addition, with age, some of these defects close on their own. However, with larger atrial septal defects, constant blood flow prevents these openings from closing.
Large DMPPs may require surgical treatment. Recently, there have been options for minimally invasive intravascular (endovascular) treatment of such defects - the installation of various occluders (caps), closing the communication between the atria.
Ventricular septal defect (VLD).
DMZhP is an opening between the lower chambers - ventricles. As a result of the formation of this hole, oxygen-enriched blood flows from the left ventricle to the right, instead of entering the aorta and further to the organs and tissues of the body during contraction.
Like the atrial septal defect, DMJP can be small or large. With a small size, the defect usually closes on its own or requires minimal treatment. Large DMZhP lead to an overload of a left ventricle, increase in intensity of its reduction and increase in arterial pressure in the right departments (chambers) of heart and lungs because of receipt of additional volume of blood. Increased heart rate and wear and tear can lead to heart failure and impaired growth of the child. If the interventricular septal defect is not closed in time, persistent high blood pressure in the lungs or pulmonary hypertension can cause gradual sclerosis and narrowing of the small pulmonary arteries and subsequent pneumosclerosis. Open cardiac surgery is commonly used to correct congenital heart disease such as DMJP.
Congenital pathology of the valves .
Simple UTIs can cause abnormal development of the heart valves, which maintain normal blood circulation between the atria and ventricles, as well as between the ventricles and large vessels (aorta and pulmonary trunk). There is the following congenital valve pathology:
· Valve stenosis. This is a condition in which the heart valve does not open completely, causing additional strain on the heart muscle, which is needed to pump blood through the narrowed valve.
· Atresia of the valve. This is a condition in which the heart valve forms incorrectly, a sharp narrowing occurs at the site of its formation and blood does not pass from one chamber of the heart to another.
· Insufficiency and regurgitation of the valve. This is a condition where the valve does not close completely and the blood "leaks" back, creating an additional burden on the heart.
The most common congenital valvular malformation is pulmonary artery valve stenosis. The degree of such stenosis can vary from moderate to severe. At a moderate stenosis of the pulmonary valve the course of pathology can be absolutely asymptomatic and the defect of the valve can be revealed at auscultation on characteristic noise in heart. Usually, moderate stenosis does not require any treatment.
In a newborn or child with severe pulmonary artery valve stenosis, the right ventricle is overloaded when pumping blood through the pulmonary arteries and lung tissue. As a result, less blood passes through the lungs and, accordingly, arterial blood receives less oxygen than is necessary to maintain proper tissue metabolism. The blood becomes darker and this is manifested by a change in the color of the skin, lips and nails to a bluish color, and the condition itself is called cyanosis.
Older children with pulmonary artery valve stenosis may experience symptoms such as severe fatigue . and intolerance to physical activity. Currently, the method of choice in the treatment of severe pulmonary valve stenosis is intravascular (endovascular) balloon dilatation of the valve using a special balloon catheter.
Examples of complex Air Force.
Complex congenital heart defects are treated mainly through surgery. Modern advances in medicine in the diagnosis and treatment of this category of patients allow surgery even with very complex defects that require the use of high technology.
The most common combined (complex) heart disease is the Fallot tetrad, which is a combination of four defects:
· Pulmonary artery valve stenosis (pulmonary stenosis).
· Major interventricular septal defect (VLC).
· Dextraposition of the aorta - a condition when the aorta departs from the right ventricle or high deviation of the aorta from the left ventricle, then it turns out that with narrowed excretory tract of the pulmonary artery, with contraction of both ventricles blood tract for both ventricles of the heart. As a result, oxygen-poor blood enters only the aorta instead of the pulmonary trunk, causing cyanosis of the skin, so this defect is classified as "blue".
· Hypertrophy of the right ventricle- thickening of the muscular wall of the right ventricle, which occurs during the formation of a constant load on the right heart, necessary for pumping blood into the pulmonary artery.
Newborns and infants with Fallot’s tetrad may develop episodes of cyanosis, sometimes very severe. Previously, this type of heart disease was not operated on after birth or after the first year of life. As adults, such children are severely retarded in development and get tired quickly at the slightest physical exertion. However, in modern conditions, Fallot tetrad is well amenable to surgical treatment and correction at an earlier age, which allows children with this defect to develop on an equal footing with their peers and prevent the symptoms of the defect.
The tactics of the planned surgical treatment for tetrad of Fallot depends on the degree of stenosis of the pulmonary artery valve and always involves open cardiac surgery. At the expressed stenosis of the valve and disturbance of blood circulation of babies operate immediately after a birth, carrying out before that a course of the therapy allowing to compensate and stabilize a condition of the child. At less expressed stenosis of children try to operate within 1 year of life. In any case, after the operation, such children are under the control of a pediatric cardiologist and cardiac surgeon for life.