GENERAL INFORMATION
The heart is an organ that pumps the blood needed by the whole body. It starts working from the baby's 20th day in the womb and pumps 7,000-8,000 liters of blood to the body per day by contracting an average of 100,000 times a day.
Structure of the Heart
The heart consists of four chambers. There is an atrium and a ventricle on the right side of the heart, and a similar atrium and a ventricle on the left side (figure 1). While the right side of the heart collects dirty blood and sends it to the lungs for oxygenation, the left side sends oxygenated clean blood to our body. There are walls between the dirty blood in the right heart and the clean blood in the left heart to prevent them from mixing. In addition, there are a total of 4 valves, one between the atria and ventricles and one at the mouth of the main veins. The function of these valves is to allow blood to flow forward freely when the heart contracts, and to close when the heart relaxes and prevent this blood from coming back.
Childhood Heart Diseases
What we see in childhood We categorize heart diseases into two main groups: congenital and acquired. Unlike adults, most of the heart diseases seen in childhood are congenital heart diseases. Children with congenital heart disease are born with some structural defects in the heart. These structural disorders are the result of affecting the normal development of the heart in the very early stages of pregnancy (the heart completes its development in the 7th week of pregnancy), often when the mother is not even aware that she is pregnant. Although the factor that disrupts the normal development of the heart is often unknown, it has been shown that some viral diseases (measles, rubella, mumps, some microbes that cause the common cold, etc.) play a role in this. In addition, heredity (through genes) and chromosomal anomalies (the risk of heart disease in children with Down syndrome is 50%) are among the factors that increase the risk of congenital heart disease. It has also been reported that some drugs (some drugs used in the treatment of epilepsy and neurological diseases) and alcohol used during pregnancy, especially in the first 3 months, cause disorders in heart development. With this However, it is generally not possible to know whether the disease is due to these reasons or not. Therefore, if there is no proven reason, families and parents should not feel guilty.
The severity of these structural disorders seen in the heart depends on a simple problem such as a small "hole" between the chambers. The risk of giving birth to a child with congenital heart disease for each expectant mother is 8 out of 1000 births. Accordingly, approximately 10,000 to 15,000 children are born with congenital heart disease every year in our country. Approximately half of this number consists of major diseases that require surgical intervention before the age of one. If parents have a child with congenital heart disease, the risk in subsequent children increases to approximately twice the normal (16/1000). If the mother or father has congenital heart disease, the risk of the unborn child may vary between 2% and 16%, depending on the disease and whether the mother or father has the disease. Today, with the "Fetal Echocardiography" method applied by experts trained in this field, it is possible to examine the baby's heart and detect major heart anomalies between the 16th and 20th weeks of pregnancy in risky pregnancies. However, there is no treatment yet in the womb.
How and when do heart diseases occur in children?
The symptoms of heart diseases in children depend on the type of disease. may show significant differences. Even the same disease may not produce similar symptoms in every child. For example; Children with significant congenital heart disease usually become apparent within the first few months after birth. Rarely, it may present as an emergency situation in the baby shortly after birth as a result of severe low blood pressure and impaired blood circulation. In some babies, bruising (on the lips, tongue and nail bases) is the first symptom. In another group of heart diseases, the first symptoms may be frequent breathing, difficulty breathing, poor nutrition, inability to gain weight or weight loss, and excessive sweating.
Not too serious In some cases, most of the time the child does not have any complaints. These types of disorders mostly occur during examinations performed as a result of hearing a "murmur" in the heart during routine examinations.
Murmur is an additional sound heard between heartbeats. After the examination and tests performed by the heart doctor, it will be revealed whether the murmur is a sign of any disease. More than half of the "murmurs" heard in children are called "normal" or "innocent murmurs", that is, the heart is completely normal and this murmur does not increase the child's risk of heart disease in the future. However, some of these may be signs of an insidious heart disease that does not show any external symptoms. An experienced pediatric heart disease specialist can most likely tell which group this murmur will fall into as a result of his examination, but echocardiographic examination is recommended for definitive diagnosis, especially in children under 2 years of age.
Treatment of Congenital Heart Diseases:
Small heart holes that do not prevent the patient's growth and/or may close on their own, vascular stenosis that is mild and does not progress, or Except for some problems with heart valves, the treatment of most major congenital heart diseases is surgery. Treatment of Congenital Heart Diseases requires very specific and meticulous care.
Treatment with Interventional Cardiological Methods:
Today, the place of interventional cardiological methods in the treatment of congenital heart diseases is increasing very rapidly. For example, many valves or vascular stenosis can now be opened in the angiography laboratory without the need for surgery. Additionally, some vascular openings and intracardiac holes can be closed without the need for surgery.
CLASSIFICATION
We can roughly classify the heart diseases seen in children under certain basic groups as follows in order to be more easily understood.
A. CONGENITAL HEART DISEASES
I. Acyanotic heart diseases (No bruising)
a. Shunt lesions (Cal p holes, vascular openings etc.)
b. Obstructive lesions (such as vascular or valve stenosis)
c. Mitral valve prolapse
II. Cyanotic heart diseases: (causing bruising)
Diseases in which lung blood flow is reduced (insufficient oxygenated blood can reach the body in cases that prevent oxygen-poor blood from going to the lungs for cleaning)
Mixture lesions (mixing of oxygenated blood and oxygen-poor blood due to abnormal development of the heart and distribution of oxygen-poor blood throughout the body)
B. ACQUIRED HEART DISEASES
I. Rheumatic (such as Acute rheumatic Fever)
II. Infectious (such as Kawasaki syndrome, myocarditis)
Now we will examine the common congenital heart diseases a little more closely and in detail on a disease basis.
I. Acyanotic Heart Diseases:
a. Shunt Lesions:
Shunt lesions occur in every baby when there is an opening (hole) in the wall between the atrium (ASD), ventricle (VSD) or both chambers (AVSD) of the heart, or between two large arteries coming out of the heart. It is the result of an intervening artery (PDA) remaining open, which should be closed after birth. These openings cause an amount of blood, in direct proportion to the width of the defect, to pass to the side where the pressure is low (usually to the lung circulation side) with each contraction of the heart, causing the circulatory balance to be disrupted and the heart to become unnecessarily tired.
Atrial Septal Defect (ASD):
It is the name given to the presence of an opening in the wall between the atria of the heart. Therefore, some of the clean blood passes to the right heart. Due to the increase in blood flow to the lungs, it may cause damage to the lung vessels and heart by enlarging them over the years.
Diagnosis:
It usually does not cause any symptoms for many years. In fact, there have been cases where the diagnosis could not be made until the age of 30-60 in people who had not been to the doctor much. doctor for this disease but for another reason. When going to the hospital, it is suspected when a heart murmur and some additional sounds are heard or when the heart size is seen on an x-ray. The definitive diagnosis is made by examination and echocardiography by a pediatric cardiologist.
Treatment:
The size of the hole determines the time of treatment. Openings that do not close spontaneously and are at risk of increased pressure in the pulmonary artery are usually closed between the ages of 3-6, that is, before the child starts school. There are usually no problems during and after surgery. A scar from the surgery remains in the middle part of the chest. There are also different surgery options to make this scar appear in less visible places. Nowadays, the angiography/catheter method is also used to close such holes in patients. This cannot be applied to every patient, but some measurements can be made if appropriate.
What needs to be done for the future:
Usually, there is an additional pathology in the heart. Otherwise, in the latest recommendation booklet of the American Society of Cardiology, they do not require preventive treatment against endocarditis (inflammation of the inner layer of the heart) before some interventions such as surgery, circumcision, tooth extraction and filling. However, it is recommended that they receive preventive treatment for the first 6 months after surgery or catheter treatment. Patients should be under medical supervision at approximately 1-year intervals to be protected from unexpected complications. At less frequent intervals, this also applies to patients who have had surgery.
Ventricular Septal Defect (VSD):
It is an opening (hole) in the wall between the two ventricles of the heart. Through this opening, some of the clean blood from the left side of the heart passes to the right side. The severity of the patient's complaints and the type of treatment (medication or surgery) largely depend on the size of the opening, that is, the amount of blood passing through it.
Diagnosis:
In small VSDs, the diagnosis is usually made when a doctor goes to the doctor for any reason such as fever or cough and hears a murmur during the examination. It is placed by chance. The definitive diagnosis is made by examination and echocardiography by a pediatric cardiologist.
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