General Information
Congenital heart diseases, which are usually diagnosed in the womb or after birth, are a situation that causes extreme concern in families. However, with the development of technology, the majority of congenital heart diseases can be completely eliminated either with the help of an angiocatheter or with open or closed surgical methods. Almost all of these children continue their lives as completely normal, productive individuals in adulthood.
We can examine heart diseases seen in childhood in 3 subgroups:
1- Congenital. Heart Diseases,
2- Rheumatic Heart Diseases,
3- Rhythm and Conduction Disorders
1- Congenital Heart Diseases
Heart shape and function disorders that exist from birth, starting from the embryo stage (the first initial form of life) during pregnancy, during the baby's organ development in the womb, but also due to damage caused by genetic and external factors. is all. It includes an extremely wide range of problems such as pauses in the development of the heart and vessels, development problems of the heart cavities, holes in the walls separating the heart cavities, deterioration of the structure of the heart valves, leakage or narrowing.
In terms of congenital heart diseases. risk factors; ı- Exposure to X-rays or radiation in the first 8 weeks of pregnancy, ii- viral infections such as rubella in the same period, iii- drug use without the control of a doctor, iv- diabetes mellitus, especially babies of mothers using insulin, v- parents advanced age, vi- familial genetic diseases, vi- nutritional disorders
Findings in congenital heart diseases; They are detected by examinations made due to the sounds heard in the heart during breastfeeding, iii- bruising, iii- getting tired easily, iv- letting go of the breast quickly while breastfeeding, v- growth retardation, rapid breathing, viii- frequently recurring upper respiratory tract infection, viii- fainting.
Do We examine the common heart diseases under two main headings: heart diseases that progress with cyanotic (cyanotic) heart diseases and acyanotic = heart diseases without bruising. The way these diseases occur and their treatment features vary. In Asian heart diseases, the blood flow between the holes in the heart is generally from left to right, and they are diseases that progress with a severe increase in blood flow to the lungs, and life expectancy and quality are generally much better in this group. Cyanotic heart diseases are generally more complicated and the direction of blood flow is from right to left, therefore blood with low O2 enters the circulation and blood with CO2 rises in HB, which is what we call cyanosis, which occurs with slight exertion and breastfeeding or crying. and it continues after a certain period of time.
In the acyanotic patient group; There are diseases such as ASD (hole between the upper chambers of the heart), VSD (hole between the lower chambers of the heart), PDA (the vessel between the main artery and the white artery does not close, which should be closed after birth), and heart valve failure.
Cyanotic heart diseases; TOF (Tetralogy of Fallot), Circuspid valve or pulmonary valve atresia, Total abnormal pulmonary venous return anomaly, Hypoplastic left heart syndrome.
Generally, the diagnosis is made in the womb at 14-23 weeks. It is applied between weeks and attempts can be made for temporary solutions in the womb, as well as treatment can be done in all childhood ages, such as early infancy, play age, during birth. Supplements are essential to protect the child from infections and accelerate its development until the treatment period is reached.
Congenital Heart Diseases
Congenital heart diseases occur within the first 8 weeks of pregnancy. It is the most common congenital anomaly. Having this type of disease in the family increases the likelihood. It is more common in pregnancies of diabetic women who use insulin. Using medications in the first 8 months of pregnancy, x-rays, and infections such as rubella increase the possibility of anomalies. There may be major disorders or minor anomalies that do not cause any symptoms, which can change the dynamic and anatomical structure of the heart. bruising, frequent breathing Fatigue, difficulty breathing, developmental delay, frequent respiratory tract infections, and fainting are common symptoms. Congenital Heart Diseases are divided into two: acyanotic (without bruising) and cyanotic (with bruising). If there is a shunt in acyanotic congenital heart diseases (ASD, VSD, PDA , EYD)is predominantly from left to right, and pulmonary flow is greater than systemic flow. In cyanotic Congenital Heart Diseases, the shunt is generally from right to left and the blood flowing to the lungs is reduced. The most common cyanotic congenital heart disease is Tetralogy of Fallot (5-7%). Aortic Stenosis is seen in 4-7%, great artery trans position is seen in 3-5%, while other Cyanotic Congenital Heart Diseases (Tricuspid Atresia, Pulmonary Atresia, Truncus Arteriosus, Total abnormal Pulmonary Venous return and Hypoplastic Left Heart ) is seen between 1-3%.
Prognosis is better in acyanotic congenital heart diseases. Children with Cyanotic Congenital Heart Disease, other than Tetralogy of Fallot, rarely live past one year of age if not intervened. The life expectancy of untreated patients with Tetralogy of Fallot is 2.5 - 7 years, only 10% of them survive the age of 20 without treatment. In Tetralogy of Fallot surgery, the prognosis is quite good and a life close to normal is achieved.
Heart disorders can be diagnosed in the womb by performing fetal echocardiography after the 14th week before birth. However, more sensitive examinations can be performed at the 23rd week.
All people with congenital heart disease have a risk of valve infection before and after the operation. An antibiotic should be used before any other operations or interventions (such as tooth extraction) to prevent infection. Ensuring oral hygiene is also an important factor that reduces the risk of endocarditis.
Patent Ductus Arteriosus (PDA)
Approximately % of all congenital heart diseases. 10 of them are PDAs. Ductus arteriosus, a vein that connects the pulmonary artery (pulmonary artery) and the main artery (aorta) r structure. All babies have a normal ductus arteriosus (PDA) at birth. This is a vital structure for blood circulation in the womb, which is different from normal. However, it must close a few hours after birth. The incidence is much higher in premature babies and in children of mothers who had rubella infection in the first three months of pregnancy, in places where the oxygen rate is low. If it remains open, it is called PDA. Some of the oxygen-rich blood coming to the aorta returns to the lungs through this connection. Pressure rises in the pulmonary artery. The left side of the heart is overloaded. If the connection is large, the child gets tired easily, his growth is delayed, his breathing becomes difficult and he easily catches lung infections. Symptoms such as difficulty breathing with exertion, palpitations, and chest pain are due to left heart failure and pulmonary hypertension. If the connection is small, he may have no complaints. Sometimes symptoms may appear after a few months. If right-to-left shunt flow develops as a result of pulmonary hypertension, an appearance called differential cyanosis may occur, with bruising on the left arm and lower body, but not on the right arm. It varies depending on the width of the . As drug treatment, Indomethacin, digoxin and diuretics can be given in patients with heart failure. If it does not close within 6 months or if there is heart failure that does not respond to treatment, surgery is performed. Devices called umbrellas or coils applied via a catheter can close the connection. However, closed heart surgery may also be required. Circulation will return to normal after treatment.
Ventricular Septal Defect (VSD)
The most common congenital heart disease is VSD' is (25-30%). If there is an opening between the two ventricles of the heart, a lot of blood will pass from the left ventricle to the right ventricle due to the pressure difference. Oxygen-rich blood coming from the lungs to the left of the heart passes to the right and is pumped back to the lungs. The amount of blood going to the lungs and the blood pressure in the pulmonary artery (pulmonary artery) increase. Therefore, the harder working heart becomes larger.
Clinical symptoms of the disease, VSD. It may take more than a few weeks for postpartum symptoms to appear. If VSD is large, children have problems eating and gaining weight, have difficulty breathing, and get tired easily. Pulmonary hypertension may occur. High pressure can cause permanent damage to the lung vessels after a while. This hole in the heart needs to be closed with surgery as soon as possible. Because if permanent pulmonary hypertension develops, the chance of surgery may be eliminated. If the opening is small, the load on the heart will be less. In this case, there may be no symptoms other than a heart murmur. It can close on its own without the need for surgery. For this, you must wait until a certain age, and if it does not close on its own, surgery can be performed. It is then covered with a patch (which will be covered with normal heart tissue). If babies have a long-term infection, more than one VSD, or if open heart surgery cannot be performed due to other diseases, closed heart surgery can be performed to eliminate their complaints and prevent the development of pulmonary hypertension. In this operation, the diameter of the pulmonary artery is narrowed (pulmonary banding) and the blood flowing to the lungs is reduced, thus reducing the pulmonary blood pressure. The child's growth and development recover, although not completely. In older ages, the band is removed and the opening is closed with open heart surgery. Closing the VSD allows blood flow to return to normal and heart failure to improve. There is a normal life expectancy in the long term.
Atrioventricular Septal Defect (ASD)
It is the presence of a large hole in the middle of the heart. This opening concerns both the upper and lower chambers of the heart (atrium and ventricle) image003. In addition, the valves separating the atria and ventricles (mitral and tricuspid valves) are not fully formed and both are in the form of a single, large valve. This heart defect may be associated with Down syndrome (Mongolism).
Both atria,
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