Congenital Heart Diseases
Congenital heart diseases occur within the first 8 weeks of pregnancy. It is the most common congenital anomaly. The possibility of having this type of disease in the family increases. 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, easy fatigue, difficulty breathing, developmental delay, frequent respiratory infections, and fainting are common symptoms. Congenital Heart Diseases are divided into two: acyanotic (without bruise) and cyanotic (with bruise).
If there is a shunt in acyanotic congenital heart diseases (ASD, VSD, PDA, EAT) 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 4-7%, large artery trans position 3-5%while other Cyanotic Congenital Heart Diseases (Tricuspid Atresia, Pulmonary Atresia, Truncus Arteriosus, Total abnormal Pulmonary Venous return and Hypoplastic Left Heart) are seen in 1-3%.
The prognosis is better in Acyanotic Congenital Heart Diseases. Children with Cyanotic Congenital Heart Disease, other than Tetralogy of Fallot, rarely live past the age of one unless intervention is made. Survival for untreated patients with Tetralogy of Fallot is 2.5 – 7 years, only10% 'u may exceed 20 years of age 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 (endocarditis) before and after the operation. An antibiotic should be used before 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 10% of all congenital heart diseases occur. u PDA. Ductus arteriosus is a vascular structure that connects the lung artery (pulmonary artery) and the main artery (aorta). At birth, all babies normally have a ductus arteriosus (PDA). This is a vital structure for the 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 the 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 increases 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. One complaint if the link is small It may not be. 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, while there is bruising in the left arm and lower body, but not in the right arm.
The type of treatment depends on the age of the patient and the severity of the PDA. varies depending on width. 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(25-30%). If there is an opening between the two ventricles of the heart, too much 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 lung artery (pulmonary artery) increase. Therefore, the harder working heart becomes larger.
The clinical symptoms of the disease are proportional to the width of the 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 disappear.
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. SmallVSDs will be covered with stitches, large VSDs will usually be covered with normal heart tissue (later on). which)is covered with a patch. 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 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). In addition, the valves that separate 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).
Due to the openings in both the atrium and ventricle, the oxygen-rich blood in the left side of the heart passes to the right side of the heart and again. into the lung It is pumped to the r. Similar to patients with large VSD, growth and developmental delay occurs. Frequent breathing, inability to feed, sweating, and frequent lung infections occur. Pressure in the pulmonary artery increases (pulmonary hypertension) and over time, permanent damage to the pulmonary artery may occur.
In some babies, this single, large valve separating the upper and lower chambers may not close completely. Because of this valve that does not close completely, blood in the ventricles may leak back into the atria. This condition is defined as valve regurgitation or insufficiency. The leak can be found on the right side, left side, or both sides of the heart. Leakage in the valve causes the heart to pump excessive amounts of blood and may further increase existing heart failure.
Surgery is usually performed in infancy in children who develop pulmonary hypertension or have serious disease symptoms. With surgery, this large opening in the heart is closed using one or two patches. The single, large valve located between the ventricles and atria is divided into two to create two separate valves.
After surgical repair of the atrioventricular valve defect, blood flow returns to normal. However, there may be some insufficiency or sometimes stenosis in the new valves created. This situation may also occur or increase in subsequent years. For this reason, there is a possibility of a second surgical intervention for the valves in the future.
Sometimes, in cases where open heart surgery is considered too risky due to the general condition of the patient, closed heart surgery (pulmonary banding) can be applied. With this surgery, the pulmonary artery is narrowed and excess blood flow is controlled. Lung pressure is reduced and time is gained for corrective surgery by allowing the patient to grow and improve his general condition. Your child after surgery z should be monitored regularly by a pediatric cardiologist.
Aortic Stenosis
The aortic valve is located between the left ventricle of the heart and the aorta, the main artery. With the contraction of the heart, the aortic valve opens and oxygen-rich blood is thrown into the aorta. The cover area is normally 2.5 cm2. If there is a 1/3 narrowing (stenosis) in this area, it will be difficult for blood to pump to the body. Aortic Stenosis is the second most common cause of cyanotic congenital heart disease in children (4-7%). The function of the aortic valve may be impaired due to congenital or acquired diseases. Aortic stenosis may develop due to congenital, rheumatic, atherosclerotic or infective endocarditis. Degenerative sclerotic aortic stenosis is seen in people over the age of 70.
There are three leaflets in the aortic valve. In congenital stenosis of the aorta, there may be a single, thick and hard leaflet (unicuspid)or two leaflets (bicuspid) on the valve. It may originate from the lower part of the valve (subaortic stenosis: Hypertrophic obstructive cardiomyopathy or membranous, band type), or above the valve (Supraaortic stenosis)in the aortic vessel (valvular: the most common type).
Complaints such as pale appearance, rapid fatigue, drop in pulse pressure, blackout and fainting, chest pain, respiratory distress, rhythm disorders, sudden death, left heart failure may occur due to advanced ages or very serious aortic stenosis. . Stenosis will often cause coronary problems. As the stenosis increases, the need for surgery also increases.
Operation is performed in symptomatic patients with an aortic valve area smaller than 0.8 cm2. Surgery should be performed in patients with impaired left ventricular function. In cases of severe aortic stenosis in children, surgery is performed even if there are no symptoms. Under the lid
Stenosis may increase over time, so the patient must remain under control throughout life. Stenoses may not be corrected surgically as desired and insufficiency may occur.
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