Congenital heart disease is one of the most common congenital ailments. Of the 1000 babies, 8-10 babies are born with malfunctions in the main organ. Fortunately, 95% of young patients who had surgery in time, grow up to be absolutely healthy people.
“Up to four years old, Rita was a healthy, cheerful child, she didn’t even have a runny nose for more than three days. In general, there was no reason to worry. her heart ... "And after a few days, the pediatric cardiologist expressed more concretely:" Your daughter has a congenital heart defect, atrial septal defect - urgent surgery is necessary. "
I didn’t believe the doctors, although I remembered that our precinct pediatrician occasionally and in passing mentioned a small noise in the heart of Rita. He mentioned, but no more than that - he did not alarm anyone. Yes, and I did not notice anything suspicious. My daughter grew calm. They say about such babies: where you plant them, you will take them there.However, when my daughter became older, after running around on the street for a long time I could not catch my breath, drank a lot. She endured the heat badly, in the summer she even cried on the street. In general, having learned that my daughter had a heart defect, I decided to consult with all Kiev cardiologists, even drove the girl to Moscow. But all experts confirmed the need for surgery. Then we returned home, did all the tests, and put our daughter in the hospital.
I was so worried then that I couldn’t find a place for myself, could neither eat nor drink, all my strength went so as not to cry at my daughter, smile and pretend that heart surgery was a sheer nonsense, nothing terrible. It was necessary to hold on, because Rita perfectly felt the mood of her mother, and any of my emotions, especially tears, could cause her heart palpitations. Before the operation, the daughter drew only broken hearts. She even invented a fairy tale about a princess that the prince had abandoned, and her heart broke with grief ...
In general, as my daughter and I tried to be courageous, before the operation she could not stand it, was frightened and did not let the anesthesiologist to her. Primary anesthesia I introduced Rita.
And when my girl was already in the operating room, my heart suddenly became very sick, it seemed that they were cutting it. Neither before, nor after such pain did I feel. Later, the operating sister told me that at that very moment the surgeon made an incision in my girl's heart.
There is such a sign in hospitals: when a child is taken for an operation, his shoes are placed at the door of the ward - so that the baby will return, as if he has found the way back. You walk along the hospital corridor and see - at the door there are small slippers, tiny socks, booties are lying ... And the Ritochkins were there too ...
When my daughter began to recover after the anesthesia, she opened her eyes, recognized me, smiled and whispered: "I’m scared that way - Happiness? .."
A week after the operation, Rita jumped on one leg, dabbled, called for other children to play hide-and-seek - and this despite the fact that physical activity was contraindicated to her! And now, 2 years after the operation, even I can’t believe that my daughter was seriously ill and had a difficult operation. What to speak about strangers - it never occurs to anyone that my girl, who goes to dance, gymnastics, drawing, English, and also to school, had a heart defect.
But there is nothing surprising in this: the child looks like he is cared for, loved as he is. And if parents are fighting for their baby and in spite of everything they believe in luck, then everything can be overcome. And a serious illness too. "
Irina GNEDENKO, Kiev
Head of the Medical and Organizational Management of the Academy of Medical Sciences of Ukraine, Deputy Director for Research of the Institute of Cardiovascular Surgery named after N.N. Amosova, Academy of Medical Sciences of Ukraine, professor, honored doctor of UkraineVasily Lazorishinets
The girl we saved
8 years ago I had an operation on a baby, who was only one month old. She had a very serious defect - the common arterial trunk (two vessels - the aorta and the pulmonary artery - grew together). The operation is complicated: it was necessary to divide the common trunk into two parts, and then sew the pulmonary artery to the right ventricle of the heart, and the aorta to the left. Today, the girl goes to school, loves to draw, runs, jumps, rides a bicycle - in general, lives like all children. Periodically, she comes to our Institute to visit, show herself and have fun.
At the end of the XIX century, the famous doctor William Osler wrote,that congenital heart defects have "limited clinical interest, since most of these anomalies are incompatible with life, and in other cases nothing can be done to eliminate the defect or at least alleviate the symptoms." But half a century later, when they began to perform the first heart surgery, the diagnosis of "congenital heart disease" stopped sounding like a sentence.
Congenital heart disease is a disease that develops in the prenatal period due to various disruptions in the normal formation of the heart of the child and the vessels departing from it.
The heart is a powerful muscle pump. You can learn about its size by looking at the fist. The pump consists of four chambers. The upper two are called the atria, and the lower two are called the ventricles. The atria are divided by the interatrial septum, the ventricles by the interventricular septum.
Blood flows from the atria to the ventricles, and then to the arteries through four heart valves, which open and close like gates, allowing blood to flow in one direction only.
Having given all the life-giving oxygen to the body, "blue" venous blood returns to the heart.Through the right ventricle, it enters the pulmonary artery, from where it "goes" to the lungs for the next portion of oxygen. After that, she returns to the heart through the pulmonary veins. From the heart of the "scarlet" arterial, oxygen-rich blood is pumped into the aorta (the largest artery), which, in turn, carries blood throughout the body. The process of blood circulation is continuous and continuous.
There are about 300 reasons that prevent a small heart from developing normally. And only 3-5% of them are genetically determined, all the rest are the result of the influence on the future mother of external and internal factors: radiation (radioactive, isotopic), drugs not intended for pregnant women, infectious diseases (especially rubella; however, even influenza), contact with heavy metals, stress, alcohol, smoking and drugs.
Congenital heart defects are formed from 19 to 72 days of pregnancy, because on the 19th day the baby's heart begins to shrink, and by 72 it finally forms and looks like a small, but adult organ.
To determine congenital defects of the development of the heart muscle or blood vesselsit is already possible on the 20th week of pregnancy - therefore all women must undergo planned ultrasound examinations. Unfortunately, not every specialist in women's clinics ultrasound is able to recognize the shortcomings of a tiny heart, and even more so to determine the type of pathology. However, on specific grounds, one can suspect the disease and send the expectant mother for an additional examination in a special institution that is engaged in the diagnosis of cardiac pathologies. If the diagnosis is confirmed, doctors evaluate the severity of the defect, determine the possible treatment. A baby with congenital heart disease is born in a specialized hospital, where he is immediately given cardiological care.
If a heart disease was not diagnosed in the prenatal period of development, then immediately after birth, a neonatologist (pediatrician of the first month of life) in 80% of cases may suspect the disease for four main symptoms:
If these symptoms are present, then a small patient is prescribed special diagnostic methods: electrocardiography (a study of the electrical potentials of the heart) and x-rays.If further studies are needed, an ultrasound of the heart and angiocardiography (an x-ray of the heart and large vessels after inserting a contrast agent into the bloodstream using a catheter) are done to the baby.
The main radiological signs of congenital cardiac disease are cardiomegaly (dilation of the heart chambers) and dextracardia (right heart location).
Types of disease
All congenital heart defects are divided into 3 types: with increased, normal and reduced pulmonary blood flow. With defects of the first and second types, the child is born with normal skin color, and with the defects of the third, the skin becomes blue (therefore, they are called “blue” type defects).
The most common representative of the "blue" type is Falo's tetrad. This is a very serious illness, it includes 4 defects: stenosis of the pulmonary artery (narrowing); defect of interventricular septum; displacement of the aorta towards the right ventricle; hypertrophy (increase) of the right ventricle.
The second most common "blue" defect is the transposition of the great vessels. When it changes places the pulmonary artery and the aorta.The pulmonary artery carries venous waste blood to the lungs in order to saturate it with oxygen. The aorta, the largest artery, carries oxygen-rich blood throughout the body. In the presence of a defect, already used blood circulates through the aorta, and enriched with oxygen returns to the lungs. Without timely surgical correction, more than 50% of children with this pathology die within the first month of life, and about 90% by the end of the first year.
Defects in which the baby’s skin does not turn blue, are relatively “simple” —for example, interventricular or interatrial septal defects, in which the left and right heart sections communicate with each other. These defects are not always recognized in the maternity hospital. That is why parents need to know the symptoms that indicate possible problems with the heart of the child.
What can parents notice
If the child is lethargic, sucks poorly, often spits up, turns blue when screaming, he has shortness of breath at the time of feeding, does not gain weight, and heart rate is more than 160 beats / min.
When to operate
First, the most important task of the doctors is to send the baby to a specialized clinic so that he can be examined by a qualified pediatric cardiologist and a cardiac surgeon.After an accurate diagnosis is established, specialists determine the duration of the operation.
A child diagnosed with "atresia of the pulmonary artery" (no communication between the lungs and the ventricle of the heart) or "critical stenosis of the pulmonary artery" (narrowing) falls on the operating table 2-4 days after birth.
If the child has a transposition of the great vessels, the operation is done for 10-15 days of life. But the surgeon must perform special manipulations immediately after the birth of the baby (for 1-2 days). To save the child, a balloon is introduced into the heart at the level of the interatrial septum, which is inflated so that it breaks the septum, mixing venous and arterial blood. Only after this procedure, the baby can live. At 10-15 days the vessels are rearranged - put on the "right" places.
There are operations that do by half a year. For example, the elimination of ventricular septal defects. Although this operation is simple - you need to put a "patch" on the place of the defect - it is very important not to lose time. If the operation is not done in the period from 3 to 6 months, irreversible changes occur in the child’s body - up to the development of pulmonary vascular sclerosis.It is difficult to make a diagnosis in case of malfunction of the interventricular septum that heart murmurs may disappear suddenly. It would seem that this is a good symptom, but, unfortunately, with this pathology, it indicates that the defect in the septum is very large and the child needs urgent surgery.
If congenital heart disease is minor, then you can do without surgery. Thus, in 30% of cases, muscle defects of the interventricular septum are closed by the end of the first year of life without any intervention.
With some "simple" congenital heart defects (for example, atrial septal defect), people live for a very, very long time. But, unfortunately, a heart abnormality shortens a person’s life by about 20 years. Therefore, even minor deviations from the norm, it is desirable to eliminate surgically at the age of 1 to 3 years. If, even in childhood, the defect did not give out in any way, and the doctors did not diagnose it, all the same, its symptoms (shortness of breath, heart rhythm disorder) will sooner or later “pop up”. In women, congenital heart defects usually occur during pregnancy, and in men after 30 years. In such cases, patients must do the surgery.Expectant mothers, of course, are operated only after the birth of a child. By the way, the heart can be “repaired” at any age. For example, once we discovered a congenital heart disease in a 56-year-old woman — the poor patient could no longer walk, she had terrible shortness of breath and arrhythmia. After a successful operation, all symptoms disappeared.
Before and after the operation, the infant is fed with adapted infant formula. If the child is long connected to the ventilator, special nutrient solutions (amino acids, proteins) are administered intravenously. Approximately 1-2 weeks after the elimination of the defect, the mother can breastfeed the baby, if, of course, she managed to keep the milk.
Baby after surgery
Upon returning home, the operated small patient does not require any special care: it grows and develops, just like a healthy child. However, at first after the operation, the crumb is more carefully observed by experts: the local pediatrician (month) and the doctors from the hospital where they performed the operation (3 years).
If a child has a minimal heart disease, then in the future he will be able to play sports on a par with his peers, but under the control of a sports doctor or a local pediatrician. With heart defects, you can even achieve good results in a great sport.For example, the famous football player Nvanko Kanu from Nigeria, who played for the Italian club Inter, and now defends the interests of the English Arsenal, had a congenital heart disease (aortic defect), with which he miraculously ran for many years and scored balls. After the operation, Kanu continued his sports career.
At the Institute of Cardiovascular Surgery them. NN Amosov, Academy of Medical Sciences of Ukraine, there were also several cases when professional athletes were operated on. For example, only at the age of 20 they diagnosed a congenital heart disease and underwent surgery for the European boxing champion. One more patient of the Institute is a tennis player who is among the five best racquets in Ukraine.
About 4.5-6 thousand children with congenital heart defects are born in Ukraine every year. If cardiac surgery is not provided to these children, 40-70% will die in the first year of life.
According to the latest world classification, there are 160 types of congenital heart defects. And operations that save the lives of young patients, more than 200 varieties. In Ukraine, pediatric cardiac surgeons perform any operations, except for heart transplants in newborns and surgeries for left-side hypoplasia syndromeheart (this is a complex defect in which the child does not have a left ventricle and the ascending aorta - they need to be constructed, completely rebuilding the heart).
Ukrainian surgeons have operated on newborns only since 1992. Prior to this, heart surgery in our country was done exclusively for adult patients. However, after the staff of the Institute of Cardiac Surgery them. N. N. Amosova of the Academy of Medical Sciences of Ukraine completed internships in the USA, Canada, Australia and Germany, they began to save even the smallest patients. During the 10 months of 2004, the Institute's pediatric cardiac surgeons operated on 1,597 children, including newborns.
In addition to the two departments of surgery for congenital heart defects, the Institute has a Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine. Another 8 cardiac surgery centers operate children in Lviv, Donetsk, Dnepropetrovsk, Zaporozhye, Odessa, Kharkov, Lutsk and Kherson.
Since September 2003, all operations for children and adolescents up to 18 years old are carried out free of charge (the approximate cost of one operation, together with the examination, is 4.5-5 thousand hryvnias).
In 1956, Nikolai Nikolayevich Amosov performed the first heart surgery in Ukraine.Since then, experienced surgeons of the Institute of Cardiovascular Surgery. N. N. Amosov of the Academy of Medical Sciences of Ukraine performed more than 90 thousand operations, of which 30 thousand were children
Institute of Cardiovascular Surgery them. NN Amosov AMS of Ukraine: Kiev, st. Nikolay Amosov, 6. Tel. 275-42-33.