Pediatric cardiology: diseases — симптомы, диагностика и лечение

Congenital heart disease is a defect in the structure of the heart or large vessels that formed before the birth of the child. Such defects occur in approximately 8 children out of a thousand and remain the most common congenital anomaly. The main thing that parents should know today is that the word “vice” has long ceased to be a sentence. Some small defects close on their own in the first year or two of life, some are closed through a puncture of a vessel on the thigh without opening the chest, and most of the rest are successfully operated on, and the child grows, goes to school and plays sports. The decisive factor is not the fact of the defect itself, but how early it was found and whether the correction was made on time.

The phrase “your child has a heart murmur” scares parents almost more than any other pediatrician’s conclusion. Meanwhile, noise is not a diagnosis or a disease, but just a sound that occurs when blood moves in the heart and blood vessels. Such a sound is heard at one time or another during childhood in a significant proportion of absolutely healthy children, and in the vast majority of cases it turns out to be functional, that is, safe and not associated with any disorders of the structure of the heart. The doctor’s task is not to “remove the noise,” but to answer one question: is this noise coming from a normal heart or does it indicate a defect. And, as a rule, one study answers it - echocardiography.

A bicuspid aortic valve is a congenital condition in which the valve between the left ventricle and the aorta consists of two leaflets rather than three. It is one of the most common congenital heart defects, and many people live with it for decades without knowing it. However, such a valve experiences increased stress, wears out faster and calcifies earlier, so over time, a narrowing of the hole or reverse blood flow may develop. In some patients, the wall of the ascending aorta is simultaneously damaged - it expands and forms an aneurysm. That is why the defect does not require treatment, but regular monitoring by echocardiography.

A ventricular septal defect is a congenital heart defect in which there is a hole in the wall between the right and left ventricles. Through it, blood under high pressure is discharged from the left ventricle into the right and again goes to the lungs, overloading the pulmonary circulation. The larger the defect, the greater the burden: the child sucks worse, sweats during feeding, does not gain weight well, and more often suffers from bronchitis. Minor defects often close on their own in the first years of life and do not interfere in any way. The diagnosis is made by echocardiography, and the decision about surgery is made by a pediatric cardiologist together with a cardiac surgeon.

The accessory, or false, chord of the left ventricle is a thin connective tissue cord stretched inside the cavity of the ventricle between its walls. Unlike real chordae, it is not associated with the mitral valve leaflets and does not participate in its operation. This is a structural feature of the heart that is formed before birth and refers to minor developmental anomalies. It is found accidentally during echocardiography, often after the doctor hears a low noise in the child. Such a chord has virtually no effect on the pumping function of the heart: the chambers do not expand, the valves work normally, and blood circulation does not suffer. In most cases, treatment is not required, and restrictions in physical education and sports, as a rule, are not necessary.

Coarctation of the aorta is a congenital narrowing of the main vessel of the body, most often immediately after the separation of the arteries supplying the head and arms. Due to the obstruction, blood has difficulty getting into the lower half of the body: in the vessels of the arms and head the pressure is high, and in the legs it is low. The left ventricle works under overload, its wall thickens. In newborns with severe narrowing, the condition worsens sharply in the first days of life when the ductus arteriosus closes. In older children and adults, the defect is often detected during examination for persistent arterial hypertension. Treatment is to eliminate the narrowing.

A patent foramen ovale is a small opening with a flap valve in the septum between the atria. Before birth, blood flows through it, bypassing the lungs, and after the first breath, the pressure in the chambers of the heart changes, the valve is pressed and the hole usually closes up during the first or second year of life. If fusion does not occur, the window is called open. Most often, this is not a heart defect, but a minor developmental anomaly: there is no noticeable discharge of blood, the heart works normally, the child grows and develops as usual. The finding becomes significant in adults and only in certain situations - for example, with a stroke without an established cause or in divers. The window itself does not require surgery, but an examination by a cardiologist and echocardiography are advisable.

The ductus arteriosus is a vessel that in the prenatal period connects the pulmonary artery and the aorta, allowing blood to bypass the unexpanded lungs. After the first breaths, it should close: in full-term babies, usually within the first two days, completely - by 2–4 weeks. If the duct remains open, blood from the aorta is constantly dumped into the pulmonary artery, overloading the lungs and left side of the heart. It most often occurs in premature infants. A small duct may not give any complaints for years, but a large one causes shortness of breath, poor weight gain and requires closure.

Mitral valve prolapse (MVP) is the bowing of one or both valve leaflets between the left atrium and the left ventricle toward the atrium during heart contraction. More often it is associated with congenital weakness of the connective tissue of the valves and chords. In most cases, the prolapse is small, does not interfere with the functioning of the valve and does not require treatment: the person lives a normal life, and the finding is discovered by chance on an ultrasound of the heart. It is not so much the deflection itself that is important, but the severity of the reverse flow of blood - mitral regurgitation. With significant regurgitation, the chambers of the heart enlarge over time, shortness of breath and rhythm disturbances appear, and surgery may be necessary. Therefore, periodic monitoring by a cardiologist and repeated echocardiography are recommended for people with MVP.

Wolff-Parkinson-White syndrome is a congenital feature of the conduction system of the heart, in which an extra muscle bridge, an additional conduction path, remains between the atria and ventricles. The impulse travels along it, bypassing the atrioventricular node, so part of the ventricle is excited ahead of schedule, and characteristic changes appear on the ECG. This path in itself does not interfere with life, but it can close the impulse in a circle and trigger an attack of very rapid heartbeat. If changes are visible only on film and there are no attacks, they speak of the WPW phenomenon; if there are attacks, talk about the syndrome. The condition is completely treatable with catheter ablation.