1 in 125 babies are born each year in the US with a Congenital Heart Defect.
Children are included to the risk of the availability of congenital heart disease with:
If a child has pronounced developmental defects, violations in the structure or function of major organs, a pediatrician should send him to the Pediatric Cardiology.
This is a normal fetal ultrasound showing one pattern of the fetal heartbeat. Some ultrasound machines have the ability to focus on different areas of the heart and evaluate the heartbeat. This is useful in the early diagnosis of congenital heart abnormalities.
AHA classification of congenital heart disease
Ventricular septal defect
The cause of VSD is not yet known. This defect often occurs along with other congenital heart defects.
Patients with ventricular septal defects may not have symptoms. However, if the hole is large, symptoms, the baby often has symptoms related to heart failure.
The most common symptoms include:
Cyanosis of rhino-lip triangle
Exams and Tests
Septal defect. 12 weeks pregnancy.
Listening with a stethoscope usually reveals a heart murmur (the sound of the blood crossing the hole). The loudness of the murmur is related to the size of the defect and amount of blood crossing the defect.
Tests may include:
Chest radiograph of a patient with ventricular septal defect (direct view): the heart shadow is increased at the expense of both ventricles, marked protrusion of the arc of pulmonary trunk (indicated by arrow), pulmonary picture in the basal parts of the lungs is strengthened.
Angiogram at VSD
Except for the case of heart attack associated VSD, this condition is always present at birth.
Atrial septal defect
Small to moderate sized defects may produce no symptoms, or not until middle age or later. Symptoms that may occur can include:
Exams and Tests
Tests that may done include:
Chest radiograph with atrial septal defect (direct view): increase of right ventricle, bulging of the pulmonary trunk of the arc on the left contour of the shadow of the heart (indicated by arrow); signs of hypertension of the pulmonary vessels.
Doppler study of the heart
Aortogram at ASD
Figure A shows the heart’s position in the body and the location and angle of the MRI images shown in figure C. Figure B is a MRI angiogram, which is sometimes used instead of a standard angiogram. Figure C shows MRI pictures of a normal left ventricle (left image), a left ventricle damaged from a heart attack (middle image), and a left ventricle that isn’t getting enough blood from the coronary arteries (right image).
ASD may not require treatment if there are few or no symptoms, or if the defect is small. Surgical closure of the defect is recommended if the defect is large, the heart is swollen, or symptoms occur.
A procedure has been developed to close the defect without surgery. The procedure involves placing an ASD closure device into the heart through tubes called catheters. The health care provider makes a tiny surgical cut in the groin, then inserts the catheters into a blood vessel and up into the heart. The closure device is then placed across the ASD and the defect is closed.
Not all patients with atrial septal defects can have this procedure.
Prophylactic (preventive) antibiotics should be given prior to dental procedures to reduce the risk of developing infective endocarditis immediately after surgery for the ASD, but they are not required later on.
With a small to moderate atrial septal defect, a person may live a normal life span without symptoms. Larger defects may cause disability by middle age because of increased blood flow and shunting of blood back into the pulmonary circulation.
There is no known way to prevent the defect, but some of the complications can be prevented with early detection.
Patent ductus arteriosus
Signs and symptoms
While some cases of PDA are asymptomatic, common symptoms include:
The type and timing of surgical repair depends on the child's condition and the type and severity of heart defects.
An incision may be made through the breastbone (sternum) and between the lungs (mediastinum) while the child is deep asleep and pain-free (under general anesthesia). For some heart defect repairs, the incision is made on the side of the chest, between the ribs (thoracotomy) instead of through the breastbone. Heart-lung bypass may be needed. Tubes are used to re-route the blood through a special pump that adds oxygen to the blood and keeps it warm and moving through the rest of the body while the repair is being done.
Tetralogy of Fallot
Newborn with tetralogy of Fallot
Clubbing of fingers (skin or bone enlargement around the fingernails)
Specific form of heart
Heart in the form of "boots"
Most cases can be corrected with surgery. Babies who have surgery usually do well. Ninety percent survive to adulthood and live active, healthy, and productive lives. Without surgery, death usually occurs by the time the person reaches age 20.
Patients who have continued, severe leakiness of the pulmonary valve may need to have the valve replaced.
Transposition of the great vessels
This means there is decreased oxygen in the blood that is pumped from the heart to the rest of the body. Low blood oxygen leads to cyanosis (a bluish-purple color to the skin) and shortness of breath.
The condition is the second most common cyanotic heart defect.
Exams and Tests
The health care provider may detect a heart murmur while listening to the chest with a stethoscope. The baby's mouth and skin will be a blue color.
The child's symptoms will improve after surgery to correct the defect. Most infants who undergo arterial switch do not have symptoms after surgery and live normal lives. If corrective surgery is not performed, the life expectancy is months.
Women who plan to become pregnant should be immunized against rubella if they are not already immune. Eating well, avoiding alcohol, and controlling diabetes both before and during pregnancy may be helpful.
Hypoplastic left heart
These symptoms may include:
In healthy newborns, bluish color in the hands and feet is a response to cold (this reaction is called peripheral cyanosis).
However, a bluish color in the chest or abdomen, lips, and tongue is abnormal (called central cyanosis). It is a sign that there is not enough oxygen in the blood. Central cyanosis often increases with crying.
Exams and Tests
A physical exam may show signs of heart failure:
Tests may include:
Today heart transplantation is considered a better choice than the 3-step surgery process. However, there are few donated hearts available for small infants.
Exams and Tests
Tests that can help diagnose this condition include:
Ultrasound of the heart (echocardiogram)
PhCG with Ebstein 's anomaly in the V intercostal space on the left of the sternum: beat the average amplitude, pathological IV tone.
Treatment depends on the severity of the defect and the specific symptoms.
Medical care may include:
In general, the earlier symptoms develop, the more severe the disease.
Some patients may have either no symptoms or very mild symptoms. Others may worsen over time, developing blue coloring (cyanosis), heart failure, heart block, or dangerous heart rhythms.
A severe leakage can lead to swelling of the heart and liver, and congestive heart failure.
Other complications may include:
There is no known prevention.
Symptoms of aortic stenosis include:
In infants and children, symptoms include:
Children with mild or moderate aortic stenosis may get worse as they get older. They also run the risk of developing a heart infection (bacterial endocarditis).
Exams and Tests
The following tests may be performed:
Chest radiograph with aortic stenosis: the shadow of the heart has the shape of shoe (aortic configuration) with an increase due to hypertrophy of the left ventricle (indicated by arrow), the tip is rounded.
Phonogram of heart at aortic stenosis: systolic murmur diamond shape (indicated by arrows).
EchoCG at aortic stenosis
Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.
Coarctation of the aorta
Aortic coarctation is a narrowing of part of the aorta (the major artery leading out of the heart). It is a type of birth defect. Coarctation means narrowing.
Symptoms depend on how much blood can flow through the artery. Other heart defects may also play a role.
Around half of newborns with this problem will have symptoms in the first few days of life.
In milder cases, symptoms may not develop until the child has reached adolescence.
Note: There may be no symptoms.
Exams and Tests
The absence of the aortic arch at Aortogramma with contrast
Aortogramma patient with coarctation of the aorta (right oblique projection): a complete interruption of the aorta shadow in its isthmus (indicated by arrow).
Macroscopic remote part of the aorta in coarctation: the lumen of the aorta is narrowed sharply, which shows drawn through a needle injection.
Long-term complications include:
There is no known way to prevent this disorder; however, being aware of your risk may make early diagnosis and treatment possible.
Rheumatic fever develops about 20 days after strep throat or scarlet fever. The streptococcus infection which leads to rheumatic fever may be asymptomatic in a third of all cases.
The morphological changes reflect a systemic disorganization of connective tissue, especially the cardiovascular system with specific necrotic-proliferative reactions (Aschoff's body) and nonspecific exudative manifestations. The latter are more expressive in childhood, which determines a large (compared with adults), severity and activity of the process, the severity of carditis and other manifestations of rheumatic fever.
Myocardial Aschoff body – the cells are large with large nuclei; some are multinucleated.
Necrotic proliferative reactions in connective tissue
Diseased Heart Valve
The clinical manifestations of rheumatic fever include:
Major Jones criteria:
Minor Jones criteria:
Schematic representation of the aetiopathogenic events occurring during the development of carditis
Aortic valve showing active valvulitis. The valve is slightly thickened and displays small vegetations – "verrucae"
X-ray except not always pronounced increase in heart determined by an impairment of tonic and myocardial contractility, mitral or aortic configuration of the heart
Doppler image of mitral valve regurgitation
prolonged P-Q as criteria of RF
The Role of Polyarthritis in Rheumatic Fever
Vertebral joints are not usually affected but the following joints may be affected:
Joint pain and fever associated with rheumatic fever usually The laboratory value of the erythrocyte sedimentation rate usually returns to normal within 3 months if carditis does not persist.
Arthralgia associated with rheumatic fever differs from arthralgia associated with rheumatoid arthritis by the absence of tenderness during passive movement of the affected joint (person performing examination moves patient's joint through range of motion).
Annular and nodosum erythema
Annular erythema - pale pink rash in the form of a thin ring-shaped rim, does not rise above the skin surface and then disappears when pressing. Appears in 7-10% of children with rheumatism, mostly at an altitude of disease and usually is fragile.
Annular and nodosum erythema
Differential diagnosis of rheumatic fever
Prevention of rheumatic fever.
Acquired heart anomalies
Clinic and diagnosis.
The amplified, shifted to the left and spilled apical beat with mitral insufficiency
On auscultation over the apex there is blowing systolic murmur, sometimes it is accompanied by systolic tremor.
The ECG in patients with mitral insufficiency shows
leftcardiogram, the interval P - Q is prolonged.
At phonocardiogram first tone merges with systolic murmur.
An extension of the heart to the left in direct projection is showed on X-rays. Waist absent because of the expansion of the left atrium, enlarged left ventricle.
Doppler echocardiography may clarify the nature and extent of the damage.
Treatment of mitral insufficiency is surgical.
Mitral stenosis Mitral stenosis
Thickening of the cusps, commissures
with calcifications and thrombus,
thickening, compaction and
shortening of the chord
Peripheral signs include:
Insufficiency of aortic valve
revealed aortic configuration of the heart due to expansion of left ventricle. Ascending aorta is extended.
Doppler image of aortic valve with regurgitation
in tricuspid insufficiency are pulsations of the neck veins and the liver, synchronously with the systole of the ventricles of the heart. Liver is enlarged, painful. systolic murmur is auscultated on right part of the sternum. indicates an increasing of the right heart, and when combined with other defects expansion of all parts of the heart. provides an opportunity to identify high pressure in the right atrium and the portal veins.
ECG in tricuspid valve inssuficiency
Increased pressure and pulsation of blood flow in the portal vein in tricuspid insufficiency.
Echo symptoms of tricuspid insufficiency
Radiography of the heart with varying degrees of tricuspid insufficiency
Etiology is rheumatic endocarditis.
View looking down on the right atrium (no tricuspid valve is present)
Echo- and Doppler sings of tricuspid stenosis
Hypertrophy of the right ventricle with stenosis of the right atrioventricular
Operation on the narrowing of the tricuspid valve is commissurotomy. When mitral stenosis is combined with stenosis of the tricuspid valve operations are performed simultaneously.
Aortic valve stenosis
A failing aortic valve may cause a variety of symptoms including:
X-ray sings of aortic stenosis
Doppler sings of aortic stenosis