The Congenital heart defects in children

 

Overview

A congenital heart defect is a problem with the structure of the heart that a child is born with.

Some congenital heart defects in children are simple and don't need treatment. Other congenital heart defects in children are more complex and may require several surgeries performed over a period of several years.

Symptoms

Serious congenital heart defects usually are noticed soon after birth or during the first few months of life. Signs and symptoms could include:

1- Pale gray or blue lips, tongue or fingernails (cyanosis)

2- Rapid breathing

3-Swelling in the legs, belly or areas around the eyes

4-Shortness of breath during feedings, leading to poor weight 

gain

Less-serious congenital heart defects may not be diagnosed until later in childhood. Signs and symptoms of congenital heart defects in older children may include:

1-Easily becoming short of breath during exercise or activity

2- Easily tiring during exercise

or activity

3- Fainting during exercise or  activity

4- Swelling in the hands, ankles or feet

Causes

to understand the causes of congenital heart defects, it may be helpful to know how the heart typically works.

The heart is divided into four chambers, two on the right and two on the left. To pump blood throughout the body, the heart uses its left and right sides for different tasks.

The right side of the heart moves blood to the lungs through the lung (pulmonary) arteries. In the lungs, blood picks up oxygen then returns to the heart's left side through the pulmonary veins. The left side of the heart then pumps the blood through the body's main artery (aorta) and out to the rest of the body.

congenital heart defects  develop

during the first six weeks of pregnancy, the baby's heart begins to form and starts beating. The major blood vessels that run to and from the heart also begin to develop during this critical time.

It's at this point in a baby's development that congenital heart defects may begin to develop. Researchers aren't sure exactly what causes most of these defects, but they think genetics, certain medical conditions, some medications, and environmental or lifestyle factors, such as smoking, may play a role.

There are many different types of congenital heart defects. They fall into the general categories described below.

Altered connections in the heart or blood vessels 

Altered connections allow blood to flow where it usually wouldn't. Holes in the walls between heart chambers are one example of this type of congenital heart defect.

An altered connection can cause oxygen-poor blood to mix with oxygen-rich blood. This lowers the amount of oxygen sent through the body. The change in blood flow forces the heart and lungs to work harder.

Types of altered connections in the heart or blood vessels include:

1- Atrial septal defect is a hole between the upper heart chambers (atria).

2- Ventricular septal defect is a hole in the wall between the right and left lower heart chambers (ventricles).

3- Patent ductus arteriosus (PAY-tunt DUK-tus ahr-teer-e-O-sus) is a connection between the lung artery and the body's main artery (aorta). It's open while a baby is growing in the womb, and typically closes a few hours after birth. But in some babies, it stays open, causing incorrect blood flow between the two arteries.

4- Total or partial anomalous pulmonary venous connection occurs when all or some of the blood vessels from the lungs (pulmonary veins) attach to a wrong area or areas of the heart.

Congenital heart valve problems

valves are like doorways between the heart chambers and the blood vessels. Heart valves open and close to keep blood moving in the proper direction. If the heart valves can't open and close correctly, blood can't flow smoothly.

Heart valve problems include valves that are narrowed and don't open completely (stenosis) or valves that don't close completely (regurgitation).

Examples of congenital heart valve problems including:

1- Aortic stenosis (stuh-NO-sis). A baby may be born with an aortic valve that has one or two valve flaps (cusps) instead of three. This creates a small, narrowed opening for blood to pass through. The heart must work harder to pump blood through the valve. Eventually, this leads to enlarging of the heart and thickening of the heart muscle.

2- Pulmonary stenosis. A defect on or near the pulmonary valve narrows the pulmonary valve opening and slows the blood flow.

3- Ebstein anomaly. The tricuspid valve — which is located between the right upper heart chamber (atrium) and the right lower chamber (ventricle) — is malformed and often leaks.

Combination of congenital heart defects

Some infants are born with several congenital heart defects that affect the structure and function of the heart. Very complex heart problems may cause significant changes in blood flow or undeveloped heart chambers

For example, tetralogy of Fallot (teh-TRAL-uh-jee of fuh-LOW) is a combination of four congenital heart defects:

1- A hole in the wall between the heart's lower chambers (ventricles)A

2- narrowed passage between the right ventricle and pulmonary artery

3- A shift in the connection of the aorta to the heart

4- Thickened muscle in the right ventricle

 

Risk Factors

 Most congenital heart defects result from changes that occur early as the baby's heart is developing before birth. The exact cause of most congenital heart defects is unknown, but some risk factors have been identified. Risk factors for congenital heart defects include:

1- Rubella (German measles). Having rubella during pregnancy can cause problems in a baby's heart development. A blood test done before pregnancy can determine if you're immune to rubella. A vaccine is available for those who aren't immune.

2- Diabetes 

Careful control of blood sugar before and during pregnancy can reduce the risk of congenital heart defects in the baby. Diabetes that develops during pregnancy (gestational diabetes) generally doesn't increase a baby's risk of heart defects.

3- Medications. 

Certain medications taken during pregnancy may cause birth defects, including congenital heart defects. Give your health care provider a complete list of medications you take before trying to become pregnant, medications known to increase the risk of congenital heart defects include thalidomide (Thalomid), angiotensin-converting enzyme (ACE) inhibitors, statins, the acne medication isotretinoin (Myorisan, Zenatane, others), some epilepsy drugs and certain anxiety drugs.

4- Drinking 

alcohol during pregnancy. Drinking alcohol during pregnancy increases the risk of congenital heart defects.

5- Smoking.

 If you smoke, quit. Smoking during pregnancy increases the risk of a congenital heart defect in the baby.

6- Family history and genetics.

 Congenital heart defects sometimes run in families (are inherited) and may be associated with a genetic syndrome. Many children with an extra 21st chromosome (Down syndrome) have congenital heart defects. A missing piece (deletion) of genetic material on chromosome 22 also causes heart defects.

Complications 

Potential complications of a congenital heart defect include:

• Congestive heart failure. This serious complication may develop in babies who have a significant heart defect. Signs of congestive heart failure include rapid breathing, often with gasping breaths, and poor weight gain.
• Heart infections. Congenital heart defects can increase the risk of infection of the heart tissue (endocarditis), which can lead to new heart valve problems.
• Irregular heart rhythms (arrhythmias). A congenital heart defect or scarring from heart surgery may cause changes in the heart's rhythm.
• Slower growth and development (developmental delays). Children with more-serious congenital heart defects often develop and grow more slowly than do children who don't have heart defects. They may be smaller than other children of the same age. If the nervous system has been affected, a child may learn to walk and talk later than other children.
• Stroke. Although uncommon, some children with congenital heart defects are at increased risk of stroke due to blood clots traveling through a hole in the heart and on to the brain.
• Mental health disorders. Some children with congenital heart defects may develop anxiety or stress because of developmental delays, activity restrictions or learning difficulties. Talk to your child's provider if you're concerned about your child's mental health

 Prevention

Because the exact cause of most congenital heart defects is unknown, it may not be possible to prevent these conditions. If you have a high risk of giving birth to a child with a congenital heart defect, genetic testing and screening may be done during pregnancy.

There are some steps you can take to help reduce your child's overall risk of birth defects such as:

• Get proper prenatal care. Regular checkups with a health care provider during pregnancy can help keep mom and baby healthy.
• Take a multivitamin with folic acid. Taking 400 micrograms of folic acid daily has been shown to reduce birth defects in the brain and spinal cord. It may help reduce the risk of heart defects as well.
• Don't drink or smoke. These lifestyle habits can harm a baby's health. Also avoid secondhand smoke.
• Get a rubella (German measles) vaccine. A rubella infection during pregnancy may affect a baby's heart development. Get vaccinated before trying to get pregnant.
• Control blood sugar. If you have diabetes, good control of your blood sugar can reduce the risk of congenital heart defects.
• Manage chronic health conditions. If you have other health conditions, including phenylketonuria, talk to your health care provider about the best way to treat and manage them.
• Avoid harmful substances. During pregnancy, have someone else do any painting and cleaning with strong-smelling products.
• Check with your provider before taking any medications. Some medications can cause birth defects. Tell your provider about all the medications you take, including those bought without a prescription.

What is Pediatric Cardiac Surgery ?

What is Pediatric Cardiac Surgery ?

Heart surgery in children is done to repair heart defects a child is born with (congenital heart defects) and heart diseases a child gets after birth that need surgery. The surgery is needed for the child's wellbeing.

.There are many kinds of heart defects Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels outside the heart. Some heart defects may need surgery right after the baby is born. For others, your child may be able to safely wait for weeks, months or years to have surgery.

One surgery may be enough to repair the heart defect, but sometimes a series of procedures is needed. Three different techniques for fixing congenital defects of the heart in children are described below.

Open-heart surgery is when the surgeon uses a heart-lung bypass machine.

1- An incision is made through the breastbone (sternum) while the child is under general anesthesia (the child is asleep 

and pain free).

2- Tubes are used to re-route the blood through a special pump called a heart-lung bypass machine. This machine adds oxygen to the blood and keeps the blood warm and moving through the rest of the body while the surgeon is repairing the heart.

3- Using the machine allows the heart to be stopped. Stopping the heart makes it possible to repair the heart muscle itself, the heart valves, or the blood vessels outside the heart. After the repair is done, the heart is started again, and the machine is removed. The breastbone and the skin incision are then closed.

For some heart defect repairs, the incision is made on the side of the chest, between the ribs. This is called a thoracotomy. It is sometimes called closed-heart surgery. This surgery may be done using special instruments and a camera. In most cases, a heart-lung bypass machine is not needed with this approach. Not all heart defects are able to be treated with this approach.

Another way to fix defects in the heart is to insert small tubes into an artery in the leg and pass them up to the heart. This is called a cardiac catheterization. Only some heart defects can be repaired this way.

The Ozaki Procedure for Aortic Valve Replacement

What Is the Ozaki Aortic Valve Replacement Procedure ?

The Ozaki technique is an innovative alternative technique for aortic valve replacement using tissue from the sac around your heart (autologous pericardium)

The aortic valve separates your heart's lower left chamber from your aorta. If the valve isn't working as it should, it can disrupt blood flow to your heart and through your body

The goal of the Ozaki aortic valve replacement is to replace the nonworking valve with a new one using your own tissue

People with aortic valve disease who haven't had prior open-heart surgery are potential candidates for the Ozaki aortic valve replacement

Risks and Benefits of the Ozaki Aortic Valve Replacement Technique

• preserves normal contributions of the aortic root to left-sided cardiac function
• 
  
• native leaflets avoid the use of a mechanical or synthetic bioprosthetic valve, which requires lifelong dependence on anticoagulants
• 
  
• the size and shape of the leaflets provide the valve with the potential to
• 
  
• expand as the heart grows and still maintain its ability to function as a valve, which is particularly relevant in pediatric cases
• 
  
• preserves the right ventricular outflow tract and pulmonary valve, avoiding future surgical intervention on the pulmonary valve does not preclude performing a Ross procedure at a later time
• 
  
• takes less time to perform than the Ross procedure, and patients spend less time on bypass

Risks of the Ozaki aortic valve replacement technique are much like the risks of other aortic valve replacement procedures:

• Bleeding
• Blood clots
• Infection
• Irregular heart rhythm

Heart Valve Conditions We Treat with the Ozaki Procedure

The cardiac surgeons can treat the following aortic valve diseases with the Ozaki aortic valve replacement method:

• Aortic valve stenosis: A condition in which your valve doesn't open wide enough to allow for proper blood flow
• 
  
• Aortic valve regurgitation: A condition in which blood leaks backward from the aorta, causing it to flow in two directions
• 
  
• Bicuspid aortic valve: An inborn condition in which the valve may not close correctly, causing blood to flow backward into the heart

The Ozaki Technique for Aortic Valve Replacement  What to Expect

Before your heart valve surgery

If the Ozaki aortic valve replacement procedure is a treatment option for you, you'll have pre-op testing

This includes noninvasive scans, like a CT scan of the chest, to:

• Inspect the quality of your heart sac tissue (pericardium)
• 
  
• Look at the size of the heart and blood vessels
• 
  
• Give you more details about the procedure, such as when to arrive and what to expect

• 
  

During your heart valve surgery

The Ozaki aortic valve replacement technique is an invasive surgery. Your care team will give you general anesthesia and put you on a heart-lung machine

During the 3 to 4 hour procedure, your surgeon:

• Makes a large cut in your chest and separates the breastbone
• 
  
• Removes a piece of tissue from the sac around your heart and uses a chemical called glutaraldehyde to strengthen it
• 
  
• Constructs a new aortic valve, removes the diseased valve, and replaces it with the newly built valve from your own tissue

After your Ozaki aortic valve replacement

• You can expect to stay in the hospital for 5 to 7 days post-op
• 
  
• It will take 1 to 2 months for the breastbone to heal and for you to fully recover. After that, you can resume life as normal

• You won't need to take blood thinners beyond a daily baby aspirin for 3 months after surgery
• 
  
• You will have follow-up appointments with your doctor to check on the condition of the valve 

 Coronary Artery Disease

 

Overview

  

Coronary artery disease is a common heart condition. The major blood vessels that supply the heart (coronary arteries) struggle to send enough blood, oxygen and nutrients to the heart muscle. Cholesterol deposits (plaques) in the heart arteries and inflammation are usually the cause of coronary artery disease.

Signs and symptoms of coronary artery disease occur when the heart doesn't get enough oxygen-rich blood. If you have coronary artery disease, reduced blood flow to the heart can cause chest pain (angina) and shortness of breath. A complete blockage of blood flow can cause a heart attack.

Coronary artery disease often develops over decades. Symptoms may go unnoticed until a significant blockage causes problems or a heart attack occurs. Following a heart-healthy lifestyle can help prevent coronary artery disease

? Who Gets It

Anyone can develop CAD. It begins when fats, cholesterols and other substances gather along the walls of your arteries. This process is called atherosclerosis. It's typically no cause for concern. However, too much buildup can lead to a blockage, obstructing blood flow. There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease. First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup. Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you're at a greater risk. All these factors together can paint a picture of your risk for 

developing CAD

 ? How is it diagnosed 

Diagnosing CAD starts by talking to your doctor. They'll be able to look at your medical history, do a physical exam and order routine blood work. Depending on that, they may suggest one or more of the following tests: an electrocardiogram or ECG, an echocardiogram or soundwave test of the heart, stress test, cardiac catheterization and angiogram, or a cardiac CT scan

 ? How is it treated

Treating coronary artery disease usually means making changes to your lifestyle. This might be eating healthier foods, exercising regularly, losing excess weight, reducing stress or quitting smoking. The good news is these changes can do a lot to improve your outlook. Living a healthier life translates to having healthier arteries. When necessary, treatment could involve drugs like aspirin, cholesterol-modifying medications, beta-blockers, or certain medical procedures like angioplasty or coronary artery bypass surgery (CABG)

 ? Symptoms 

Symptoms may go unrecognized at first, or they may only occur when the heart is beating hard like during exercise. As the coronary arteries continue to narrow, less and less blood gets to the heart and symptoms can become more severe or frequent

Coronary artery disease signs

and symptoms can include:

Chest pain (angina).

 You may feel pressure or tightness in your chest. Some people say it feels like someone is standing on their chest. The chest pain usually occurs on the middle or left side of the chest. Activity or strong emotions can trigger angina. The pain usually goes away within minutes after the triggering event ends. In some people, especially women, the pain may be brief or sharp and felt in the neck, arm or back

Shortness of breath. 

You may feel like you can't catch your breath

Fatigue.

 If the heart can't pump enough blood to meet your body's needs, you may feel unusually tired

Heart attack.

 A completely blocked coronary artery will cause a heart attack. The classic signs and symptoms of a heart attack include crushing chest pain or pressure, shoulder or arm pain, shortness of breath, and sweating. Women may have less typical symptoms, such as neck or jaw pain, nausea and fatigue. Some heart attacks don't cause any noticeable signs or symptoms

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