What Is Congenital Heart Surgery?

Congenital heart disease is the most common type of congenital malformations, accounting for about 28% of various congenital malformations. It refers to abnormal anatomical structures caused by the development of the heart and large blood vessels or abnormal development during embryonic development, or birth After the channel that should be closed automatically fails to close (in the case of a fetus is normal). The incidence of congenital heart disease should not be underestimated, accounting for 0.4% to 1% of living infants, which means that China has an annual increase of 150,000 to 200,000 patients with congenital heart disease. The spectrum of congenital heart disease is particularly wide, including hundreds of specific types, and some patients can have multiple deformities at the same time, the symptoms vary widely, the lightest can be asymptomatic for life, and the severe ones will have severe symptoms such as hypoxia, shock and even death. . According to hemodynamics and pathophysiological changes, congenital heart disease can be divided into cyanosis or non-cyanosis, and can be divided into three types according to the presence or absence of shunts: no shunt (such as pulmonary artery stenosis, aortic constriction), Right shunt (such as atrial septal defect, ventricular septal defect, open ductus arteriosus) and right to left shunt (such as tetralogy of Fallot, macrovascular dislocation).

Basic Information

English name: congenital heart disease
Visiting department: Cardiac surgery

Common causes: Genetic factors, environmental factors, and infection during pregnancy
Common symptoms: Repeated respiratory infections, palpitations, asthma, cyanosis, etc.

Causes of congenital heart disease

It is generally believed that early pregnancy (5-8 weeks) is the most important period of fetal heart development. Congenital heart disease has many causes. Genetic factors account for only about 8%, and the majority of 92% are caused by environmental factors. Women taking drugs during pregnancy, infection with viruses, environmental pollution, radiation radiation, etc., can cause abnormal fetal heart development. In particular, rubella virus infection in the first 3 months of pregnancy can increase the risk of congenital heart disease in children.

Clinical manifestations of congenital heart disease

There are many types of congenital heart disease, and their clinical manifestations mainly depend on the size and complexity of the deformity. Complicated and severe deformities can develop severe symptoms soon after birth and can even be life-threatening. It should be noted that some simple deformities, such as ventricular septal defect and arterial duct opening, may not have obvious symptoms at an early stage, but the disease will still potentially develop and aggravate, and timely diagnosis and treatment are needed to avoid losing the opportunity for surgery. The main symptoms are:

1. Frequent colds and repeated respiratory infections are prone to pneumonia.

2. Poor growth and development, weight loss, and sweating.

3. Suffering from weak sucking and difficulty feeding, or infants refusing to feed or choking, usually shortness of breath.

4. Children complain of fatigue and poor physical strength.

5. Lips, nails or bruises, or bruises after crying or activity, clubbing fingers and toes.

6. Like squatting, syncope, and hemoptysis.

7. Auscultation revealed a heart murmur.

Diagnosis of congenital heart disease

Diagnosis can usually be made through symptoms, signs, electrocardiograms, and echocardiography, and the hemodynamic changes, extent and extent of lesions can be estimated to determine a treatment plan. For congenital heart disease with multiple deformities and complex problems, specialists will selectively use 3D CT, cardiac catheterization or cardiovascular angiography to understand the degree, type and scope of the lesion, and comprehensive analysis according to the situation. Make a clear diagnosis and guide the development of a treatment plan.

Congenital heart disease treatment

1. In general, only a few types of congenital heart disease can recover naturally, and some of them will gradually increase with age, and the disease will gradually worsen.

The choice of treatment and the right timing for surgery depend on the scope and extent of the congenital heart malformation. Simple and slight deformities such as atrial septal defect and simple pulmonary valve stenosis. If the diameter of the defect is small, it has no significant effect on hemodynamics and can be used for life without any treatment. Severe congenital heart disease, such as complete aortic transposition or left ventricular dysplasia syndrome, must be performed immediately after birth, or the child will not survive.

2. Conservatively observed cases of congenital heart disease.

(1) For those patients with secondary foramen who have a small diameter and no tendency to pulmonary hypertension, reoperation can be observed at the age of 3 to 5 years;

(2) Membrane ventricular septal defects with a diameter of less than 4 mm have a small effect on cardiac function and the possibility of automatic closure. Therefore, 3 to 5 years old can also be observed. If the ventricular defect has not been closed, surgical treatment should be considered. Due to the lack of the possibility of bacterial endocarditis induced by the small chamber, and the current surgical safety is very high, it is not recommended to wait for a long time at present;

(3) Aortic valve stenosis with a transvalvular pressure difference of less than 40 mmHg, and pulmonary valve stenosis less than 60 mmHg. The premise of conservative treatment in these cases is that cardiac ultrasound must be checked more than twice in a hospital with a high level of congenital surgical treatment. In addition, regular follow-up observations and necessary inspections should be performed during the observation period to avoid misdiagnosis and delay the treatment timing.

3. Choosing the right surgical timing is the key to successful congenital heart disease surgery and a good prognosis.

At present, there are several main factors in determining the timing of surgery:

(1) The pathological characteristics of congenital heart disease and its degree of influence on hemodynamics Generally speaking, the more complicated the malformation, the greater the impact on hemodynamics, and the sooner surgical treatment should be performed.

(2) Progression of secondary pathological changes Left-to-right shunt-like congenital heart disease should be surgically corrected before pulmonary vascular obstruction changes occur. Spontaneous and obstructive congenital heart disease should be sought before severe myocardial hypertrophy and fibrosis occur.

4. Treatment of congenital heart disease:

There are a variety of surgical treatment, interventional treatment and drug treatment. The choice of treatment and when it is most suitable for surgery should be based on the condition and the cardiologist recommends the specific situation of the child. No shunt type or left to right shunt type, after timely operation, the effect is good and the prognosis is better. Patients with right-to-left shunt or compound deformity, who are more severe, have complicated and difficult surgery, and some patients cannot be completely corrected due to incomplete development of certain cardiac structures, and can only undergo palliative surgery to reduce symptoms and improve quality of life.

Interventional therapy is broadly divided into two categories: one is to relieve the stenosis of blood vessels and valves by balloon dilation, such as aortic valve stenosis, pulmonary valve stenosis, aortic constriction, etc .; the other is to use various memories Metal trait occluders should be used to occlude unwanted defects, such as atrial septal defect, ventricular septal defect, and arterial duct. Due to the advancement of medical technology and the continuous research and improvement of materials and processes, interventional therapy has been further developed in clinical applications at home and abroad. Not only can it avoid the risks and trauma of thoracotomy, but it also has a short hospital stay and fast recovery, which is very effective. Treatment. Interventional treatment partially replaces but cannot completely replace surgical thoracotomy. The technique has strict indications.

The surgical methods of congenital heart disease are mainly determined based on comprehensive factors such as the type of cardiac malformation and the degree of pathophysiological changes. The surgical methods can be divided into three categories: radical surgery, palliative surgery, and heart transplantation.

(1) Radical surgery can make the patient's heart dissected back to the structure of a normal person.

(2) Palliative surgery can only improve symptoms but not curative effect. It is mainly used for complex congenital diseases that have no curative method at present, such as modified Glenn, Fontan surgery, or as a kind of preparatory surgery, which promotes the original Well-developed structures grow and develop, creating conditions for radical surgery, such as body-lung shunt surgery.

(3) Heart transplantation It is mainly used for terminal heart disease and complex congenital heart disease that cannot be treated with current surgical methods.

Congenital heart disease prevention

Marriage of appropriate age

Medicine has proven that pregnant women over 35 years of age have a significantly increased risk of developing fetal genetic abnormalities. Therefore, it is best to give birth before the age of 35. If this is not possible, it is recommended that older pregnant women must undergo strict perinatal medical observation and care.

2. Make adjustments to your mental and physical state before preparing for your child

If expectant mothers have the habit of smoking and drinking, it is best to stop at least six months before pregnancy.

3. Strengthen health care for pregnant women

Especially in the early pregnancy, actively prevent rubella virus diseases such as rubella and flu. Pregnant women should avoid taking medicines as much as possible. If they must be used, they must be taken under the guidance of a doctor.

4. Minimize exposure to adverse environmental factors such as radiation and electromagnetic radiation during pregnancy.

5. Avoid traveling to high altitude areas during pregnancy

Because it has been found that the incidence of congenital heart disease is significantly higher in high altitude areas than in plain areas, which may be related to hypoxia.