Stenosis of the aorta
Aortic stenosis is a congenital heart disease accompanied by deformation of valve flaps and( or) constriction of the aortic aperture.
With aortic stenoses, the myocardium( muscle shell) of the left ventricle increases with a small expansion of its cavity as a result of overload with an increased volume of blood. With the contraction of the left ventricle, not all blood can pass through the narrowed aperture. As a result, some part of the blood remains in the cavity of the left ventricle. To this volume, blood from the left atrium is added, which comes when it is contracted into the left ventricle. As a result of this, the ventricular muscle shell first tries to contract as much as possible in order to expel the entire accumulated volume of blood. This leads to its increase, as with constant training in the gym increases the muscle mass of athletes. After the ventricular muscle has increased to its maximum, it begins to stretch, which increases the volume of the ventricle.
Most children with aortic stenosis do not complain for a long time, develop normally. In cases of severe constriction, as well as with its combination with other vices, signs of the disease appear in the first year of life in the form of pallor of the skin, shortness of breath, rapid heartbeat, there may be seizures of sudden anxiety, heart failure is formed. At the older age after a long period of "well-being" there are complaints of pain in the heart, periodic dyspnea, periodic syncope( syncope).Syncope is a sign of severe aortic constriction. The reason for a short-term loss of consciousness is a reduced ejection of blood from the left ventricle into the large circle of blood circulation. This leads to oxygen starvation of the brain and, as a consequence, to loss of consciousness.
Children with stenosis of the aorta have a peculiar appearance - the "face of the elf": thickened skin folds above the upper eyelids;skin fold, covering the angle of the eye gap, located closer to the nose( epicanth);strabismus;twisted nostrils;thick lips;half-open mouth. At the same time, abnormalities in the development of the skeleton, hernia, joint looseness, flat feet, decrease in muscle tone, oligophrenia are noted.
There is no cardiac hump for aortic stenosis, as the heart remains not enlarged, and the developing enlargement of the left ventricular myocardium reduces the chamber volume for a long time without its expansion. When listening to the work of the heart, the doctor determines the characteristic noise for this disease. When you feel the area of the heart often determines the tremor to the right of the sternum.
Additional methods of examining a child are ECG, FGK( graphic recording of heart sounds), chest radiograph, ultrasound of the heart. In doubtful cases, cardiac catheterization and aortography( insertion of a contrast medium into the aorta followed by chest X-ray) are performed.
The course and prognosis for aortic stenosis are determined by its location and severity, concomitant defeat of the heart, a combination with other vices. With heart failure in the first year of life, moderate doses of cardiac glycosides( digoxin) and diuretics are used. Between 4 and 18% of children with congenital stenosis of the aorta die suddenly. The constriction of the aorta is quite significant, although complaints can be absent, and there are minor changes on the ECG.Fainting and pain in the heart when exercising in children with aortic stenosis serve as an indication for surgery, since a combination of these two signs indicates the possibility of sudden death. If infectious endocarditis( bacterial damage to the inner lining of the heart) with heart failure, resistant to drug treatment, is attached to the stenosis of the aorta, an urgent surgical correction of the defect with prosthetic valve is performed.
Long-term follow-up of children with different types of stenosis( constriction) of the aorta often indicates a continuously progressive course of the disease. With age, the intensity of stenosis increases, calcium salts are deposited in the valve tissue. For the prevention of endocarditis, all surgical procedures( removal of tonsils, adenoids, teeth, etc.) are performed against the background of antibiotics.