Small anomalies of heart development - Causes, symptoms and treatment. MF.

The heart of a man is laid at the end of the third week of pregnancy and develops throughout the intrauterine period. In the process of its development, not only the cardiac muscle( myocardium) is formed, but also the connective tissue that forms the fibrous "skeleton" of the organ and large vessels( aorta, pulmonary artery, upper and lower hollow vein, pulmonary veins).During pregnancy, a number of physiological features of the fetal circulation are observed, for example, in its heart there are vascular communications( an oval window between the right and left atria, arterial and venous ducts, the eustachian valve is the formation in the inferior vena cava that directs a part of the blood from the right atrium through the ovalwindow to the left atrium).These communications are created by nature so that the blood, flowing from the heart of the fetus, circulates through the small organism, bypassing the lungs, as they are in a state of functional rest and do not breathe in the womb of the mother. By birth all connective tissue structures of the heart ripen, and at the time of the first cry of the newborn, the vascular communications are closed under the influence of increased intracardiac pressure.

Sometimes it happens that in the course of pregnancy there are changes in the development of connective tissue of the heart, or it is not enough to physiological closure of the holes in the heart of the child in childbirth. Connective tissue structures of the heart are either too soft to perform their frame functions, or unripe, and then as the newborn child develops everything comes back to normal. In such cases, it is said that the child has small anomalies of heart development.

Small cardiac abnormalities is a large group of conditions that includes anatomical abnormalities in the heart structure that do not cause significant clinical and hemodynamic( cardiac-determining) disorders. These anomalies are generally considered small because they can disappear in the course of the child's development and do not have a significant effect on the work of the cardiovascular system and the whole organism as a whole, in contrast to heart defects, for example, as with defects there is a gross violation of anatomy and physiologyheart. In recent years, the frequency of recording heart abnormalities has increased, which is associated with a more widespread spread of the examination of newborns by the method of ultrasound examination of the heart.

If the child has one or two anomalies, then most likely, it is a congenital peculiarity of the heart structure that does not pose a threat to the health of the child;if three or more, the doctor should think about the presence of the patient such a disease as connective tissue dysplasia - a disease characterized by damage to connective tissue, not only in the heart, but in other organs and systems( muscles, skeleton, urinary, digestive, bronchopulmonary systemand etc).Also, the enlargement or narrowing of the root of the aorta and pulmonary trunk is more common in hereditary diseases of connective tissue( for example, Marfan syndrome).

Reasons for the occurrence of small heart development anomalies in a child

Why do these anomalies arise? As already mentioned, the basis for the development of heart abnormalities is the change in the properties of the connective tissue of this organ. The main cause of connective tissue dysplasia of the heart is a genetically conditioned defect in the synthesis of type 111 collagen( a protein used as the main building material of the body).That is, the inherent features of the heart structure are transmitted to the child by inheritance, especially from the mother. Also, unfavorable ecological conditions, stresses, insufficient intake of vitamins from pregnant women, use of toxic substances during pregnancy( drugs, alcohol, nicotine), oxygen starvation of the fetus and all those factors that can have a negative effect on the fetus during the fetal period play an important role here.

Symptoms and signs of small cardiac abnormalities

In most cases, the diagnosis of MARS is an accidental finding in the conduct of a planned ultrasound of the heart to newborn babies or young children. As a rule, small anomalies do not manifest themselves in any way, but the following complaints can be observed:

- In newborns and infants, the appearance of cyanosis( gray or blue skin dyeing) of the nasolabial triangle, dyspnea or heart palpitations during feeding, exercise( for example, after bathing, active games)
- in adolescents during hormonal changes and rapid growththere are complaints from the heart and blood vessels: rapid heartbeat, a feeling of fading, heart failure, cardialgia( pain in the heart), a feeling of "coma" in the throat, a decrease in exercise tolerance. There may also be manifestations of vegetative-vascular dystonia: dizziness, nausea, fainting, increased sweating, fatigue, weakness, a slight increase in temperature.
- in cases where the patient has several anomalies at the same time, it can affect the function of the heart. For example, a reverse transfer of blood to the atrium due to valve prolapse( regurgitation of grade 3) and discharge of blood into the right atrium through an open oval window can lead to stagnation of blood in the lungs, which is manifested by dyspnea with minimal physical exertion, and transverse chords in the left ventricle andEustachian valves can cause heart rhythm disturbances( sinus tachycardia, PQ shortened syndrome).

Diagnosis of small cardiac abnormalities

The presence of anomalies in the structure of the heart doctor can assume even at the stage of clinical examination of the child. In newborn children, along with heart abnormalities, umbilical and inguinal hernias, congenital dislocations of the hip joints can be detected. When examining a teenager, a doctor can see high growth, elongated limbs and fingers, a curvature of the chest, increased mobility( hypermobility) of the joints.

Auscultatory( in the process of listening to the chest), all small anomalies manifest themselves by systolic noises, clicks or a combination of them.

From the instrumental examination methods, an ECG is prescribed( to determine arrhythmias, if any), chest radiography( to determine whether the heart is widened in diameter and whether blood is stagnant in the blood vessels).

The most informative is echocardiography( ultrasound of the heart).This method allows you to visualize the heart and large vessels, clarify the presence of heart abnormalities and determine whether there are irregularities in his work.

Depending on the location on ultrasound, the following anomalies can be seen:

1. Atrial septum and atrium:
- open oval window;
- a slight aneurysm( protrusion) of the interatrial septum;
- enlarged more than 1 cm Eustachian valve.
2. Mitral valve and left ventricle:
- prolapse( sagging) of the mitral valve( with or without regurgitation);
- additional chords in the left ventricle( tendon filaments attached to the valve, providing its support and mobility);
- ectopic attachment of tendinous chords( in the wrong place).
3. Tricuspid valve:
is the displacement of the valve into the right atrial cavity( tricuspid valve prolapse), it is rare in isolated form, it is more often combined with mitral valve prolapse.
4. Aorta and pulmonary artery:
- a two-fold aortic valve( instead of three valves),
- aortic valve prolapse;
- narrowing of the root of the aorta;
- dilatation( expansion) of the root of the aorta;
- prolapse of the pulmonary artery valve;
- dilatation of the pulmonary trunk.

Any of the listed building anomalies can occur either alone or in combination with others.

Each anomaly looks different on the ultrasound of the heart. Thus, if the patient has a dilatation or dilatation of the root of the aorta or pulmonary trunk, ultrasound is characterized by characteristic structural changes and the presence or absence of intracardiac hemodynamic disturbances, in particular a significant difference in pressure in the aorta and left ventricular cavity, volume overload of the right atrium and ventricle.

In the presence of an open oval window there is a break in the echosignal in the region of the interatrial septum, and the Doppler will detect a turbulent( with "swirls") blood flow near it and the absence of hemodynamic disturbances. An aneurysm of the interatrial septum is manifested by ultrasonography protrusion into the right atrium, without overloading the right atrium and ventricle. The Eustachian valve is seen as an additional structure longer than 1 cm at the border of the right atrium and inferior vena cava.

Ectopic attachment of chords to ultrasound looks like strands attached not to the valves from the ventricles, but to the interventricular septum or the back wall of the ventricles. In the presence of mitral or tricuspid valve prolapse, the degree of prolapse of the valves in millimeters is estimated, as well as the degree of regurgitation, depending on the level to which the back stream of blood fills the atrial cavity. Additional chords in the cavity of the ventricles represent an additional linear formation having an echomolar structure, and can be single and multiple, as well as longitudinal, transverse and diagonal.

So, for example, mitral valve prolapse appears when performing echocardiography( PML)

Treatment of small cardiac abnormalities

Is it necessary to treat small heart abnormalities? In those cases when these features of the structure of the heart do not affect the work of the heart and blood vessels and do not manifest themselves clinically, this child does not need treatment. It is enough to visit the cardiologist every year with echocardiography. But it is not forbidden to apply general health measures aimed at preserving the health of any child, including with heart abnormalities. These include the right daily routine with a rational alternation of work and rest, sufficient sleep for a long time, active walks in the fresh air, rational nutrition enriched with vitamins, adequate exercise( what kind of sport can this patient do, the doctor decides individually).

If a patient exhibits noticeable symptoms of small heart anomalies, several anomalies are observed simultaneously or signs of hemodynamic disturbances appear, then medications should be prescribed. The most commonly used vitamins( nicotinic acid, riboflavin, thiamine), magnesium and potassium preparations( manna B6, potassium orotate, panangin, magnerot), drugs that improve the supply of oxygen to the heart muscle( ubiquinone, cytochrome C, carnitine).If abnormalities of rhythm and conductivity occur, adrenoblockers( carvedilol, bisoprolol, etc.) are indicated. As a treatment for manifestations of vegetative-vascular dystonia, sedative herbs( motherwort, hawthorn, valerian, etc.) are prescribed.

It is very rare if there are several anomalies and they have a significant effect on hemodynamics, significantly worsen the overall health and quality of life, cardiosurgical treatment of cardiac abnormalities may be indicated.

In conclusion, I would like to note that parents who heard such a diagnosis from their child should not panic, as usually small heart anomalies do not pose a threat to the health and life of the baby. But forget about such an innate feature of the child is also not worth it, you need to regularly undergo scheduled physical examinations with the involvement of methods of instrumental diagnosis. The question of the need to prescribe medications is decided only by the doctor in each individual case.

Extremely rare( 2-4%) in the case of multiple heart abnormalities there are complications, including life-threatening ones, such as fatal rhythm disturbances and sudden cardiac death, paradoxical embolism, bacterial endocarditis, acute mitral insufficiency. Preventing the development of complications is the timely access to the doctor in cases of complaints from the patient's heart and the performance of all medical and diagnostic measures prescribed by the doctor.

Doctor therapist Sazykina O.Yu.