Atrial septal defect in a child

The atrial septum is the internal structure of the heart that separates its left and right parts. Normally, in adults, this wall is solid, but sometimes, due to the underdevelopment of the septum, a lumen remains in the wall: an open oval window or an atrial septal defect.

The oval window is a functional channel that is formed in humans during the process of intrauterine development. The fetus needs it for normal functioning, and after birth, in a healthy heart, it normally closes in the first years of life, and it can close during the first year. Its failure is attributed to minor pathologies and is not considered a heart defect with acceptable blood discharge volumes [1].

Causes of DMPP

Atrial septal defect refers to congenital heart defects, that is, it is formed during fetal development. The embryo's heart is laid very early. It is formed already at 2 weeks after development from the tube, the shape of which is gradually becoming more complicated. At week 4 after conception, a two-chambered heart is formed, and by week 8, almost all organ structures have already been formed.

The main reason for the formation of the defect is the underdevelopment of the primary or secondary septum between the atria in the embryonic period. The disorder can be triggered by genetic features, infectious processes during pregnancy, and environmental factors.

In many cases, a child's heart defect occurs spontaneously without any apparent connection with any external factors.

Symptoms of DMPP

Atrial septal defect is a defect that is often characterized by poor symptoms and late manifestation. However, already in early childhood, symptoms may be associated with the development of heart failure, poor weight gain in a child, and heart murmur may also occur. Most often, these signs occur only if the hole in the partition is large. In this case, parents can pay attention to the following signs of heart disease:

1. Moderate heart failure: when playing with peers, the child gets tired faster than others, breathes frequently or heavily, and may complain of lack of air.
2. The child eats poorly, gains little weight, differs from his peers in short stature, fragile build, pale skin.
3. The baby is susceptible to respiratory infections, often suffering from bronchitis and pneumonia, the symptoms of which, despite treatment, persist for a long time.

Secondary defects of small size can go unnoticed until adolescence or even adulthood, when symptoms of heart failure appear, such as shortness of breath, exercise intolerance, heart pain, feeling of heart failure or palpitations. Older patients may develop signs of pulmonary hypertension: cyanosis, weakness, dizziness, fainting.

Extracardial complications in children are quite rare for DMPP, even with significant sizes of the pathological opening. Nevertheless, the child develops signs of heart failure, which, without treatment, can significantly affect his development. However, over time, the pathology progresses and in adulthood, the risk of such dangerous pathologies as strokes, rhythm disturbances, and pulmonary hypertension increases significantly. Therefore, the issue of closing the defect is considered immediately after its detection and carrying out the necessary diagnostics.

Diagnostics

Diagnosis of DMPP in children is carried out by a pediatric cardiologist, to whom a small patient usually gets a referral from a pediatrician. The cardiologist interviews the patient or his parents, conducts a physical examination to identify the external signs of heart failure. An experienced doctor can make a preliminary diagnosis already at the initial consultation, after listening to the heart, examining the child, and performing an ECG, which will detect the characteristic signs. An ECG allows you to determine the overload of the right parts of the heart, to obtain information that indirectly indicates the presence of pathology.

However, the initial diagnosis can only be confirmed with the results of instrumental and other diagnostics:

1. Echocardiography. It allows you to reliably assess the anatomy of the heart and identify abnormalities that may indicate a septal defect, visualize the defect itself and identify its characteristic features, as well as concomitant pathology, such as an increase in the size of the right atrium and right ventricle, increased blood flow topulmonary artery, signs of other concomitant heart defects and abnormalities. Already at this stage, it is possible to draw a conclusion about the size of the defect, its localization and characteristic features.
2. Chest X-ray. It reveals an increase in the mass and size of the heart, an expansion of the pulmonary trunk, an increase in the pulmonary pattern and other abnormalities. With the development of echocardiography, it gradually recedes into the background, but in some cases it is necessary.
3. In some cases, and in the presence of concomitant malformations, a CT or MRI scan with contrast may be performed.
4. Laboratory diagnostics are used to diagnose heart failure, signs of hypoxemia (decreased oxygen content in the blood), and other basic indicators.

DMPP treatment

The only treatment method that can completely eliminate DMPP is surgery to close the defect. It can be performed endovascular or by an open method and completely eliminates the heart defect. Nevertheless, individual management tactics for patients with atrial septal defect are developed taking into account their age characteristics and the size of the pathology. Sometimes, before closing the defect, doctors prefer the method of expectant observation with the treatment of heart failure and overload of the right heart, which helps the heart to cope with overloads due to the defect. In these cases, regular monitoring of the patient's condition is carried out, with an ECHO CG and an ECG. Although the prospect of surgical intervention scares some parents, in reality, surgical treatment of the defect is quite safe, well-developed and carried out in a routine manner.

If a child needs surgery, treatment is often recommended before the age of 5-7, with a maximum of 12 years or from the moment the defect is detected. Only in this case, irreversible vascular changes can often be prevented, which sometimes cannot be corrected in adolescents and adults.

Most often, operations are performed using a gentle endovascular technique. At the same time, a miniature occluder device is inserted into the lumen of the artery, which, under X-ray control with the help of a catheter, is guided to the heart defect and covers it, opening like an umbrella. The size of the umbrella is selected individually depending on the characteristics of the defect, and the EMS delivery system is always used once. Recovery after surgery takes no more than 2-3 days, discharge from the clinic is carried out after 1-2 days with further supervision by a pediatric cardiologist, the risk of complications is usually minimal.

However, in about 20% of cases, due to the location or size of the hole, endovascular closure is not possible. In this case, an open surgical procedure is performed.

Treatment of DMPP in children at the EMC clinic

Thanks to high-quality prenatal diagnostics, the detection of a heart defect in a child at the EMC clinic is possible even before birth. If the pathology is confirmed, expectant parents can consult a pediatric cardiologist. The specialist will answer all the questions of mom and dad, talk about the risks of pathology, treatment methods and prevention of complications. DMPP refers to those defects that are difficult to establish in utero. Therefore, echocardiography is mandatory for all children at 1 month. If a defect is suspected, and after birth, the baby undergoes a consultation with a pediatric cardiologist, as well as instrumental examinations: EchoCG, ECG. Taking into account the fact that newborns always have an open oval window after birth, which begins to close only After birth, diagnosis of DMPP can be individual and carried out in several stages during the first year of life.

If the defect is small, the intervention may sometimes be delayed. Doctors can follow a wait-and-see approach with therapy aimed at treating heart failure, since DMPP is characterized by signs of overload of the right heart and pulmonary blood flow. Sometimes, during the first year of life, there is a possibility of spontaneous closure of the defect (with therapy support), however, this applies to a larger oval window than to primary DMPP.

Thus, the decision on the tactics of managing a baby with a heart defect, the necessity and time of surgery in each case is made only by the attending pediatric cardiologist.

Benefits of DMPP treatment at the EMC clinic:

1. Highly qualified, experienced pediatric cardiologists. Children with congenital heart disease are advised by Professor of the department, PhD Filaretova Olga Vladimirovna and PhD Vasilevskaya Irina Valentinovna. Also, admission and treatment in our clinic is conducted by one of the best pediatric X-ray endovascular surgeons in the country, Professor, MD Pursanov Manolis Georgievich.
2. The most modern methods of endovascular treatment.Thanks to the use of the latest surgical techniques and equipment, our endovascular surgeons can perform operations on children. The advantages of the method include the short duration of surgery (2-3 hours), the absence of the need for large incisions, the absence of prolonged hospitalization, significantly less trauma for a small patient compared to large open-heart surgeries, and individual supervision by a pediatric cardiologist. throughout the entire period of hospitalization, the parents are close to the child, comfortable conditions of stay and individual fasting.
Low risk of complications.Complications after high-quality surgical intervention are extremely rare. Usually, adverse events are observed on the first day. Therefore, in the early postoperative period at the EMC clinic, the patient is under the individual supervision of pediatric cardiologists, an anesthesiologist, an intensive care unit, and a pediatric nurse. Parents can also usually stay with their child in the intensive care unit after the intervention.
3. Postoperative management of the patient.After discharge from the hospital, the baby continues to be under the dynamic supervision of a pediatric cardiologist. The child is regularly monitored: ECHO-KG, ECG, daily ECG monitoring, laboratory tests. During preventive visits, the doctor also answers all questions from parents, monitors and corrects medication intake. In the first 6 months, the child often receives treatment aimed at reducing the risk of thrombosis. The recommended follow—up period is at least 12 months. After that, there is practically no risk of surgical complications. The child grows and develops without lagging behind his peers, can lead a normal lifestyle and attend sports clubs (parents can also discuss recommendations on sports with a pediatric cardiologist).