CARDIOVASCULAR CONDITIONS OF CHILDHOOD

Cardiovascular Conditions of Childhood

Congenital cardiac diseases are the most common of anomalies developed in the womb. Congenital cardiac diseases account for fifteen percent of infant deaths in the first 30 days of the neonatal period,.

Eight babies out of one thousand are born with congenital heart disease. This is equivalent to 1 percent of live births.

There exist a wide variety of pediatric cardiac diseases. Specialists categorize pre-natal cardiac diseases into three:

• Congenital cardiac diseases
• Rheumatic cardiac diseases
• Rhythm-conduction disorders

Congenital Cardiac Diseases

Congenital cardiac diseases are among the most common of cardiac diseases seen in infants. Disorders in this category include anomalies that emerge during fetus development. Hundreds of variations exist, some of which are mild, with others causing severe and complicated problems.

Rhythm-Conduction Disorders

These are irregularities in the electrical system of the heart as made apparent by abnormally slow, paused or accelerated rhythms. Although mostly observed in adults, they can also inflict on infants with congenital cardiac diseases, following cardiac surgery or without an apparent reason. Although with a lower rate of occurrence than the more common cardiac illnesses, cardiac muscle or cardiac membrane diseases such as cardiomyopathy, myocarditis and pericarditis do occur

Rheumatic Cardiac Diseases

Rheumatism is a disease that causes problems in the organs of origion. Throat infections are one among its most common causes. . Viruses called “hemolytic streptococcus” settle in the throat and infectthe area. They may also settle in the heart and cause deformation, constriction, or inadequaies in the cardiac valves.

Diagnosis And Treatment of The Most Common Congenital Cardiac Diseases

Anomalies in the hearts of infants born with congenital cardiac disease may sometimes be mild enough to unncessitate the need for treatment, while at other times, they may progress to life-risking levels. Severe congenital cardiac diseases are usually diagnosed in infancy. However, surgical intervention has a high rate of correction even in severe cases of anomaly..

Diagnostic Methods

Severe congenital cardiac diseases are usually diagnosed in infancy as babies with such anomalies show severe symptoms from birth. However, sometimes, the diagnosis does not take place until childhood or as late as adulthood. This happens when the congenital anomaly is so small. In some cases, the person can go through his/her entire life without showing any symptoms and problems.

A pediatric cardiologist follows a physical examination with various analyses in order to be able to diagnose.

• Electrocardiography (ECG) is a device that senses weak electrical currents in the heart of the child and recordsheartbeats onto ECG paper. As no electrical current is applied, the child does not feel any pain.
• The cardiologist obtains information about the size and shape of the child’s heart and lungs by performing a chest X-ray. The level of radiation used in chest X-rays is very low and has no side effects.
• The echocardiograph examination makes it possible to monitor live images through the use of sound waves outside the chest. Blood streams in the heart and veins are measured using sound waves with the Doppler technique. These two techniques provide the cardiologist with information about the structure and function of the heart. Most of the cardiac anomalies are diagnosed using this method of examination.
• Fetal echocardiography is a method similar to ultrasonography that can be used after the 16th week of the pregnancy. It does not harm the mother or the baby. It makes it possible to examine the condition and function of the heart and cardiac veins of the fetus and to identify any cardiac anomalies before birth.
• Cardiac catheterization – angiography is an advanced examination method used with the help of a highly developed X-ray machine. It is usually performed with the help of a thin tube (catheter) inserted into the aorta or vena through the inguinal area and guided to the heart.
• The Effort test is performed by continuously taking the heart’s electrocardiography while the child walks on a treadmill at a fast pace.
• Cardiac electrophysiology: Congenital disorders or cardiac surgery may sometimes cause cardiac rhythm disorders. The cause and type of cthe disorder can be determined by a special test similar to cardiac catheterization called cardiac electrophysiology. This enables the center causing the arrhythmia and abnormal conduction paths to be treated using a method called ablation (cauterization with radiofrequency waves) upon necessity.
• Cardiac MRI: In some infants, it may not be possible to completely diagnose a cardiac disease despite all tests. In such cases, certain advanced techniques like the MRI (Magnetic Resonance Imaging) or MRI angiography might become necessary to enable accurate diagnosis. These tests provide the physician with valuable information related to the structure of the major veins entering and exiting the heart and the pulmonary veins.

Treatment

How are congenital cardiac diseases treated?

Medically treated Cardiac Diseases

Congestive Heart Failure

WHAT IS IT? When the heart pump does not work sufficiently, fluid accumulates in the lungs and other organs causing edema (swelling). This condition is found quite frequently in a number of cardiac anomalies.

TREATMENT: The cardiac muscle is strengthened by using drugs including digoxin. Diuretic medication can also be administered to help discharge the excess fluid accumulated in the body.

Cardiac Rhythm Disorders

There are three different types of cardiac rhythm disorders:

Tachycardia: This is the beating very fast of the child’s heart. In children, the heart beats 60 to 150 times a minute depending on age. Excessive beating can cause fatigue in the heart. However, tachycardia is not always a sign of congenital cardiac disease. Drug therapy can be used to lower the rate of heartbeat to a normal level.

Bradycardia: This is the very slow beating of the child’s heart. It may deteriorate the blood-pumping function of the heart. Although it is usual congenital, on rare occasions, it may also develop after surgery. In some children, it may be necessary to implant a device (pacemaker) that enables the heart to beat normally.

Arrhythmia: This is irregularity of the heartbeat. It may be congenital and develop after surgery, and should be treated according to the type of irregularity of the cardiac rhythm.

Cardiac Diseases Treated Using Catheterization

Balloon Septostomy

This is a procedure used in the treatment of certain cardiac anomalies, such as the transposition of great arteries (TGA) to prolong the life of an infant until surgical intervention.

Valvotomy, Balloon Angioplasty

Some of the narrow cardiac valves and coronary veins are expanded using a balloon during catheterization. Although re-narrowing may take place, this procedure provides the baby with time to grow.

Coil Embolization and the Umbrella Device

Certain atrial septal defects (ASD) and patent ductus arteriosus can be treated with catheterization. However, implementation of these procedures require suitability of both the size of the patient and the location and width of the defect.

Electrophysiology and Ablation

In certain pediatric patients, rhythm problems can be treated with cauterization using a method called “ablation”. In such cases, the cause of the problem should be found using cardiac catheterization (an electrophysiological study).

Surgically Treated Cardiac Diseases

1. Cardiac Diseases without Cyanosis

These patients usually have a septal defect, constriction, or disorder in the veins or valves. There is no cyanosis as venous blood does not circulate in the body. Generally, symptoms of heart failure are observed.

• Patent Ductus Arteriosus (PDA)
• Atrial Septal Defect (ASD)
• Ventricular Septal Defect (VSD)
• Atrioventricular Septal Defect (AVSD)
• Aortic Stenosis (AS)
• Aortic Coarctation (AoCoA)

2. Cardiac Diseases That Develop With Cyanosis

Under normal conditions, the blood pumped from the heart to the body is oxygen-enriched and lighter red in colour. However, in cardiac diseases characterized with cyanosis, the blood pumped to the body is oxygen-deprived and darker red. In such cases, the infant’s skin appears purplish. The degree of this condition, also called cyanosis, can vary depending on the patient’s pathology, age and activities.

• Tetralogy of Fallot (TOF)
• Pulmonary Stenosis (PS)
• Transposition of Great Arteries (TGA)
• Tricuspid Atresia (TA)
• Pulmonary Atresia (PA)
• Truncus Arteriosus
• Total Anomalous Pulmonary Venous Drainage (TAPVD)
• Hypoplastic Left-Heart Syndrome (HLHS)