Detailed classification of heart defects: congenital and acquired diseases. Heart disease Heart disease, congenital or acquired

The cardiovascular system consists of the heart, which pushes the blood, and the vessels through which the blood carries nutrition and oxygen to the cells. This system is closed, and blood flows in only one direction thanks to the four valves of the heart, which open and close, allowing the next portion of blood to pass through. Changes in the structure of the valves is called a defect, which can lead to disruption of the heart and the movement of blood in the circulatory system.

What is heart disease?

In order to understand, you need to know how the heart valves work. Normally, the heart has two atria at the top and two ventricles at the bottom. The right and left halves of the heart are separated by a septum, and the valves are located as follows:

• Mitral valve (bicuspid) - Located between the left atrium and the ventricle, its function is to prevent backflow of blood from the ventricle to the atrium.
• Tricuspid valve - Located between the right atrium and ventricle. Its function is to prevent the reverse flow of blood from the right ventricle into the right atrium.
• Aortic valve - located at the exit from the left ventricle to the aorta. Its function is to prevent the flow of blood from the aorta into the ventricle.
• Pulmonary valve - located at the exit from the right ventricle to the pulmonary artery. Its function is to prevent blood from flowing back from the artery to the right ventricle.

The most common mitral valve defect (50-75% of cases), less common aortic valve defect (up to 20% of all cases). Malformations of the pulmonary valve and tricuspid valve occur less frequently than all others (up to 5% of all cases). Heart disease can be isolated (malformation of 1 valve) and multiple (malformation of 2 or more valves).

In addition to these defects, there are also defects of the atrial and interventricular septa, as well as defects in which blood is thrown from the right half of the heart to the left and vice versa (open Botallo duct, Fallot's tetrad and others). The defect can be manifested by insufficiency of the valve walls or narrowing of the lumen (stenosis), as a result of which blood circulation is also impaired.

In rare cases, it occurs mitral valve prolapse which is characterized by protrusion of the valve walls. Bulging of the leaflets prevents the normal flow of blood from the left atrium into the left ventricle, and can be either congenital or acquired.

All heart defects are divided into congenital and acquired. Congenital heart defect Is a defect in any of the valves from the moment of birth. Children born with heart defects do not live long, and congenital heart disease is the main cause of early infant mortality.

Acquired heart disease- This is a defect resulting from various diseases or disorders of the heart. In this case, heart disease is, as a rule, a secondary process after the underlying disease.

Causes of heart defects

The causes of congenital malformations in children are not fully understood. But it has been proven that the formation of the heart occurs between 5 and 8 weeks of pregnancy. Any factor that can be harmful can cause congenital heart disease.

These can be infections (viruses, fungi, bacteria), as well as radiation exposure, medication, large doses of alcohol or drugs. Most often, such diseases of the mother as rubella, viral hepatitis, and influenza lead to a malformation of the valves. Heart disease in children occurs in 5-8 newborns per 1000 children.

The causes of acquired heart defects can be the following diseases:

• Rheumatism (long-term illness and ineffective treatment).
• Atherosclerosis of the vessels, leading to an increase in the load on the heart.
• Infectious diseases of the heart (infective endocarditis).
• Syphilis.
• Connective tissue diseases (systemic scleroderma, ankylosing spondylitis).
• Various injuries in the area of ​​the heart.
• Myocardial infarction.

As a result of various diseases, the valve leaflets first become inflamed, then collapse, and at the end they are covered with scar tissue, which is deformed and cannot keep the reverse blood flow. Deformation and damage to the valves cannot pass without leaving a trace for the heart itself, which operates under increased stress.

If at this stage of the disease the necessary treatment is not carried out, then as a result of increased work of the heart, hypertrophy (thickening) of the walls of the heart, expansion of its cavities, a decrease in the contractility of the heart and the phenomenon of heart failure occur.

Heart disease symptoms

Children with a congenital defect usually lag behind in development and growth, they have severe shortness of breath during physical exertion, pallor or cyanosis (cyanosis) of the skin. Less common symptoms such as anxiety, headaches, dizziness, pain in the heart.

Congenital heart disease in newborns usually appears immediately after birth. A characteristic sign of severe congenital heart disease in a baby is a bluish skin color. On the second or third day, you can notice how the child quickly gets tired when feeding, he is lethargic or restless, and while listening to the heart, a heart murmur is clearly heard.

It is much more difficult to detect an acquired heart defect, since the body, when the first signs of heart failure appear, tries to compensate for this on its own. Symptoms of heart defects vary somewhat and depend on the lesion of a particular valve.

In most cases, patients are worried about shortness of breath during exertion and pain in the heart, as well as general weakness, heart palpitations, edema in the legs and other various manifestations of heart failure.

Depending on the course of the disease, the following manifestations of acquired heart defects are distinguished:

• Compensated defects. In this case, the heart muscle completely copes with its function, and the symptoms are weakly expressed or not expressed at all.
• Subcompensated defects. With this form of the disease, the symptoms of heart disease may be mild, since this form is transitional between compensated and decompensated defects.
• Decompensated defects. Moreover, all the symptoms of heart failure are pronounced. This happens due to the fact that the increased work of the heart muscle leads to its weakening.

Treatment and prevention of heart defects

Treatment of congenital malformations in children is mainly surgical, since according to statistics, without surgery, more than half of children diagnosed with heart disease die in the first year of life. If, for some reason, the operation is not performed, then the child must be given various medications to maintain cardiac activity.

Medications are prescribed only by a doctor after a complete clinical examination, which it is advisable to use strictly at a certain time and in a dosage prescribed by the doctor. In addition, the child needs walks in the fresh air, and the feeding regime should be increased by 2-3 times, while reducing the number of one-time meals. Of course, it is better to feed children with heart defects with mother's (or donor's) milk.

Patients with compensated defects do not need special treatment, since it is enough to observe the diet, work and rest. In this case, it is necessary to eliminate all those causes that could cause heart disease (rheumatism, chronic infections).

In this case, patients should engage in light physical labor to maintain normal blood circulation (heavy loads are contraindicated). In order to prevent the appearance of complications, it is better to give up overeating, drinking alcohol and smoking.

Currently, the cardiological service is well developed, which can offer modern methods of diagnosis and treatment. This is especially true for patients with acquired subcompensated and decompensated heart defects. With the help of surgical intervention, valve replacement or mitral commissurotomy can be performed, after which the patient can lead a normal life.

There are no traditional preventive measures for acquired heart defects, but the risk of their occurrence can be significantly reduced if the underlying disease is treated promptly.

A healthy heart is a strong, 24/7 muscle pump that is only slightly larger than an adult's fist.

The heart has four chambers. The upper two are the atria, the lower ones are the ventricles. Blood flows from the atria to the ventricles, after which it enters the main arteries through the heart valves (there are four of them). The valves let the blood flow in only one direction, working like "skimmers" of the pool - opening and closing.

Heart defects are such changes in the structures of the heart (septa, walls, valves, outgoing vessels, etc.), in which blood circulation is disrupted in the large and small circles of blood circulation, or inside the heart itself. Defects are congenital and acquired.

Causes of the onset and development of heart defects

From five to eight newborn children out of a thousand have congenital heart defects... These occur in the fetus even in the womb, and quite early - between the second and eighth weeks of pregnancy. Doctors are still unable to unequivocally diagnose the causes of most cases of congenital heart defects. However, medicine still knows something. In particular, the fact that the risk of having a child with a heart defect is higher if the family already has a child with the same diagnosis. True, the likelihood of a defect is still not very high - 1-5%.

The risk group also includes future babies whose mothers abuse drugs or medicines, smoke or drink a lot, and have been exposed to radiation. Infections that affect the body of the expectant mother in the first trimester of pregnancy (for example, diseases such as hepatitis, rubella and flu) are also considered potentially dangerous for the fetus.

Recent studies by doctors have also found that the risk of having a baby with a congenital heart defect increases by 36 percent if the mother-to-be is overweight. However, the relationship between the development of heart disease in a baby and the obesity of his mother is still not clear.

Acquired heart disease most often occurs due to rheumatism and infective endocarditis. Less often, syphilis, atherosclerosis and various injuries become the causes of the development of defects.

Classification of heart defects

Experts divide the most severe and common heart defects into two groups. The former are caused by the fact that there are shunts in the human body (workarounds). Through them, oxygen-rich blood (coming from the lungs) returns to the lungs. At the same time, the load on the right ventricle and the vessels through which blood enters the lungs increases. These are the vices:

• atrial septal defect. It is diagnosed if, by the time a person is born, there is a hole between the two atria
• non-closure of the ductus arteriosus. The fact is that the lungs do not immediately begin to work in the fetus.
• the ductus arteriosus is a vessel through which blood flows to bypass the lungs
• ventricular septal defect, which is a "gap" between the ventricles

There are also defects associated with the fact that the blood meets obstacles in its path, due to which the heart has a much greater load. These are problems such as narrowing of the aorta (coarctation of the aorta) and stenosis (narrowing) of the aortic or pulmonary heart valves.

Heart defects include valvular insufficiency... This is the name of the expansion of the valve opening, due to which the valve flaps are not completely closed in the closed state, as a result of which some of the blood flows back. In adults, this heart defect can be based on gradual degeneration of the valves in two types of congenital disorders:

• The arterial valve has two cusps (should have three). According to statistics, this pathology occurs in one person in a hundred.
• Mitral valve prolapse. This disease rarely causes significant valve failure. It affects from five to twenty people out of a hundred.

Not only are all the described defects completely self-sufficient, they are often found in different combinations.

The combination in which the defect of the interventricular septum, hypertrophy (enlargement) of the right ventricle, displacement of the aorta and narrowing of the outlet from the right ventricle are simultaneously expressed, is called Fallot's tetrad. This very tetrad often becomes the cause of cyanosis ("cyanosis") of the child.

Acquired heart defects are formed in a person as a failure of one of the heart valves or stenosis. In most cases, the mitral valve suffers - this is the one located between the left atrium and the left ventricle. Less commonly, it gets the aortic valve located between the left ventricle and the aorta. The pulmonary valve (the one that separates the right ventricle and, as you might guess, the pulmonary artery) and the tricuspid valve that separates the right atrium and ventricle feel even safer.

There are cases when both insufficiency and stenosis occur in one valve. Combined valve defects are also common, when not one, but several valves are simultaneously affected.

About manifestations of heart defects

The first years of life in children, congenital heart disease may not manifest itself at all. However, imaginary health lasts no longer than three years, and then the disease still floats to the surface. It begins to manifest itself as shortness of breath during physical exertion, pallor and cyanosis of the skin. In addition, the child begins to lag behind peers in physical development.

So called "Blue vices" often accompanied by sudden attacks. The child begins to behave restlessly, overly agitated, shortness of breath appears and cyanosis of the skin ("cyanosis") increases. Some children even pass out. This is how seizures pass in children under the age of two. In addition, children of the "risk group" love to sit on their haunches.

Another group of vices received a characteristic Pale... They manifest themselves in the form of a child's lag behind peers in terms of the development of the lower half of the body. In addition, starting from 8-12 years old, the child complains of shortness of breath, dizziness and headache, and also often experiences pain in the abdomen, legs and heart itself.

Diagnosis of heart defects

In order to diagnose heart defects, you need to contact medical specialists called cardiologists and cardiac surgeons. The most common diagnostic method is echocardiography (ECG). The condition of the muscles and valves of the heart is examined using ultrasound. The doctor can assess the speed at which blood moves in the cavities of the heart. To clarify the results of examinations of the state of the heart, the patient can be sent for a chest X-ray. In addition, the so-called ventriculography (X-ray examination using a special contrast agent) is often needed.

ECG is a mandatory method for studying the activity of the heart. In addition, other ECG-based studies are often used. This is a stress ECG (bicycle ergometry, treadmill test), and a Holter ECG monitoring. The first (stress ECG) is a cardiogram recording carried out during exercise, and the second (holter monitoring) is an electrocardiogram recording carried out within 24 hours.

Heart disease treatment

Modern medicine successfully treats many types of heart defects. Treatment is performed surgically, after which the person conducts normal life. For most of these operations, doctors have to stop the heart of a patient who, while doctors are working, is under the care of a heart-lung machine (AIC). If heart defects are not congenital, valve replacement and mitral commissurotomy are the main ways to deal with them.

Prevention of heart defects

Science is not aware of prevention methods that can completely protect a person from the development of heart disease (or defects). However, scientists know how to significantly reduce the risks. We need prevention and timely treatment of streptococcal infections, in particular - tonsillitis. After all, they most often become the causes of the development of rheumatism. In the event that rheumatism has already attacked you, bicillin prophylaxis is imperative. It should be prescribed by the doctor who is leading the disease.

If a person has already suffered a rheumatic attack or is diagnosed with mitral valve prolapse (or there are other risks of developing infective endocarditis), it is necessary to start taking special antibiotics for prophylactic purposes some time before medical interventions. The "interventions" include the extraction of a tooth, tonsils or adenoids, as well as other surgical operations. For prevention to be effective, you need to take yourself as seriously as possible. It is important to always remember that it is much more difficult to cure a heart defect than to prevent its development. Despite the significant advances in modern cardiology, a healthy heart works longer and better than one that had to undergo surgery.

Heart defects

Heart defects- changes in the structures of the heart (valves, ventricles, atria, outgoing vessels), disrupting the movement of blood inside the heart or in the greater and lesser circulation, congenital or acquired .

Acquired heart defects

Acquired heart defects changes in the valve apparatus of the heart, in the atria and ventricles, as well as in nearby vessels, are called changes that occur during the period of postnatal development. The most common are combined mitral, aortic and mitral-aortic defects. Isolated stenoses and valve insufficiency, as well as defects of the right half of the heart, are less common.

Stenoses of the valves of the left half of the heart lead to a reduced flow of blood into the systemic circulation, and the right half - into the small circle.

Insufficiency of the valves is usually accompanied by a reverse flow (regurgitation) of blood: in case of insufficiency of the aortic valve or the valve of the pulmonary artery, blood flows into the left or right ventricle of the heart during diastole, respectively; in case of insufficiency of the mitral or tricuspid valve, blood during systole enters the left or right atrium, respectively. Currently, using Doppler ultrasound, it is possible to assess the degree of regurgitation and thus to judge the severity of valvular insufficiency.

Congenital heart disease

Congenital heart disease represent a group of anomalies in the development of the heart itself and nearby vessels, the main distinguishing feature of which is moderate or minor hemodynamic disturbances. They belong to the group of so-called "white defects", in which a pathological discharge of blood occurs from the large to the pulmonary circulation, or is absent at all. More often than others, there are defects of the atrial and interventricular septa, patent ductus arteriosus, coarctation of the aorta.

In most cases, it is not possible to isolate any factor leading to the formation of congenital heart disease. Often the cause of multiple congenital pathology is intrauterine viral infection: rubella, influenza, mumps. Often, congenital heart defects are associated with chromosomal abnormalities, such as Down syndrome, Turner syndrome, etc., or individual point mutations that give the defect, for example, an atrial septal defect, a familial character. Sometimes the occurrence of a congenital defect is associated with various intoxications and / or metabolic disorders in the mother's body.

Physiotherapy exercises for heart defects

The tasks of physiotherapy exercises for heart defects: to have a general strengthening effect on the body, to adapt it to physical activity, to improve the work of the cardiovascular system and other organs.

The starting positions when doing the exercises are first lying and sitting, then standing. The activities include dosed walking, exercise with objects, and as the condition improves, skiing at a slow pace. With compensated heart defects, with the permission and under the supervision of a doctor, you can engage in certain sports: swimming, skiing, ice skating, cycling, playing volleyball, small towns, table tennis and tennis.

CONGENITAL AND ACQUIRED HEART DISEASES

Congenital heart defects that form during the period of embryonic development of the fetus are diverse, and it is unlikely that a description of all the options should be given here - there are more than 100 of them. simultaneously.

Heart defects include: defects of the septa of the heart, pathological communications between the large and small circles of blood circulation, narrowing in the mouths of the great vessels and along their length, disturbances in the structure of the valve apparatus, abnormal discharge of the great vessels (transposition) and their atypical combinations and combinations.

The incidence of congenital heart and vascular defects is kept at a constant level and is about 0.8 percent of all births. In other words, about 100,000 children with congenital heart defects are born annually in the world.

Prevention of these diseases is only taking the first steps, drug treatment is symptomatic, while most of them are subject to surgical correction today.

All the numerous manifestations of congenital heart defects can be represented in the form of separate syndromes, the main of which are the overflow of the pulmonary bed with arterial blood with the possible development of pulmonary hypertension, a deficiency of pulmonary blood flow causing chronic oxygen deficiency, and overloading of individual heart chambers.

Basically, congenital heart defects are characterized by impaired hemodynamics (circulation), the transport of blood gas - oxygen, suffers. During normal functioning of the body, tissues receive blood saturated with oxygen through the vessels, and carbon dioxide is removed through it. The movement of blood occurs continuously in a closed cardiovascular bed. Under normal conditions, venous blood, containing only 75 percent oxygen, moves in the veins communicating with the right side of the heart and in its cavities. Arterial blood, 96-98 percent saturated with oxygen, fills the vessels communicating with the left heart and its cavities. The blood pressure in the centripetal vessels near their confluence with the atria and in the atria themselves does not exceed 5 millimeters of mercury. In centrifugal vessels and ventricles, the pressure increases significantly, and in the cavities and vessels carrying arterial blood, it is higher than in the cavities and vessels with venous blood.

In the presence of vicious communications between the cavities of the heart or the main vessels, the normal conditions of blood circulation are disturbed: the pressure in the vascular bed and the cavities of the heart increases, the pathways of blood movement, the processes of saturation with oxygen and its delivery in the required amount to the tissue undergo significant changes, and there is a lack of oxygen in the tissues.

Blood, instead of moving along the normal path of the systemic circulation, can travel a shorter path and flow directly into the right atrium. As a result, a vicious "discharge" of blood from one circle of blood circulation to another: arterial blood passes into the venous bed, or, conversely, venous blood flows from the right heart into the arterial bed. Then the blood enriched with oxygen makes a repeated path through the pulmonary circulation, which is accompanied by "ballast" work of the heart and lungs. The heart of patients with such disorders has to experience a great burden. Some of them have blood only in the pulmonary veins or in the left atrium.

If the defect is located in the interventricular septum, there is a "discharge" of arterial blood (due to the pressure difference in the cavities of the ventricles and the associated increase in the stroke volume of the right ventricle) and blood passing through the pulmonary circulation. Violation of hemodynamics in this case increases during the patient's life and leads, as a rule, to irreversible pulmonary hypertension. Left heart hypertrophy is also one of the characteristic signs of a ventricular septal defect.

Hemodynamic disorder with atrial septal defect is mainly explained by pathological communication between the two atria. The discharge of blood then occurs from the left atrium to the right. Patients with this kind of defects suffer from diseases of the respiratory tract, lagging behind in development.

With other types of congenital malformations (Fallot's tetrad, vascular transposition, etc.), when venous blood is discharged into the arterial bed, patients experience chronic oxygen starvation, since the body tissues receive blood depleted in oxygen. At the same time, cyanosis of the oral mucosa of one degree or another testifies to heart disease.

There are a number of congenital malformations, which are characterized by the absence of subjective manifestations for a long time, while in the process of an objective study, serious hemodynamic disturbances are revealed (congenital narrowing of the aorta, pulmonary artery stenosis, stenosis of the aortic mouth, etc.). Identifying such patients in order to start their treatment in a timely manner is an urgent task of modern medicine.

The diagnosis of congenital heart disease, therefore, can be made on the basis of pronounced signs of hemodynamic disorder and the data of generally accepted functional diagnostics.

Unfortunately, symptomatic treatment is ineffective here. For surgical intervention, a more accurate diagnosis is required by the method of contrast angiocardiography, when a contrast agent under the control of an X-ray apparatus is injected into the cavities of the heart and blood vessels. First, the probe is inserted through the saphenous ulnar vein and then through the brachial vein, then goes into the vena cava and into the right atrium. Further, depending on the task of the study, it is either delayed or moves through the right ventricle into the pulmonary artery and its branches. When the probe approaches the desired area of ​​the heart cavity, it is used to rapidly inject a contrast agent in the required amount.

The idea of ​​examining the conditions of the cardiac cavities with the help of a catheter belongs to the German doctor V. Forsman, who in 1928 carried out this experiment for the first time on himself. At first, in the presence of a colleague, he began to inject a specially made probe through the ulnar vein towards the heart, but it was not possible to stretch it to the heart, since the doctor who participated in the experiment forbade it to do so, fearing negative consequences. The catheter traveled 35 centimeters.

Forsman, confident that he was right, repeated the experiment a week later. This time, the probe several millimeters thick moved 65 centimeters along the venous blood flow and entered the right atrial cavity. The researcher conducted the experiment under the control of an X-ray machine and could see the catheter in the vein while it was moving. The experiment ended successfully, Forsman did not experience any unpleasant sensations. However, years passed before this method was established in clinical practice, its author received the Nobel Prize in 1957.

Subsequently, on the basis of the Forsman method, ways of studying the left ventricle and left atrium were developed.

Probing allows you to accurately identify intracardiac circulatory disorders. It helps today, without much risk, to clarify the diagnosis of thousands of patients in need of surgery for diseases of the heart and blood vessels. With congenital heart defects, the use of angiocardiography makes it possible to detect perverted blood outflow pathways, violations of the usual contours of large vessels and their special location, to clearly see the change in the shape and size of the heart cavities. In addition, through the pathological opening in the atrial or interventricular septum, the probe can penetrate into such parts of the heart and large vessels where it does not pass under normal conditions, for example, from the right heart to the left, into the pulmonary veins from the aorta, into the Batall duct, etc. ...

With the help of a heart probe, you can also take blood samples from the cavities of the heart and large vessels and study their gas composition, record pressure, its differences and other characteristics. Differential study of arterial, venous and "mixed" blood allows you to calculate the minute volume of the heart, the amount of blood discharges and their direction.

Simultaneously with angiocardiography, in the diagnosis of congenital defects, electrocardiograms and other polygraphic tests are used that detect rhythm disturbances, the degree of hyperfunction of a particular part of the heart, etc. An electrocardiogram taken from the inner surface of the heart gives an idea of ​​the most delicate aspects of the activity of this organ.

An accurate diagnosis of a congenital malformation is important for an open-heart surgeon, and today he is able to obtain the necessary information through a thorough analysis of clinical and diagnostic data. At the modern level of knowledge, the diagnosis of such forms of congenital malformations as non-closure of the ductus arteriosus, defect of the interventricular septum, and others, does not cause great difficulties. Difficulties arise in the case of combined defects, aggravated by one or another concomitant disease, as well as in assessing the patient's reserves and the degree of risk of surgery.

The technique of surgical intervention for the correction of congenital defects is extremely complex and requires special training - a surgeon must have knowledge of many issues of normal and pathological physiology, X-ray diagnostics, and functional research methods. Large surgical centers and departments of hospitals have been created in our country for the surgical treatment of congenital heart defects. During operations, diagnostic devices and apparatus are used to control the basic vital functions of the body (cardiac monitors, breathing apparatus). Due to this, the risk of surgical interventions on the heart and large vessels has sharply decreased, and the functional results from the operations have improved. Certain advances have also been made in the surgical treatment of heart defects in newborns and young children.

Surgery of heart defects in newborns has its own fundamental features. The heart and blood vessels of an infant are very small. The volume of blood circulating in them is, depending on age, 300 - 800 millimeters. Therefore, the loss of even a small amount of it is extremely dangerous. But the main thing is that a child cannot be viewed as an adult in miniature. Infants are sharply distinguished by the peculiarities of metabolism and their reaction to heart disease and surgical trauma.

For the development of surgical treatment of congenital heart defects at an early age, a group of surgeons (V. Burakovsky, B. Konstantinov, Ya. Volkolapov, V. Frantsev) was awarded the USSR State Prize in 1973.

However, despite the advances made in open heart surgery, many issues require further study. The most urgent problem remains to overcome hypoxia (oxygen depletion of the body). In this regard, good results are obtained by the use of hyperbaric oxygenation - saturation of the body with oxygen under high pressure. The method is being successfully introduced into clinical practice. Methods for the prevention of severe complications during and after surgery are being improved, in particular, pathological conditions of the terminal period are being investigated - agony and clinical death.

The acquired heart defects are based on pronounced irreversible morphological changes leading to severe hemodynamic disorders.

There are many reasons for their occurrence. Among the most famous we will name rheumatic and bacterial infections, a number of diseases with an etiological (causal) factor that has not been fully deciphered.

However, whatever the root cause that caused disturbances in the anatomy and function of the valve (or valves) of the heart, the essence of the disease is reduced to narrowing of the leaflets (stenosis) with a restriction of their capacity, to a gaping valve opening (failure). Therefore, the term "valvular heart disease" is often used to denote acquired defect. Its diagnosis today is not very difficult, but the tasks of assessing the stage of the disease, predicting the results of treatment, choosing a method of treatment and the time of surgery are still extremely relevant.

The following example shows how important this is. Technically well developed operation of mitral valve replacement (prosthetics) is fatal in 3 percent of patients with the third stage and in 18 percent of patients with the fourth stage of the disease according to the classification of A. Bakulev and A. Damir. Consequently, the problem of timely surgical treatment of acquired heart defects is extremely topical, and its solution is urgent.

Rheumatic infection most often leads to damage first to the mitral and then to the aortic valves. Conservative, drug treatment usually does not eliminate the developed deformation in the form of organic narrowing of the holes. The essence of the operation for mitral stenosis lies in the fact that with a finger or a special instrument inserted into the heart cavity, the surgeon breaks the adhesions between the valve flaps and expands the opening for a more free flow of blood from the atrium into the ventricle. True, in this case there is a danger of severe bleeding and embolism, which can lead to the death of the patient, as well as uncontrolled damage to the valve and, as a result, its failure.

In 1925, Professor I. Dmitriev, who worked at the Department of Operative Surgery of the 1st MMI, proposed and experimentally substantiated the original method of mitral stenosis surgery. It consists in the fact that the surgeon presses the atrial appendage into the heart cavity with his finger, feeling the opening between the atrium and the ventricle, orienting himself in the obstacles that interfere with the flow of blood. With a finger, you can expand the narrowed opening to the desired size and advance in this way into the ventricle and further - to the opening of the aorta.

However, closed methods (without opening the heart) with significant fibrous deformities of the valves do not always give stable positive results, mitral insufficiency may occur. Therefore, a number of surgeons (for example, E. Coe) began to actively promote open surgery for mitral stenosis using a heart-lung machine. Some surgeons (B. Petrovsky) are in favor of a differential approach to the choice of surgery.

Since 1960, the method of valve prosthetics has been widely used in our country for the treatment of acquired heart defects.

Heart valves are often affected by rheumatic conditions, as we have said. They can also be damaged due to inflammation of the endocardium - the inner lining of the heart cavity - and the valve apparatus. In many cases, replacing the affected valve with a prosthesis is the only way to normalize hemodynamics and restore the patient's health and performance.

The pioneer of heart valve prosthetics is S. Hufnagel, who in 1954 proposed the use of a ball prosthesis in a plastic chamber for implantation into the thoracic aorta in the treatment of aortic insufficiency. It was from this moment that the prosthetics of the heart valves began in the clinic. Research on improving the shape of prostheses, choosing materials, and increasing reliability in work is being successfully carried out in many countries of the world, including the Soviet Union.

Currently, biological and mechanical artificial heart valves are used for prosthetics. To create biological valves, the patient's own tissues are used - the pericardium, the fascia lata of the thigh, the tendon part of the diaphragm - and foreign tissues, such as heart valves taken from a pig. However, over time, these "materials" lose their elasticity, become inactive, undergo calcification, and sometimes rupture.

Mechanical valves are more widely used. Initially, researchers sought to create prostheses that would be as close to natural valves in their structure as possible. Therefore, mainly folded (petal) forms were developed. Such artificial valves consisted of a rigid frame on which movable petals were attached; they had low weight and volume, did not change the central blood flow. However, the functioning of the petal valves lasted on average two to three years, then they collapsed due to the "fatigue" of the synthetic material caused by the constant bending of the leaflets-petals.

Other mechanical valves consist of a metal frame with a locking element inside. This element (ball or disc), in contact with the base of the prosthesis - "saddle", closes the inlet of the valve and stops the flow of blood. At the moment of removal of the obturator from the “saddle”, blood flows freely into the next chamber of the cardiovascular system.

A valve with a locking element in the form of a ball is so durable and reliable that one American surgeon jokingly said: "The creator, if he had an extra $ 100 in his pocket, would have created this very design for a man instead of a heart." However, in practice, such valves are not always applicable. Due to their significant size and weight, they cannot, for example, be implanted in patients with a small volume of ventricular cavities and a narrow aorta. Therefore, recently, cardiac surgeons began to give preference to the so-called small-sized prostheses, which have a disc locking element.

Along with positive functional properties, artificial valves also have a number of technical disadvantages. For example, some patients cannot tolerate loud noise from prostheses. When using them, there is also a risk of thrombus formation, and the possibility of the appearance of various complications associated with the need to take anticoagulants for life - anticoagulants - should also be taken into account.

In addition, wear and tear of the material from which the prosthesis is made, which makes 80 million open-close cycles a year, can lead to dysfunction of the valve and cardiac arrest. Therefore, for the production of mechanical prostheses, durable, inert materials with anti-thrombotic properties of surfaces are required - high-alloyed stainless steels, cobalt-chromium alloys, tantalum, titanium, high molecular weight synthetic polymers. Recently, in the USSR and abroad, heart valve prostheses began to be made of pyrolytic graphite.

The search for the optimal material continues. For example, at the Department of Operative Surgery and Topographic Anatomy of the 1st MMI named after I.M.Sechenov, high-strength, biologically inert, corrosion-resistant ceramics, the crystalline basis of which is aluminum oxide, are tested in an animal experiment. Similar work is also being carried out in the USA, Japan, and the Federal Republic of Germany.

Replacing damaged heart valves with prostheses has significantly increased the life expectancy of many patients and restored their lost working capacity. The ultimate goal of scientists, designers and doctors is to create such valve substitutes that would function throughout the patient's life.

The results of such operations cannot but be considered good. So, if patients with mitral valve defect are not operated on, then after 6 years only 5 percent of them will remain alive. After surgery, 75 percent continue to live.

In recent years, the arsenal of the intensive care service has grown immeasurably, on the work of which the outcomes of operations largely depend. The possibility of continuous monitoring of patients with the help of computers and analog-digital devices, the use of hyperbaric oxygenation, blood components and blood substitutes, intra-arterial counterpulsation with a balloon inflated synchronously with cardiac cycles for the prevention and treatment of cardiogenic shock, various methods of auxiliary blood circulation and artificial temporary left ventricle of the heart - here is not a complete list of achievements in this area, designed to facilitate the efforts of doctors in the fight for human life.

In the study of heart failure in the postoperative period and in the development of new methods and methods of treatment, mathematical modeling using a third-generation computer plays an important role. It allows you to receive continuous information about the most complex pathophysiological processes in the body.

Speaking about the successes of today's cardiac surgery, one cannot but mention the latest achievements of modern medical diagnostics. We have already talked about cardiac catheterization and angiography. Trends have now changed for the introduction into practice of new "bloodless" or non-invasive methods of recognizing diseases of the cardiovascular system, providing clinicians with clear and useful information. Among them should be called echolocation methods. "Inspection" of the heart and its internal structures using ultrasound allows you to assess the morphology, function, size and other characteristics of the heart valves, partitions of the heart, and its individual chambers. The doctor can repeatedly and without any risk to the patient examine it and not only clarify the diagnosis, but also develop a plan of the operation in advance and even predict its outcome. Echocardiography helps to recognize a number of diseases, the diagnosis of which was very difficult until recently. For example, using echolocation, it has become possible to diagnose primary cardiac tumors on an outpatient basis in almost 100 percent of cases. Their surgical removal gives a complete cure. Another evidence of the growing diagnostic capabilities of modern medicine is the use of computed tomography, a method whose creators were awarded the Nobel Prize. Numerous sensors capture the slightest differences in the X-ray density of body tissues, which are reconstructed with the help of a computer into an integral layer-by-layer image. It is difficult to overestimate the prospects of widespread introduction of this method. Thanks to computed tomography, the diagnosis of aneurysms of the ascending aorta, proceeding with the dissection of its walls, is successfully carried out, and surgeons today safely operate on such patients. The operation consists in dissecting the aneurysm and stitching a valve-containing prosthesis into its lumen with the movement of both coronary arteries into it. Such operations, performed at the All-Union Center of Surgery of the USSR Academy of Medical Sciences, save the doomed and protect them from recurrence of aortic dissection.

Acquired heart defects

General information

Acquired heart defects- a group of diseases (stenosis, valve insufficiency, combined and concomitant defects), accompanied by a violation of the structure and functions of the valve apparatus of the heart, and leading to changes in the intracardiac circulation. Compensated heart defects can be hidden, decompensated are manifested by shortness of breath, palpitations, fatigue, pain in the heart, a tendency to fainting. If conservative treatment is ineffective, an operation is performed. Dangerous by the development of heart failure, disability and death.

With heart defects, morphological changes in the structures of the heart and blood vessels cause impaired cardiac function and hemodynamics. Distinguish between congenital and acquired heart defects.

In the stage of compensation with insignificant or moderate insufficiency of the mitral valve, patients do not present complaints and do not differ externally from healthy people; BP and pulse are not changed. Compensated mitral heart disease can remain for a long time, however, with a weakening of the contractility of the myocardium of the left heart, stagnation increases, first in the small, and then in the systemic circulation. In the decompensated stage, cyanosis, shortness of breath, palpitations appear, later - edema in the lower extremities, painful, enlarged liver, acrocyanosis, swelling of the veins of the neck.

Narrowing of the left atrioventricular opening (mitral stenosis)

From laboratory studies, the greatest diagnostic value for heart defects is the conduct of rheumatoid tests, determination of sugar, cholesterol, general clinical blood and urine tests. Such a diagnosis is carried out both during the initial examination of patients with suspected heart disease, and in dispensary groups of patients with an established diagnosis.

Treatment of acquired heart defects

Conservative treatment carried out for heart defects concerns the prevention of complications and relapses of the primary disease (rheumatism, infective endocarditis, etc.), the correction of rhythm disturbances and heart failure. All patients with identified heart defects need a cardiac surgeon's consultation to determine the timing of timely surgical treatment.

With mitral stenosis, mitral commissurotomy is performed with the separation of the fused valve leaflets and the expansion of the atrioventricular opening, as a result of which stenosis is partially or completely eliminated and severe hemodynamic disorders are eliminated. In case of insufficiency, mitral valve replacement is performed.

With aortic stenosis, aortic commissurotomy is performed, in case of insufficiency - aortic valve replacement. With combined defects (stenosis of the opening and valve insufficiency), the destroyed valve is usually replaced with an artificial one, sometimes prosthetics are combined with commissurotomy. With combined defects, operations are currently performed on their one-stage prosthetics.

Forecast

Minor changes on the part of the heart valve apparatus, which are not accompanied by myocardial damage, can remain in the compensation phase for a long time and do not disrupt the patient's ability to work. The development of decompensation in heart defects and their further prognosis is determined by a number of factors: repeated rheumatic attacks, intoxication, infections, physical overload, nervous overstrain, in women - by pregnancy and childbirth. Progressive damage to the valve apparatus and heart muscle leads to the development of heart failure, acute decompensation - to the death of the patient.

The prognostically unfavorable course of mitral stenosis, since the myocardium of the left atrium is not able to maintain a compensated stage for a long time. With mitral stenosis, early development of congestion of the small circle and circulatory failure is observed.

Prospects for work capacity with heart defects are individual and are determined by the amount of physical activity, the fitness of the patient and his condition. In the absence of signs of decompensation, the ability to work may not be impaired, with the development of circulatory failure, light labor or cessation of labor activity is indicated. In case of heart defects, moderate physical activity, quitting smoking and alcohol, performing physiotherapy exercises, sanatorium treatment at cardiological resorts (Matsesta, Kislovodsk) are important.

Prophylaxis

Measures to prevent the development of acquired heart defects include the prevention of rheumatism, septic conditions, syphilis. For this, the rehabilitation of infectious foci, hardening, and an increase in the fitness of the body are carried out.

With a formed heart defect, in order to prevent heart failure, patients are advised to observe a rational motor regimen (walking, therapeutic exercises), high-grade protein nutrition, limiting the intake of table salt, abandoning sharp climate changes (especially high-mountain ones) and active sports training.

In order to control the activity of the rheumatic process and compensation of cardiac activity in case of heart defects, dispensary observation by a cardiologist is necessary.

Heart disease refers to many diseases. Due to the fact that the structure of the heart, for one reason or another, does not correspond to the norm, the blood through the blood vessels cannot flow as it would in a healthy person, as a result of which there is a failure on the part of the circulatory system.

Consider the main classification of congenital and acquired in children and adults: what they are and how they differ.

Heart defects are classified according to the following parameters:

• By the time of occurrence (,);
• By etiology (due to chromosomal abnormalities, due to diseases, unclear etiology);
• By the location of the anomaly (septal, valvular, vascular);
• By the number of affected structures;
• By the peculiarities of hemodynamics (with cyanosis, without cyanosis);
• In relation to the circles of blood circulation;
• By phase (adaptation phase, compensation phase, terminal phase);
• By the type of shunt (simple with a left-right shunt, simple with a right-left shunt, complex, obstructive);
• By type (stenosis, coarctation, obstruction, atresia, defect (hole), hypoplasia);
• By the effect on the blood flow velocity (insignificant, moderate, pronounced effect).

Classification of congenital malformations

The clinical division of white and blue malformations is based on the prevailing external manifestations of the disease. This classification is somewhat arbitrary, since most of the defects simultaneously belong to both groups.

The conventional division of congenital defects into "white" and "blue" is associated with a change in skin color in these diseases. With "white" heart defects in newborns and children, due to a lack of arterial blood supply, the skin becomes pale in color. With the "blue" type of defects due to hypoxemia, hypoxia and venous stasis, the skin becomes cyanotic (cyanotic).

Currently, the total number of congenital heart anomalies has not been identified. This is due to the fact that many malformations of the heart and pericardial structures are components of systemic genetic syndromes (trisomy, Down's syndrome, etc.) and cannot be isolated as independent diseases.

White UPU

White heart defects, when there is no mixing between arterial and venous blood, there are signs of a left-to-right shunt, are divided into:

• With saturation of the pulmonary circulation (in other words - pulmonary). For example, when the foramen ovale is open, when there are changes in the interventricular septum.
• With the deprivation of the small circle. This form is present in isolated pulmonary artery stenosis.
• With the saturation of the systemic circulation. This form takes place in isolated aortic stenosis.
• Conditions when there are no noticeable signs of hemodynamic disturbance.

Blue

Blue heart defects occur when venous blood is thrown into arterial blood, and have several subspecies:

• Those that contribute to the enrichment of the pulmonary circulation;
• Those that deprive the pulmonary circle.

Hypoplasia

Hypoplasia is an anatomical underdevelopment of the heart or individual cardiac structures. Pathology often affects only one chamber and is manifested by progressive functional heart failure with hypoxemia and venous congestion. The blue variety of the UPU.

Obstruction defects

Obstruction is the complete closure of the anatomical opening (aorta, pulmonary trunk, outlet chambers). The essence of the pathology is expressed in the inability to pump blood through a closed opening, which causes hypertension in the adjacent ventricle. Obstructive defects are white or blue, depending on which side of the heart is obstructed.

Septal defects

Septal defects are open holes between the atria or ventricles. The defect causes a left-to-right shunt and volume overload of the heart. Subsequent pulmonary hypertension causes hypoxemia in the blood (white defects) or venous congestion (blue).

Congenital valve defects

Valvular defects of the heart are represented by narrowing or complete absence of valve openings. Stenotic defects are white (due to a significant violation of blood flow and arterial insufficiency), atresia - blue (the absence of a hole leads to a decrease in oxygen saturation of the blood).

Types of VPS according to Fridley

The classification is based on the most pronounced syndromes characteristic of each CHD group.

Classification of acquired defects

By etiology:

• Due to atherosclerosis;
• Syphilitic;
• As a consequence;
• Due to systemic autoimmune processes (scleroderma, dermatomyositis, lupus).

By severity:

• Lungs (compensated);
• Moderate (subcompensated);
• Severe (decompensated).

According to the state of hemodynamics:

• A defect with a weak effect on blood circulation;
• A defect with a moderate effect on blood circulation;
• A defect with a pronounced effect on blood circulation.

By localization:

• With the involvement of one valve;
• With the involvement of several valves ().

By functional form:

• Simple;
• Combined.

List of all faculty members

• :, a combination of stenosis and insufficiency;
• :, combination of stenosis with insufficiency;
• Tricuspid: stenosis, combination of stenosis with insufficiency;
• Narrowing of the pulmonary valve;
• Insufficiency of the pulmonary valve;
• Combined two-valve defects: mitral-aortic, mitral-tricuspid, aortic-tricuspid;
• Combined three-valve defects: aortic-mitral-tricuspid.

Prevalence

Symptoms and diagnostics

Among the most common complaints are:

• Shortness of breath;
• Cyanosis of various areas of the skin;
• Frequent edema;
• Cardiopalmus;
• Discomfort or pain in the heart area;
• Cough;
• Murmurs in the heart region.

To establish cardiac pathology, specialists use the following examinations:

• ECHOKG (to detect a defect in the interatrial and interventricular septum, patent ductus arteriosus, coarctation of the aorta, tetrad of Fallot);
• Cardiac catheterization (changes in the interventricular septum, coarctation of the aorta can be detected);
• Pulmonary artery MRI;
• Transesophageal echocardiography;
• X-ray examination of the chest organs together with contrast illumination;

Both drug treatment and the use of surgical methods are used. Drug therapy is aimed at eliminating inflammation in the heart, eliminating symptoms, preparing for radical treatment - a surgical operation that is performed using minimally invasive methods or on an open heart.

Only the side effects of the defect are conservatively resolved, for example, heart rhythm disturbances, circulatory insufficiency.

Also, cardiologists prescribe preventive measures that are aimed at preventing the onset of rheumatism of the heart and subsequent ones.

Early patient referral and timely appropriate treatment increase the chances of a favorable outcome. It must be remembered that any type of heart disease is an extremely life-threatening phenomenon that requires urgent intervention from specialists.

Heart disease is a kind of a series of structural anomalies and deformations of valves, partitions, openings between the heart chambers and blood vessels, which disrupt blood circulation through the internal cardiac vessels and predispose to the formation of an acute and chronic form of insufficient circulatory function.

As a result, a condition develops, which in medicine is called "hypoxia" or "oxygen hunger". Heart failure will gradually increase. If qualified medical care is not provided in a timely manner, it will lead to disability or even death.

What is heart disease?

Heart disease is a group of diseases associated with congenital or acquired dysfunctions and anatomical structure of the heart and coronary vessels (large vessels supplying blood to the heart), due to which various hemodynamic deficiencies (blood flow through the vessels) develop.

If the usual (normal) structure of the heart and its large vessels is disturbed - either even before birth, or after birth as a complication of the disease, then we can talk about a defect. That is, a heart defect is a deviation from the norm that interferes with the movement of blood, or changes its filling with oxygen and carbon dioxide.

The degree of heart disease varies. In mild cases there may be no symptoms, while with the pronounced development of the disease, heart disease can lead to congestive heart failure and other complications. Treatment for heart disease depends on the severity of the disease.

Causes

Changes in the structural structure of the valves, atria, ventricles or cardiac vessels that cause impaired blood flow in the large and small circle, as well as inside the heart, is defined as a defect. It is diagnosed in both adults and newborns. This is a dangerous pathological process that leads to the development of other myocardial disorders, from which the patient can die. Therefore, timely detection of defects ensures a positive outcome of the disease.

In 90% of cases in adults and children acquired defects are the result of acute rheumatic fever (rheumatism). This is a serious chronic disease that develops in response to the introduction into the body of group A hemolytic streptococcus (as a result, scarlet fever), and manifests itself as damage to the heart, joints, skin and nervous system.

The etiology of the disease depends on what kind of pathology is: congenital, or arising in the process of life.

The reasons for the appearance of acquired defects:

• Infectious or rheumatic endocarditis (75%);
• Rheumatism;
• (5–7%);
• Systemic connective tissue diseases (collagenosis);
• Trauma;
• Sepsis (general damage to the body, purulent infection);
• Infectious diseases (syphilis) and malignant neoplasms.

Causes of congenital heart disease:

• external - poor environmental conditions, mother's illness during pregnancy (viral and other infections), the use of drugs that have a toxic effect on the fetus;
• internal - associated with a hereditary predisposition on the line of the father and mother, hormonal changes.

Classification

The classification divides heart defects into two large groups according to the mechanism of occurrence: acquired and congenital.

• Acquired - occur at any age. The cause of heart disease is most often rheumatism, syphilis, hypertension and ischemic disease, severe vascular atherosclerosis, cardiosclerosis, trauma to the heart muscle.
• Congenital - are formed in the fetus as a result of improper development of organs and systems at the stage of laying down groups of cells.

According to the localization of defects, the following types of defects are distinguished:

• Mitral are the most commonly diagnosed.
• Aortic.
• Tricuspid.

Also distinguish:

• Isolated and combined - changes are either single or multiple.
• With cyanosis (the so-called "blue") - the skin changes its normal color to a bluish tint, or without cyanosis. Distinguish between generalized cyanosis (general) and acrocyanosis (fingers and toes, lips and tip of the nose, ears).

Congenital heart disease

Congenital defects are an abnormal development of the heart, a violation in the formation of the main blood vessels during the prenatal period.

If it speaks of congenital defects, then most often among them there are problems of the interventricular septum, in this case, blood from the left ventricle enters the right, and thus the load on the small circle increases. When conducting an X-ray, such a pathology looks like a ball, which is associated with an increase in the muscle wall.

If such a hole is small, then the operation is not required. If the hole is large, then such a defect is sutured, after which the patients live normally until old age, disability in such cases is usually not given.

Acquired heart disease

Heart defects are acquired, while there are violations of the structure of the heart and blood vessels, their effect is manifested by a violation of the functional capacity of the heart and blood circulation. Among the acquired heart defects, the most common is the defeat of the mitral valve and the semilunar valve of the aorta.

Acquired heart defects are rarely subject to timely diagnosis, which distinguishes them from CHD. Very often people carry many infectious diseases "on their feet", and this can cause rheumatism or myocarditis. Acquired heart defects can also be caused by inappropriate treatment.

This disease is the most common cause of disability and death at a young age. According to primary diseases, defects are distributed:

• about 90% - rheumatism;
• 5.7% - atherosclerosis;
• about 5% - syphilitic lesions.

Other possible diseases leading to a violation of the structure of the heart - trauma, tumors.

Heart disease symptoms

The resulting defect in most cases can not cause any disturbances from the cardiovascular system for a long period of time. Patients can engage in physical activity for quite a long time without feeling any complaints. All this wakes up to depend on which part of the heart has suffered as a result of congenital or acquired defect.

The main first clinical sign of a developed defect is the presence of pathological murmurs in the tones of the heart.

The patient presents the following complaints in the initial stages:

• shortness of breath;
• constant weakness;
• developmental delay is characteristic of children;
• fast fatiguability;
• reduced resistance to physical stress;
• palpitations;
• chest discomfort.

As the defect progresses (days, weeks, months, years), other symptoms join:

• swelling of the legs, arms, face;
• cough, sometimes streaked with blood;
• heart rhythm disturbances;
• dizziness.

Signs of a congenital heart disease

Congenital pathology is characterized by the following symptoms, which can manifest itself in both older children and adults:

• Constant shortness of breath.
• Heart murmurs are heard.
• The person often loses consciousness.
• Observed atypically frequent.
• No appetite.
• Slowdown in growth and weight gain (a feature typical for children).
• The appearance of such a symptom as blue discoloration of certain areas (ears, nose, mouth).
• A state of constant lethargy and exhaustion.

Symptoms of the acquired form

• fatigue, fainting, headaches;
• difficulty breathing, feeling short of breath, coughing, even pulmonary edema;
• heart palpitations, disturbance of its rhythm and change in the place of pulsation;
• pain in the region of the heart - sharp or pressing;
• blue skin due to blood stasis;
• enlargement of the carotid and subclavian arteries, swelling of the veins in the neck;
• the development of hypertension;
• swelling, an enlarged liver, and a feeling of heaviness in the abdomen.

The manifestations of the defect will directly depend on the severity, as well as the type of ailment. Thus, the definition of symptoms will depend on the location of the lesion and the number of valves affected. In addition, the symptom complex depends on the functional form of the pathology (more on this in the table).

Diagnostics

If, after reading the list of symptoms, you find matches with your own situation, it is better to play it safe and go to the clinic, where an accurate diagnosis will reveal a heart defect.

The initial diagnosis can be made using the heart rate (measured while at rest). The patient is examined by palpation, the heartbeat is listened to to detect noise and tone changes. The lungs are also checked, the size of the liver is determined.

There are several effective methods that allow you to identify heart defects and, based on the data obtained, prescribe the appropriate treatment:

• physical methods;
• ECG is performed to diagnose blockade, arrhythmia, aortic insufficiency;
• Phonocardiography;
• X-ray of the heart;
• Echocardiography;
• MRI of the heart;
• laboratory methods: rheumatoid tests, KLA and OAM, determination of blood sugar and cholesterol levels.

Treatment

With heart defects, conservative treatment is to prevent complications. Also, all efforts of therapeutic therapy are aimed at preventing relapse of the primary disease, for example, rheumatism, infective endocarditis. Correction of rhythm disturbances and heart failure is mandatory under the supervision of a cardiac surgeon. Based on the shape of the heart defect, treatment is prescribed.

Conservative methods are not effective in congenital pathologies. The goal of treatment is to help the patient and prevent the onset of heart failure attacks. Only the doctor determines which pills to drink for heart disease.

The following drugs are usually indicated:

• cardiac glycosides;
• diuretics;
• vitamins D, C, E are used to support immunity and antioxidant effect;
• potassium and magnesium preparations;
• anabolic hormonal agents;
• in the event of acute attacks, oxygen inhalation is carried out;
• in some cases, antiarrhythmic drugs;
• in some cases, medications may be prescribed to reduce blood clotting.

Folk remedies

1. Beet juice. Combined with honey 2: 1, it helps support heart function.
2. Mother and Stepmother Blend can be prepared by pouring 20 g of leaves with 1 liter of boiling water. You need to insist the product for several days in a dry, dark place. Then the infusion is filtered and taken after meals 2 times a day. A single dose is from 10 to 20 ml. The entire course of treatment should last about a month.

Operation

Surgical treatment of congenital or acquired heart defects is carried out in the same way. The difference lies only in the age of the patients: most children with severe pathologies operate in the first year of life in order to prevent the development of fatal complications.

Patients with acquired defects are usually operated on after 40 years of age, at stages when the condition becomes threatening (stenosis of valves or passages by more than 50%).

There are a lot of options for surgical intervention for congenital and acquired defects. These include:

• repair of defects with a patch;
• artificial valve replacement;
• excision of the stenotic opening;
• in severe cases - transplantation of the heart-lung complex.

What kind of operation will be performed, is decided by a cardiac surgeon on an individual basis. The patient is observed after surgery for 2-3 years.

After any surgical operation for heart defects, patients are in rehabilitation centers until they have completed the entire course of medical rehabilitation therapy with the prevention of thrombosis, improvement of myocardial nutrition and treatment of atherosclerosis.

Forecast

Despite the fact that the stage of compensation (without clinical manifestations) of some heart defects is calculated for decades, the total life expectancy can be reduced, since the heart inevitably "wears out", heart failure develops with impaired blood supply and nutrition to all organs and tissues, which leads to fatal the outcome.

With surgical correction of the defect, the prognosis for life is favorable, provided that medications are taken as prescribed by a doctor and the development of complications is prevented.

How long do you live with a heart defect?

Many people who hear such a terrible diagnosis immediately ask the question - “ How many live with such vices?". There is no unequivocal answer to this question, since all people are different and clinical situations are also different. They live as long as their heart can work after conservative or surgical treatment.

If heart defects develop, prevention and rehabilitation measures include a system of exercises that increase the level of the functional state of the body. The system of recreational physical education is aimed at increasing the level of the patient's physical condition to safe values. It is prescribed for the prevention of cardiovascular diseases.