Heart defects in children: aneurysm of the interatrial septum

AMPP usually does not pose a threat to the baby’s life; such children develop normally, and over time this disease can go away on its own. But in cases where the child’s pathology is not limited to one aneurysm, but is combined with another heart defect, then this is, of course, a cause for concern for parents. A good ultrasound specialist in Makhachkala can detect heart abnormalities in a newborn during an ultrasound examination already in the first days of the baby’s birth.

What is a cardiac aneurysm in a newborn?

Cardiac aneurysm in newborns belongs to the so-called MARS syndrome. It stands for “minor anomalies of cardiac development.” The term itself indicates that such a pathology is not a gross malformation requiring immediate surgical intervention due to a threat to the baby’s life. An aneurysm is accompanied by some thinning and bulging of the myocardium in the area of ​​the septum, which is located between the atria. However, this does not affect the quality of blood circulation, the provision of tissues and organs with oxygen and nutrients.

With an aneurysm in children, psychomotor and physical development is not impaired. The baby does not lag behind his peers, feels good and you can never tell that there is something wrong with his heart. However, it is imperative to monitor the child and periodically examine him so that the development of dangerous complications can be noticed in time and prevented.

3. Symptoms and diagnosis

In early childhood, the course is usually asymptomatic. However, the reason for a thorough examination, incl. cardiological, where an aneurysm is usually detected - should be a child’s lagging behind in psychophysical development, insufficient body weight, frequent acute respiratory viral infections; at later stages - signs of infantility of the reproductive system, constant pallor, fatigue from the slightest physical exertion, pain in the heart, sometimes noticeable protrusion of the chest in the cardiac zone.

The severity of this symptom complex varies widely - from severe to insignificant, not significantly affecting the quality of life and overall development. The greatest danger is rupture of an aneurysm with the formation of an interatrial defect (message), as a result of which the normal, natural hemodynamics of the myocardium are disrupted. However, it is no coincidence that this development of events is called unpredictable above: in some cases, the acquired defect allows you to lead a completely normal lifestyle for decades, in others it creates the threat of a stroke or the so-called. sudden cardiac death. After 40 years of age, a patient with a defect in the bladder, formed as a result of a rupture of an aneurysm, often has to be disabled due to increasing hemodynamic disturbances and risks.

In diagnosis, in addition to anamnesis, the results of clinical examination and observation, ultrasound echocardiography (EchoCG) is of greatest importance, which has virtually no contraindications, allows repeated studies over time and allows for visualization of the aneurysm with an accurate assessment of its characteristics. As a clarifying diagnosis, usually to identify and study associated anomalies and defects, transesophageal ultrasound, CT, and cardiac catheterization may additionally be prescribed.

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Why pathology may occur

Scientists have still not come to a consensus on why a child’s heart aneurysm develops. Although such a developmental anomaly is not new in medicine. Scientists have known about this pathology for a long time, but due to insufficient diagnostic capabilities, it was detected much later, when the process of various kinds of complications began. Today everything has changed. Doctors can make a preliminary diagnosis at the stage of intrauterine development, and then confirm or refute it using ultrasound when the child is born.

A cardiac aneurysm in a child is considered a fairly rare structural disorder. According to scientists from the Yaroslavl State Medical Academy, it is observed in 2.5% of full-term newborns. It is distinguished from severe heart defects by the minimality of the defect, the absence of disturbances in the contractility of the organ, the closure of the heart valves and the flow of blood through the vessels.

Scientists have been closely studying MARS syndrome for more than 35 years and cannot yet accurately predict what problems such a disorder may result in in each specific case, whether it threatens the future life of the baby or will not manifest itself in any way.

Diagnosis of the disease

STD aneurysm (type R)

As mentioned earlier, STD aneurysm is a congenital developmental anomaly. Therefore, it can be detected without difficulty even in childhood. Another situation is observed if its progressive stretching has occurred, then for the first time it can be noticed at a more mature age.

The main methods for diagnosing an aneurysm are:

• Echocardiographic study. Ultrasound of the heart can reveal protrusion of the interatrial septum.

When an aneurysm is accompanied by the existence of a patent foramen ovale, the following methods may be informative:

• ECG is the simplest method. An electrophysiological study of the heart helps to see overload of the right side of the heart. Heart rhythm disturbances are also detected. In this case, signs of atrial fibrillation can be detected.
• X-ray of the chest organs. An aneurysm with a patent foramen ovale is characterized by the presence of a specific symptom on an x-ray - “pulsation of the roots of the lungs.”
• Echocardiographic study. As in the case of non-communicating aneurysm, this method is very important in diagnosing a patent foramen ovale. Thanks to this method, you can see the turbulence of the blood flow in the area of ​​the hole. Valvular abnormalities may also be detected.

Instrumental diagnostics can also be supplemented by the following methods:

• Transesophageal ultrasound.
• Transthoracic ultrasound.
• CT scan.
• Catheterization of the heart chambers.

Symptoms of cardiac aneurysm in a newborn

In most cases, aneurysm in children does not cause severe hemodynamic disturbances, and therefore is mostly asymptomatic. Often, a baby is diagnosed during a routine ultrasound of the heart, or by chance, while examining him for another disease. Less commonly observed clinical signs include:

• heart rhythm disturbances, for example tachycardia;
• lethargy;
• increased excitability;
• poor sleep;
• cyanosis of the skin;
• retardation in physical development at a later age.

When should you see a doctor?

A visit to a pediatric cardiologist, pediatrician, and vascular surgeon is recommended if you have the following signs of an aneurysm in children:

• frequent and severe headaches in a child;
• a feeling of discomfort and unpleasant sensations in the chest;
• periodic loss of consciousness and frequent dizziness;
• shortness of breath even with mild physical exertion;
• pallor and some swelling of the skin.

An experienced pediatric cardiologist at Meditsina JSC (academician Roitberg’s clinic), located in the central district of Moscow, will carefully examine the child and record all his complaints. The specialist will talk with the parents and carefully study the provided medical documents. Based on the results, the necessary studies will be prescribed and appropriate treatment procedures will be carried out.

Aneurysm development

Many parents want to learn in more detail about what it is - an aneurysm of the interatrial septum in a newborn, and how it affects the functioning of the main “motor” of the body. To understand this, you need to look into the structure of the heart. Most internal organs of the human body have a framework of connective tissue. Its formation occurs during intrauterine development. It is thanks to connective tissue that the organ acquires its characteristic shape, does not bend or stretch, maintaining its functionality. Not only the frame, but also the heart valves, endowed with elasticity and a high margin of safety, are made of connective tissue fibers.

Connective tissue is involved in the formation of large “highways” extending from the heart - the aorta, pulmonary veins, and pulmonary trunk. The prerequisites for the occurrence of MARS syndrome are connective tissue dysplasia and changes in its structure. As a result, in one place the fibers are formed too thin and easily stretchable, and in another – hard and coarse. This leads to the appearance of minor anatomical defects, which include aneurysm in children. Scientists see the reason in a decrease in the concentration of certain types of fibrillar proteins or a violation of their proportions, which changes the structure of connective tissue.

Heredity plays a big role in this, as well as external unfavorable factors. The bad habits of the expectant mother and the infections she has suffered can also make a negative contribution to this process.

Statistics and prognosis for treatment of atrial septal defect in children in Israel

According to statistical data, up to 20% of all congenital heart defects are due to anomalies of the interatrial septum. The defect is not able to disappear on its own as the child grows, so it is also the most common congenital heart disorder, which is diagnosed after 3 years.

The prognosis of the disease depends on the severity of the changes. Minor deviations are compatible with life and are often detected after 45–50 years.

Pathological changes affect the following organs and structures:

• myocardium;
• blood vessels;
• lungs;
• liver;
• kidneys

Death occurs from chronic right ventricular failure, cardiac impulse conduction disorders, and arrhythmias. Less commonly, the patient dies from pulmonary hypertension.

Hadassah doctors successfully eliminate congenital defects of the cardiovascular system. The main factors determining the outcome of the operation are age and the intensity of changes in the myocardium.

Types of aneurysm in newborns

Cardiologists consider each anomaly in the structure of the heart from a variety of angles, taking into account its occurrence - congenital or acquired, the degree of circulatory disturbance, anatomy of the defect, the presence of complications, etc. In most cases of cardiac aneurysm in a child, intussusception into the right ventricle is observed, and the atrial septum can bulge into any side or in the shape of the letter “S”.

When making a diagnosis, the doctor does not rely on the direction of the aneurysm, but on the size of the protrusion. Even a slight deviation from the norm becomes the basis for making a diagnosis not of MARS syndromes, but of severe heart defects. Concomitant pathologies of the main “motor” of the body, problems with hemodynamics, etc. are of great importance.

Cause

Usually the cause of the formation of a cardiac aneurysm is a heart attack, most often of the left ventricle of the heart. When they talk about the development of myocardial infarction, the damaged parts of the heart are weakened, and under the influence of blood pressure they can bulge. Blood trapped in them forms a blood clot. Aneurysms occur in patients with atherosclerotic cardiosclerosis and cardiosclerosis of other origins. Much less common are aneurysms that arise due to other reasons: infections, injuries, and congenital defects.

complication

Many parents are afraid that their child's heart aneurysm will simply rupture. However, in most cases their fears are completely unfounded. This pathology does not pose a serious threat to its carrier, but in some cases there is still a risk of progression of negative consequences. The most common complications of this structural disorder include:

1. Increased or decreased heart rate.
2. Rupture of a protrusion that occurred during intrauterine development. It occurs rarely and leads to a sharp deterioration in intracardiac hemodynamics.
3. Decreased blood pressure – hypotension.
4. Heart failure.
5. Circulatory failure.
6. Increased risk of developing endocarditis, thromboembolism, etc.
7. An abnormality in the structure of the septum makes it vulnerable to bacterial infections.

Modern methods of treating atrial septal defect in children in Israel

Hadassah doctors undergo internships in the best hospitals in the United States, conduct scientific research, constantly take part in international conferences and improve their qualifications.

A child with congenital defects is sent to the Center for Cardiology and Cardiac Surgery.

In Israel, at the Hadassah Clinic, Professor Eldad Erez is treating children with defects in the development of the interatrial septum..

The doctor received his education at the Technion Institute of Technology. He specialized in cardiac surgery in the medical department and completed his residency in the United States of America at the Amory Clinic. Here the young surgeon took courses in heart transplantation and received the title of Doctor of Medicine.

The examination of the child can begin immediately after arrival. On the first day, an acquaintance with the attending physician occurs, a medical history is compiled in Hebrew, and documentation is prepared. After an initial conversation and an objective examination, parents will be given directions for additional research.

Having studied the results of laboratory and instrumental tests, the consultation will draw up a treatment plan. All individual characteristics of the child must be taken into account - drug tolerance, concomitant pathology, abnormalities identified during additional examination.

The anomaly is corrected surgically. Hadassah uses two types of surgical interventions: open and endovascular.

During open surgery, the doctor sutures the hole or puts a patch from his own or artificial tissue. Blood circulation is supported by an appropriate apparatus.

In endovascular intervention, the heart is accessed through the femoral vein. To close the hole, an occluder is used - a special device made of hypoallergenic biocompatible materials. Using a catheter, the cardiac surgeon inserts an occluder into the left atrium, where the distal disk of the device is exposed. After moving back to the right side, the proximal occluder disc is opened. The structure is fixed and the catheter is removed. Over time, the discs grow with connective tissue and become covered with endothelium, the membrane lining the ventricles and atria.

Treatment

Treatment of an aneurysm is prescribed by a pediatric cardiologist on a case-by-case basis. If the size of the anomaly in the structure of the septum does not exceed 10 mm, then the pathology is not treated. The patient is registered at the dispensary and parents are advised to undergo regular medical examinations, have ultrasound scans at the required intervals, etc. If the size of the pathology exceeds 10 mm, the child has a delay in physical development, he often suffers from colds, then it makes sense to be examined more fully and receive recommendations regarding myocardial support and correction of complications.

Treatment tactics are selected in each specific case depending on the degree of decompensation, age, gender, weight, the presence of concomitant diseases and other factors. Treatment is prescribed in a comprehensive manner, including medications to prevent complications, improve heart function, enhance immunity, etc. Folk remedies are also included in the treatment of aneurysms in children, but before using them, you must consult a specialist.

Pills

Here are the drugs prescribed for the treatment of STD aneurysm:

1. Anticoagulants and antiplatelet agents - Dicumarin, Warfarin, Phenilin.
2. Antioxidant drugs - Akrimex, Astrox, Laprot.
3. Vitamin supplements with magnesium and potassium to support heart muscle function.
4. Antiarrhythmics with a membrane-stabilizing effect - “Bisoprolol”, “Propranolol”, “Timolol”.
5. Stimulating the functioning of the immune system - “Bronchomunal”, “Viferon”, “Genferon”.

Hypotension due to an aneurysm usually does not require medication. The doctor may recommend increasing blood pressure with food - coffee, green tea, beet juice, nuts, apricots, pomegranates, etc. For bacterial carditis, antibiotics are prescribed according to a special regimen.

Surgical intervention

Typically, surgical correction of an aneurysm of the sac in children is not performed. The patient is carefully monitored, and if there is surgery, it will definitely be prescribed. Surgery requires serious indications, including the presence of concomitant anomalies of cardiac development. Before agreeing to such an intervention, it makes sense to consult several doctors at once, and only then make a decision.

Folk remedies

Traditional therapy for aneurysm involves taking decoctions and infusions of medicinal herbs. It often happens that they are traditional medicines, but you should first consult your doctor.

Herbalists recommend taking these herbs:

• Valerian root. Used as a sedative and antispasmodic. Dilates coronary vessels, excitability, eliminates insomnia. However, it is contraindicated if there is a tendency to thrombus formation, and it can provoke tachycardia.
• St. John's wort. This herb increases blood pressure, has a tonic and antimicrobial effect, and is also an antidepressant and is used for anxiety disorders. St. John's wort can help with fatigue syndrome and persistent headaches.
• Motherwort. It has long been actively used in medicine for various heart diseases. It is an excellent sedative and is used in the treatment of thrombosis, epilepsy, and hypotension.
• Hawthorn berries. Another heart remedy that has been used for medicinal purposes since the times. This helps with hypertension, as well as mental disorders, migraines, and epilepsy.
• Calamus root. The root of the marsh calamus contains substances that have a calming effect on the central nervous system, tone the heart, strengthen blood vessels, and improve brain function. It is an excellent antispasmodic with bacteriostatic and anti-inflammatory properties.

How is atrial aneurysm treated?

Aneurysm of the membranous part of the interventricular septum is treated with the same methods as other types of similar pathologies. Once the disease is identified, drug treatment is usually prescribed, during which the doctor monitors the growth of the aneurysm. The following drugs are used:

• Medicines that stimulate the production of collagen are needed to strengthen the walls of blood vessels;
• B vitamins;
• Microelements including zinc and copper;
• Medicines to relieve blood pressure if the patient is prone to hypertension;
• Drugs that resolve blood clots;
• Medicines to regulate heart rate.

The medicinal method is used for small pathologies, but if accelerated growth is observed, surgical intervention cannot be avoided. During the operation, the doctor’s task is to strengthen the walls of the aneurysm. The following methods are used:

• A synthetic patch is installed;
• Sutures are placed through a small hole;
• The oval window is closed using an endoscope.

Surgical treatment does not exclude the use of medications during the rehabilitation period. You will also have to take medications that strengthen blood vessels, vitamins and minerals. It is required to comply with all recommendations and prescriptions of the doctor for the treatment to be successful.

Prevention of cardiac aneurysm in newborns

Thanks to the active promotion of a healthy lifestyle in the country and in the world, the introduction of the practice of preparing for pregnancy and childbirth, more and more expectant parents are thinking about the health of their children. Many couples begin to prepare for conception in advance, take multivitamins, switch to proper nutrition, and give up drinking alcohol and cigarettes. This is the main prevention of intrauterine developmental anomalies, including aneurysm of the bladder.

People with a hereditary predisposition should take even more care of their health. It makes sense to visit a doctor and consult with him about how you can prevent the development of cardiac structural disorders. Remembering that infections suffered during pregnancy, and especially in the first trimester, can cause similar problems in future offspring, it is necessary to think about their prevention. It involves dressing appropriately for the weather, especially shoes. If your feet get cold or wet in wet weather, then a cold cannot be avoided.

In the era of the coronavirus pandemic, it is better to refuse any trips, avoid crowded places, try to go shopping less often, and if the need arises, be sure to wear a medical mask and change it in a timely manner. The same applies to those women who continue to work and meet people before receiving sick leave. It is also recommended to cure all existing acute and chronic diseases at the pregnancy planning stage, so that later you do not have to choose between the baby’s health and your own. The thing is that most traditional medications can adversely affect the development of the fetus and lead to the formation of various anomalies.

It often happens that a woman takes medication without yet knowing about her “interesting” situation. But it is in the first trimester that the formation of the main organs and systems of the baby, its heart, occurs. That is why it is so important to eliminate all the shortcomings of your health. And regarding chronic diseases, consult with your doctor and decide which medications you can keep, which ones it is better to abandon altogether or replace with safer ones.

Still have questions about STD aneurysm?

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Author

Salmina Daria Vladimirovna

Geneticist. Graduated from the Chelyabinsk State Medical Academy. She completed an internship at the Northwestern State Medical University named after I.I. Mechnikov.

How to make an appointment with a specialist?

JSC "Medicine" (clinic of academician Roitberg) is located in the center of Moscow in the Central Administrative District at the address: 2nd Tverskoy-Yamskaya lane, building 10 (Mayakovskaya metro station).

Our medical center employs doctors of the highest qualifications and extensive experience. All diagnostic measures are carried out with maximum efficiency. Especially when it comes to emergencies. All procedures are carried out on modern equipment using the latest technologies.

Doctors, having received the examination results, prescribe the optimal treatment method, which will be aimed exclusively at a positive result. Patients are always under the strict supervision of doctors. This allows you to quickly react if the child’s condition worsens.

If you have questions, you can make an appointment by phone.

Forecast

To prevent the disease from progressing to a more severe form, your baby should be regularly examined by a local pediatrician and cardiologist. It is also necessary to periodically do an ultrasound and perform an ECG. Such measures will allow you to monitor the dynamics of the disease and take timely actions to minimize possible complications.

In general, the prognosis for such an anomaly is favorable. The pathology does not affect the baby’s development and rarely causes discomfort. Aneurysm rupture is diagnosed in 10% of patients. Moreover, the survival rate after the operation is about 80%.

Many parents who are faced with this problem are concerned about their child’s attendance at physical education classes and sports clubs. Permission for this type of training must be given by a cardiologist. The specialist makes a decision based on the examination results, taking into account the size of the anomaly and accompanying changes in the functioning of the heart.

Prevention is relevant only at the time of planning and bearing a child. The expectant mother must monitor her health, undergo the necessary examinations and take appropriate tests to detect infections. This should be taken especially seriously by those who have relatives suffering from heart disease. During pregnancy, it is important to undergo fetal ultrasound several times. You also need to forget about bad habits such as smoking and drinking alcoholic beverages. In the first trimester, you should do everything possible to avoid infectious diseases (ARVI or influenza). To do this, it is important to eat right, take a walk every day, and minimize the time you spend in crowded places.

Therapy

Before treating a child, he must undergo certain diagnostic procedures:

• Auscultation is listening to the heart using a stethoscope. This device will allow you to hear noises if there is a possibility of an anomaly;
• ECG. Performed to check the functioning of the heart, it makes it possible to identify rhythm disturbances;
• Ultrasound. This diagnostic method is safe and quite informative. It allows you to detect bulging of the interatrial septum, as well as determine fluctuations in the cardiac cycle.

Treatment depends on the growth rate and increase in the size of the formation. As the disease progresses, the patient is indicated for surgical intervention, which involves replacing the damaged area of ​​the vessel with an artificial graft.

Small aneurysms rarely lead to rupture of a heart vessel, so they can be treated with medications. Drug therapy includes antihypertensive drugs, which are also used to stabilize blood pressure. Therapeutic measures should be aimed at normalizing the functioning of the heart muscle, adjusting the rhythm, and improving metabolic processes in the myocardium.

Treatment is not complete without magnesium supplements. The role of this microelement in the formation of collagen fibers is difficult to overestimate. Magnesium has an antiarrhythmic effect, promotes contraction and relaxation of heart cells. That is why it is included in complex therapy for rhythm disturbances.

Treatment with magnesium preparations consists of taking Magnerot three times at a dosage of 0.5 g at a time. The duration of such therapy is 1 week. After this, take 25 g of this drug for 5 weeks. The use of Magne B6 is also required. The course of treatment is 1.5-2 months. The dosage depends on the child’s weight.

For antioxidant protection and membrane-stabilizing effect, L-carnitine, Cyto-Mac, and Coenzyme Q10 are used. Metabolic therapy can last about 1.5 months. Moreover, it must be repeated several times a year, as a rule, two or three are enough.

To improve metabolism, it is recommended to take PP and B vitamins. Vitamin therapy is carried out over a two-month course, repeated up to 3 times a year.

It is also possible to use beta blockers, glycosides and anticoagulants. The former help reduce heart rate. Glycosides and anticoagulants can be prescribed at the preoperative stage.

Additionally, you should adhere to non-drug treatment, the essence of which is as follows:

• It is necessary to properly organize the child’s daily routine, ensure normal sleep, walks in the fresh air, and proper rest.
• Particular attention should be paid to the baby’s nutrition; it should be balanced and as healthy as possible.
• It will be useful to carry out hydrotherapy or balneotherapy.
• Different types of massage have a very good effect.
• Physiotherapy will also be beneficial, especially if we are talking about electrophoresis using magnesium.

Small aneurysms can be treated with folk remedies. But they should only be used under the supervision of a physician. Under no circumstances should you conduct experiments on your own, especially if the pathological formation has reached a large size.

Among traditional medicine recipes, a collection of herbs such as rose hips, valerian officinalis, hawthorn and calamus has proven itself to be excellent. To prepare the product you need to take 1 tbsp. spoon of each component, and pour boiling water (0.5 l) over the raw materials. After the infusion has stood for 2-3 hours, it is filtered and 1 teaspoon of the decoction is diluted in a glass of water. Treatment is carried out three times a day.

How does pathology manifest itself?

Health complaints are mainly due to decompensation of blood flow. The stronger the overload of certain parts of the system, the more pronounced the symptoms will be. Patients begin to worry about shortness of breath, fatigue, and frequent colds, especially in children.

When listening to the heart, a systolic murmur is heard with a source above the pulmonary artery. The sounds are caused by difficulty when too much blood flows through the lumen of the pulmonary trunk. The ECG shows signs of overload on the right side of the heart with hypertrophy in this area.

Prices for services

How much does it cost to treat atrial septal defect in children in Israel?

Relatively low prices with high effectiveness of the treatment process are the key point explaining the popularity of Hadassah. The cost of a treatment course in our institution is lower than in similar centers in Europe and the United States.

The Israeli Ministry of Health carefully controls the pricing policy of all medical institutions. Thanks to this approach, prices at the Hadassah University Hospital are no higher than in other medical institutions in the country. Our own scientific developments can significantly reduce the cost of therapy.