Congenital heart disease is a common disease in children, accounting for about 15% of births, mainly divided into two categories: cyanotic and non-cyanotic. Cyanotic or weeks after the birth of the baby mouth and around the peripheral cyanosis occurs, especially crying, it was clearly; non-cyanotic asymptomatic early infancy, often in the checkup found the heart murmur, by echocardiography can be diagnosed. Mainly for patent ductus arteriosus, atrial septal defect, pulmonary valve stenosis, diagnosed after the early treatment of heart disease should be the need of open heart repair under cardiopulmonary bypass, conventional to choose the middle of the chest incision, sternal split to show the site of operation, intraoperative are often left behind after a large scar.
Recent cardiac surgery using a small incision in the chest right axillary treatment of children with congenital heart disease, non-split sternum, not to remove or cut the ribs, thus maintaining the continuity of bony thorax, surgical trauma, pain, light, fast recovery, small incision, and in the axilla and lateral chest wall, right upper limb function spaces, almost do not see the incision scar, so that sick children and their parents from the result of the sternum before the incision scar left by which the burden and suffering.
Surgical treatment of heart disease
Common type of left-right shunt in congenital heart disease is: VSD, ASD, PDA and so on, these three diseases, heart disease come, 30% -45%. If there is no co-existence of a serious illness or severe surgical complications, surgical success rate was almost 100%, surgical long-term effect is also very good, with normal quality of life for the same. However, if serious complications such as pulmonary hypertension, surgery may be lost opportunities or significantly reduce the success rate of surgery; even if the operation is successful, a number of children with progressive pulmonary hypertension will heavier heart failure eventually occurs, or (and) arrhythmia, the quality of life of children with life and would also be seriously affected. Therefore, on proper timing of surgery is very important.
ASD
Few natural ASD closure. Studies have shown that newly diagnosed within 1 year of age were 39% closed, while the l-year-old after the first visit had no case of closure. ASD right heart volume overload increased, but rarely pulmonary hypertension, there is no clinical complications of ASD have few symptoms, often found in the examination and treatment of suspicious heart murmur. Operative age to 4.5-year-old is better, surgical indications as follows: ① echocardiography and x-ray showed expansion of the right heart; ② electrocardiogram showed right ventricular or right atrial hypertrophy or bundle branch block; ② physical growth and development behind the standards of the same age children. Of course, this 3 criteria does not necessarily exist. Cyanosis or right heart failure occurs shall be deemed to surgical contraindication.
VSD
Pathophysiology of simple VSD depends on the size of the defect and pulmonary vascular resistance, there are two groups should consider surgery. A situation of infants and young children, large ventricular septal defect combined with congestive heart failure, physical stunting and have a history of recurrent pulmonary infection, or with severe pulmonary hypertension. Another situation of older age, ventricular septal defect, and diversion are also large, the symptoms not obvious, palpable systolic precordial thrill, audible, and full-systolic murmur, apical diastolic murmur could be heard area, indicating left ventricular volume load increased, an increase in blood flow through the mitral valve. For small ventricular septal defect without pulmonary hypertension, echocardiography shows left ventricular non-expanded, normal ECG, X-ray changes in patients with obvious and not advocate surgery, but were followed up should pay attention to the prevention of infective endocarditis .
For large ventricular septal defect, drugs are difficult to control heart failure and refractory recurrent pneumonia in small infants VSD, should actively consider surgery. Right portion of ventilator-assisted breathing, still difficult to control lung infections of small babies, may be emergency surgery.
VSD closure on the natural rate of Ge Jia reports vary, in the 21% -63%. But the consensus view is that: ① the high rate of small defects closed, the large defect closure rate is low; ② younger age (eg, less than 1 year of age) found that the VSD, closed chance of big, big age (larger than 5 years of age) were closed probability of minimal; ③ membranous and muscular ventricular septal defect closure may be a natural arterial under dry-type ventricular septal defect-free natural closure possible. Therefore, to determine whether children with ventricular septal defect, or whether it is necessary to wait for a natural closed ventricular septal defect can be the basis for more than a few. But at least large ventricular septal defect and large left to right shunt, there is the history of pneumonia and heart failure, or affect their growth and development in children with pulmonary hypertension is not in line to wait for the natural closure conditions.
The natural mechanisms are currently considered to be closed: membranous ventricular septal defect and tricuspid valve anterior lobe separated by leaf affixed to the septum at the junction of the organization, resulting in increased adhesion defect closure. Muscular ventricular septal defect may be due to muscle growth interval has be reduced, closed opportunities. Infective endocarditis, because of adhesion occurred, excrescence Erzhi defect closure, is also considered a natural closure of VSD such a mechanism.
PDA
PDA may stand alone, can also merge other light heart disease, and other complex types can be a survival of congenital heart disease in children with conditions such as pulmonary atresia, ventricular septal consecutive TGA and so on, so the neonatal period when the drug off PDA should be careful. Thick artery catheter because of a large number of left-right shunt may occur in infancy with heart failure and repeated pneumonia, should be an early ligation surgery.
Tetralogy of Fallot
Complex congenital heart disease with tetralogy of Fallot (TOF) The highest incidence of heart disease about 10% of precedence is the baby cyanotic congenital heart disease after a period of up to to see one of the more contentious of the disease at present is the operative age. Based on pulmonary vascular and gas exchange units, developed in the 8 years after birth is an ongoing process, and the early loss of pulmonary arterial blood supply, leading to alveolar dysplasia before the arteries, arterial wall elastin loss, small artery thrombosis, resulting in alveolar and lung volume reduction surgery so early treatment is no doubt the overall development of children is beneficial, especially for children with severe hypoxic cyanosis, early operation should be without regard to age. TOF by about 25% died within 1 year of age, approximately 70% of children need a year of surgery. In the past due to correction of a young infant mortality and complications of surgery, hence tend to do first palliative pulmonary shunt surgery: With deep hypothermic circulatory arrest or deep hypothermic low-flow cardiopulmonary bypass technology development, neonatal and infant anesthesia management improved postoperative monitoring of the progress and technology continues to improve pediatric cardiac surgery, the small age, a correction of TOF surgery mortality and complications decreased significantly. At present a number of methods used in hospitals for a correction. It has been reported within 1 year after birth, children with surgery, severe ventricular arrhythmia was significantly lower than the incidence of late surgery who may be related to earlier surgery had ventricular hypertrophy Bu Zhiyu particularly relevant.
Total anomalous pulmonary venous drainage, complete endocardial cushion defect (atrioventricular septal defect) should be in a year of surgery, such as congestive heart failure or (and) the children with cyanotic early surgery should be considered. Partial anomalous pulmonary venous drainage, part of the endocardial cushion defect because of clinical symptoms are very light, may be the condition of patients undergoing elective surgery, surgery the best age for 3-5 years.
At present, the field of pediatric congenital heart disease are experiencing a particular period of development, not only in some congenital heart disease can be cure by surgery, and many previously inoperable or surgery for congenital heart disease effects of very poor, such as the aortic arch, right ventricular dysplasia syndrome, single ventricle, tricuspid atresia, pulmonary atresia, double outlet right ventricle and so on, due to changes in surgical and surgical materials, continuous development and updating markedly improved the success rate of surgery, pediatric heart transplant for the correction of the complex is difficult deformity in foreign countries has become a routine treatment method.
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