Small heart anomalies: features of clinical manifestations and forecast of patent foramen ovale in young children

Relevance . In connection with the increased environmental loads, improved opportunities for timely diagnosis, the number of children with minor heart anomalies (MHA) has increased significantly.

In the structure of cardiovascular pathology in children, functional disorders and conditions associated with minor anomalies in the development of the heart are of great importance. There are more than two dozen variants of microanomalies in the development of the heart. (1,3,5)

In the practical work of a pediatrician, MHA are so common, and their clinical manifestations are either absent or so diverse that it is very difficult for a doctor to see this pathology.

Unlike heart defects, these abnormalities are not accompanied by clinically significant disorders, however, at certain periods of childhood, they can cause the development of severe complications, such as heart rhythm disturbances, or seriously aggravate the course of other diseases. (2.7)

The absence of clear criteria to distinguish MHA from a structural defect causes great difficulties in the work of a pediatrician-cardiologist and often overdiagnosis of congenital heart defects, on the one hand, and underestimation of MHA, on the other.

Despite the significant spread of microanomalies in the development of the heart in the pediatric population, many issues of management tactics for such children remain undeveloped. (3,5)

At present, based on the research of many scientists, it can be assumed that the combination of MHA with cardiac arrhythmias and conduction disturbances is not a coincidence, but should be considered as interrelated phenomena. (4,6)

Most researchers indicate that it is in children with MHA that potentially serious heart rhythm disturbances are more often diagnosed. (Pisareva S.E., Chasha T.V., Gorozhanina T.Z.).

In recent decades, arrhythmias developing against the background of MHA have received special attention, since they lead to the development of clinically significant pathological conditions and life-threatening complications. (Zemtsovsky E.V. 2007). Based on this, there is an increasing need to study the arrhythmic syndrome in children with MHA in order to identify the most significant risk factors in the development of this pathology and reduce the likelihood of cardiovascular complications at an older age.

Among the microdisorders of the development of the cardiovascular system, the most frequently detected abnormalities in children are: mitral valve prolapse (MVP), abnormally located chords of the left ventricle (CHLV) and an patent foramen ovale (PFO).

In recent years, in connection with the widespread introduction of echocardiography in pediatric practice, the frequency of detection of atrial septal defects in the fossa oval area has significantly increased. In which case this phenomenon is considered a pathology (heart defect), a borderline state (a small anomaly in the development of the heart) or a variant of the norm for a pediatrician and pediatric cardiologist is still not clear in all cases. (2,3)

Open oval window is a form of atrial communication, anatomically representing a "probe" opening located in the central part of the interatrial septum - in the region of the fossa oval, formed from the overlapping parts of the primary and secondary septum of the foramen ovale. Being a rudiment of the normal blood circulation of the embryo, PFO is not a congenital malformation and refers to structural anomalies of the heart. The functioning of the foramen ovale after birth, due to the lack of need for it, normally stops, but the spontaneous closure of this fetal communication does not always occur. (3.7). In 50% of healthy children, the LLC continues to function until one year of life and, often, anatomical closure in most children occurs only in the second year of life. According to most researchers, the frequency of PFO among children ranges from 15% to 20%. (4.6).

In this regard, we set a goal : to study the effect of a patent foramen ovale on the health status of young children.

Materials and research methods. To assess the health status of children with PFO, along with clinical examination, we used ECG and EchoCG data. There were 24 children under observation with a reliable diagnosis: patent foramen ovale (18 children under one year old and 6 children from 1 year old to 2 years old). The study did not include children over 2 years old, a combination of PFOs with congenital heart defects or other organic pathology.

The examination of children was carried out in a comprehensive manner on the basis of the Regional Children's Diagnostic Medical Center in the cardiology department of the city of Andijan. We received the data of the anamnesis during the conversation with the parents. In the traditional general clinical examination, we included an assessment of the physical development of children, according to the guidelines "Growth and development of children in the first 5 years of life", developed by WHO and adapted by the Ministry of Health of the Republic of Uzbekistan. The indicators were assessed using centile intervals on the graph, in the ratio of height / age, weight / age, weight / height.

Electrocardiography was recorded in 12 standard leads on a multichannel electrocardiograph "VYUBET" (Germany) with subsequent interpretation of the results obtained. The diagnosis was based on EchoCG data, on the Aloka apparatus (Japan), using a two-dimensional mode and color Doppler. The defect was visualized and the size of the interatrial communication was assessed.

Results . The reason for the examination of children was the periodic appearance of perioral cyanosis and tachypnea during physical activity, as well as the presence of systolic murmur of varying intensity in 2-3 intercostal space to the left of the sternum.

After analyzing the anamnestic data, we found that these children, regardless of age, had a burdened course of the perinatal period. So in 1/3 of children at the time of birth, the age of the mother was in the range of 30-35 years. The course of pregnancy was aggravated by toxicosis (100%), threat of termination (12.5%) and varying degrees of anemia (100%), which was reflected by chronic fetal hypoxia. In 83.3% of mothers, childbirth ended naturally and in 4 mothers - with the use of surgical intervention. By gestational age, the majority of children (70.8%) were born on time. Regardless of gestational age, 45.8% of newborns were diagnosed with asphyxia, with a low Apgar score at birth. The early neonatal period in 2/3 of children proceeded with complications (pneumonia, post-hypoxic damage to the nervous system),

In addition, all examined children, more often in the age group up to one year, had frequent episodes of respiratory diseases that required inpatient treatment.

To assess the effect of a patent foramen ovale on the physical development of children, we calculated the parameters of height and weight at the time of the examination. It was found that the bulk of children (79.2%) had age standards, since the indicators of weight and height were located in the centile corridor corresponding to the median. Two children over one year old (33.3%) had a value above the norm (+2 SD) and three children in the age group under one year old (16.6%) had a slight weight deficit (-1 SD), which we regarded as moderate eating disorders. degree.

Electrocardiography recorded: incomplete right bundle branch block (45.8%), sinus tachyarrhythmia (16.6%), and in three children of the younger age group (12.5%) - early ventricular repolarization syndrome. In the rest of the children, no deviations from the age standards were found on the ECG.

The size of the foramen ovale was determined using echocardiography. The main group consisted of children with the size of the foramen ovale from 2.5 to 4.0 mm (87.5%). Only in three children in the age group up to one year the orifice size exceeded 4.5 mm, with signs of slight dilatation of the right atrium.

Conclusion.Thus, our survey results showed that a functioning oval window in children under two years old should not be considered as a pathology, but considered as a borderline state. Nevertheless, this category of children should be under dispensary supervision in order to avoid the addition of unwanted hemodynamic complications in subsequent age periods. If the closure of the patent foramen ovale has not occurred by the age of two, then this pathology should be considered as an atrial septal defect and the problem should be solved with the help of surgical correction.