Every February 14, World Congenital Heart Disease Day is celebrated, which are malformations in the heart or large blood vessels that can be found in the fetus and in the newborn.
They are formed in the first weeks of gestation.
World Congenital Heart Disease Day: In Mexico there are an estimated number between 18,000-20,000 new cases per year
A congenital heart disease is defined as an abnormality in the cardiocirculatory structure or in the function that includes the heart and the great vessels, and that is present at birth, even if it is discovered later, during the life of the carrier of the malformation. The true incidence of congenital cardiovascular malformation is difficult to determine due to the difficulties of its definition.
Within the framework of World Congenital Heart Disease Day, in Mexico there are an estimated number between 18,000-20,000 new cases per year. Most of the centers that care for these patients are exclusively pediatric and the Mexican Social Security Institute (IMSS) It has a clinic that caters to all ages.
It is considered that of every 100 live newborns, between 3 and 4 will present a malformation at birth. Of all the different malformations, congenital heart disease is the second most frequent in Mexico, behind malformations of the central nervous system. The risk of presenting a cardiovascular malformation increases the more preterm the newborn is.
Congenital heart disease, these are the 4 most recurrent in our country:
The cause of the vast majority of heart disease cannot be limited to a single cause, such as a genetic mutation, but rather have a wide range of causes (multifactorial). It is important to emphasize that the risk of heart disease recurring in a new baby is low (3-5%), although there are certain types that occur more or less frequently.
Since there are practically countless different congenital heart diseases, only the 4 most frequent in our country will be described:
Patent ductus arteriosus
It consists of a patent hole between the aorta (the main artery of the body) and the pulmonary trunk (pulmonary arteries). It is an embryonic remnant, as this communication is useful while the baby remains in the womb. The blood of the fetus does not need to go to the lungs to receive oxygen. Thus, the ductus arteriosus allows blood to pass from the circulation to the lungs.
At birth, the blood needs to receive oxygen in the lungs, and this hole closes on its own. All babies are born with this hole, but it narrows and closes in the first few days. If the ductus arteriosus fails in its natural closure, the blood will overload the lungs, and will not be able to oxygenate the rest of the body.
Atrial wall defect
A wall communication that separates both atria, the upper chambers of the heart. Also called “atrial septal defect”, it is part of the normal circulation of the fetus, which is destined to be obliterated at birth. When kept in the newborn, it allows oxygen-rich blood (from the left atrium) to leak into the heart’s oxygen-poor blood chambers (the right atrium).
When it is small, it can go unnoticed for a lifetime. If it is large, the excess blood returning to the right atrium causes the heart and lungs to work too hard, facilitating gradual damage to these organs.
Ventricular wall defect
Like the previous defect, the ventricular wall defect or “interventricular septal defect” is now in the wall that separates both ventricles. This is not a vestige of fetal blood circulation, but the walls are expected to close before birth to prevent mixing of deoxygenated blood (which is confined to the right chambers of the heart) with oxygenated blood (which is found only in the left chambers). The connection between both ventricles implies work overload for the heart, and adequate oxygenation. It should be noted that, like the previous alteration, the symptoms depend on the size of the lesion. Small holes can be maintained for a lifetime without any discomfort.
These three malformations are the most frequent, and it is not uncommon for two or more to occur simultaneously. In serious cases, all of them are repaired with surgery, as well as all of them can be corrected spontaneously, when they are minimal defects.
Tetralogy of Fallot
The word “tetralogy” is a Greek term that means something similar to “four words.” Despite being known since the 17th century, the French physician A. Fallot described the four components of this malformation at the end of the 19th century:
A defect in the ventricular wall (see 3rd heart disease)
- An impediment to the flow of blood from the heart to the lungs (“pulmonary atresia”)
- The poorly positioned aorta lies over the outlet between the ventricles.
- The muscle of the right ventricle becomes too thick
- The obstruction in the pulmonary valve (outflow of the heart to the lungs) prevents the usual amount of blood from being pumped to the lungs, so too much blood passes through the ventricular wall defect from the right ventricle to the left ventricle and out through the aorta. In other words, a significant volume of blood bypasses the lungs and is not properly oxygenated.
Infants and young children with unrepaired tetralogy of Fallot are often blue, due to the large flow of deoxygenated circulating blood. Tetralogy of Fallot is treated surgically.
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