Diagnostics and treatment of congenital heart diseases in newborns

Abstract

Aim. Early detection and timely appropriate surgical treatment of congenital heart disease in order to reduce infant mortality.
 Methods. The algorithm was designed for the prediction of critical conditions in congenital heart disease in newborns. The algorithm is simple to use, because it does not set a pediatrician-neonatologist a difficult task for the accurate diagnosis of congenital heart disease, but leads physician from the syndromic diagnosis to a certain group of diseases and, therefore, appropriate strategy of patient treatment and management. The algorithm combines both syndromes and hemodynamic conditions causing them. The conditions are divided into fetal-dependent and fetal-independent, which determines the time of surgery. The questionnaire consisting of a series of questions with multiple choice answers helps the doctor to see into the symptoms and syndromes. The questions are made in a way to emphasize the certain signs, the details of medical history and disease progression to pediatricians. It is important to notice that 13 out of 20 questions are based on the medical history and clinical picture, 7 questions are based on the test results such as electrocardiography, radiography, and do not include echocardiography.
 Results. Since 2000, the questionnaire was implemented in the Republic of Tatarstan as a recommended diagnostic algorithm for examining newborns with congenital heart disease. Since 2003, the questionnaire and algorithm for prediction of the critical conditions was introduced by the order №867 of the Ministry of Health of the Republic of Tatarstan «On measures to improve health care in congenital heart disease in children». Remote consultations with maternity hospitals are strictly based on them. They carry a certain training load, and when doctors pronounce aloud all the items of the test, the examination algorithm gradually becomes automatic.
 Conclusion. During 13 years of using the proposed diagnostic algorithm for congenital heart disease with physiological rationale for palliative care and timely terms of surgery, the mortality rate from congenital heart disease in the Republic of Tatarstan has significantly dropped.

Cardiosurgical Care in Case of Congenital Heart Defects: Modern Approaches and Features of the State of Patients' Health

“…Shortly thereafter, in 1944, Clarence Craford performed the first successful restoration of aortic coarctation at the Karolinska Hospital in Sweden. [3] In the same year, at Johns Hopkins Hospital in Baltimore, surgeon Alfred Blalock and pediatric cardiologist Helen B. Taussig developed a shunt to facilitate the treatment of patients with cyanotic congenital heart disease [4]. The Blalock-Taussig shunt, connecting the subclavian and pulmonary arteries, increased pulmonary blood flow in cyanotic infants with pulmonary stenosis, improving their well-being within minutes.…”

“…There is still debate about whether primary interventional balloon dilation or surgical treatment of congenital aortic stenosis will be more effective. At the same time, it has now become clear that in adolescents and young adults, replacing the valve with any other substitute, with the exception of a pulmonary autograft, leads to a reduction in the life of patients by 20 years [4].…”