Aneurysm of the heart in children

Author Ольга Кияница

2018-11-07

Severe and unpredictable diseases are considered heart aneurysm in children. Pathology can be determined both immediately after the birth of a child, and already at an older age. In any case, timely diagnosis and quality treatment is important. If necessary, emergency medical care can be provided, since various emergency conditions are associated with the aneurysm.

Aneurysms are rare pathological lesions in pediatrics that can occur in blood vessels throughout the body and in some organs (for example, in the heart). They are “bubble-like” or “bag-like” projections of the arteries or wall of the organ.

In the brain, these “bags” tend to occur in fairly predictable places. Usually they are located at points where the main artery forks into smaller ones. These formations are not in the medulla per se, but rather in the gaps between different brain lobes.

Most aneurysms that occur in older people occur in the 4th and 5th dozen of life. In rare cases, the pathology is determined in children. Sometimes aneurysms are transmitted by heredity, but in most cases they occur in the population without any specific reason.

Video: Medicine. Aneurysm of the heart

Description of the heart aneurysm in children

During embryonic development, the heart develops from those primordia as the entire vascular system, therefore the definition of “aneurysm” refers not only to the arteries, but also to the myocardium.

Aneurysm is formed at the site of thinning of the vessel wall or cardiac tissue, because of which, under pressure of blood, this area begins to bulge.

In childhood, cardiac aneurysms are extremely rare (approximately less than 1% of the total number of children).Nevertheless, the definition of this pathology requires the qualified assistance of a pediatric cardiac surgeon, since an unpredictable course is characteristic of the disease. Additionally, the clinical picture is not always fully expressed in children, since, unlike other cardiac defects, aneurysms are able to grow with the heart.

The main stages of the development of heart aneurysm in children

The main function of the heart is to pump blood, which allows all organs and tissues to receive oxygen and nutrients in sufficient quantity. The stages of development of the aneurysm associated with the stages of the violation of these functional capabilities, so they are conventionally divided as follows:

  1. Stage of compensation - is observed with a stable size of the aneurysm or its relatively slow growth. In such cases, the load on the heart may increase slightly, which allows the body to work within normal limits.
  2. The stage of decompensation - with rapid or substantial growth of the aneurysm, the contractile function of the heart is disturbed. The organ ceases to release a sufficient amount of blood into the bloodstream, which leads to various complications (heart failure, pulmonary edema, cerebral ischemia, etc.).

Aneurysm rupture is the most dangerous condition that leads to a rather rapid death of the patient. The moment of rupture is almost impossible to predict, it can happen both at rest and during physical exertion. Given these circumstances, if a child has an aneurysm, it should be carefully monitored for its condition.

The causes of the development of heart aneurysm in children

There are two main forms of cardiac aneurysm in children, which are directly related to the causal factors of development.

  1. Congenital aneurysm - is formed at the stage of intrauterine development of the child, while in such cases a variety of causal factors can be determined (TORCH infections, genetic mutations, hereditary syndromes).
  2. Acquired aneurysm - occurs in children after their birth and may be associated with various adverse circumstances.Most often, this pathology develops after a serious injury to the chest. Also, the appearance of pathological education may contribute to myocarditis and rheumatism.

Brief description of the main causative factors

Genetic disorders of embryonic cells - often associated with the wrong lifestyle of a pregnant woman, as well as with her being in an unfavorable environment. At the same time, DNA can change in a wide variety of cells, and if they are directly connected with the developing myocardium, this leads to a defect in the wall, and later on to a heart aneurysm.

Hereditary syndromes - most often aneurysms are associated with Ehlers-Danlos syndrome, Marfan and others. Under these conditions, various connective tissue disorders are observed. In particular, the disorder of collagen synthesis is determined. This leads to a violation of the structure of the heart muscle. This is especially pronounced in genetic mosaicism, when not all cells have abnormal DNA, but only some part. Under such conditions, the disease often develops hidden, which threatens with untimely diagnosis and treatment.

Primary hypertension of the newborn - in most cases associated with kidney disease of congenital origin. With an uncontrolled course of the disease, hydrostatic pressure rises in the chambers of the heart. If in some places there is a thin wall, there will be an aneurysm, often putting the child’s life at risk.

TORCH infections - this group includes various infectious diseases such as rubella, toxoplasmosis, herpes virus. In the case of an active form of the disease with their participation during pregnancy, various malformations can occur, including a heart aneurysm in children.

Defects of the septum - in the normal between the ventricles and the atria there are solid partitions, which, with improper fetal development of the fetus may have larger or smaller defects. Some of them sometimes contribute to the development of a heart aneurysm in children, as here is the non-incision of an oval window in the interatrial septum.

Regarding the acquired causes of the development of aneurysms in children, there are still some discrepancies between scientists, since on the one hand the disease can develop after the birth of a child, and on the other, the basic prerequisites for its occurrence are rooted in unfavorable heredity or congenital defects.

Despite the ongoing controversy regarding the etiology of a significant difference in the treatment of aneurysm does not exist. The main thing is the timely implementation of surgery.

Signs of a cardiac aneurysm

There are no specific manifestations of the disease, therefore, the most common symptoms are determined by the violation of the heart. If the child is small, then the observation of the parents is of no small importance. Older children can make complaints on their own, but they also mostly indicate a change in heart activity. In particular, it may be noted:

  • difficulty in physical activity due to shortness of breath;
  • after running or long walking you can see swelling;
  • moist cough, although respiratory illness is absent;
  • abnormal pulsation of blood vessels, most often in the neck or in the epigastrium;
  • pain in the left half of the chest or in the center.

Attentive parents may notice a change in activity in the child's first three years of life toward lethargy, a decrease or even a lack of appetite. In addition, sometimes swelling of the legs, pulsation in the neck or in the epigastric region is noted.

Often, during the patronage examination, pediatricians miss the first signs of a heart aneurysm in a child due to their inexpressiveness, so it is the responsibility of parents to point out the existing disorders and, if necessary, to insist on additional examination.

Diagnosis of heart aneurysm in children

Modern diagnostics is the key to successful treatment of aneurysm in children, which is why an ultrasound of the heartshould be performed for the slightest suspicion. Additionally, echocardiography can be used to evaluate the condition of large vessels.

Ultrasound of the heart is a painless diagnostic method, which is carried out relatively quickly, so it is recommended for children of different ages, ranging from newborns.

In particular, using an ultrasound scan, a defect or aneurysm of the interatrial septum and other heart defects is determined, with the maximum probability. For reinsurance, ultrasound of the heart is often prescribed to children who have shown very slight signs of cardiac aneurysm.

Video: WFP Aneurysm

Multislice computed tomography (MSCT) - used in cases where an ultrasound of the heart or echocardiography did not provide enough information to select a treatment strategy. MSCT provides three-dimensional images that clearly show the location, size, and interaction with the surrounding tissues of the existing aneurysm of the heart. Compared with ultrasound, MSCT is more dangerous for children, especially those under three years of age, which is associated with the negative effect of radiation load on the children's body.

The specificity of heart aneurysms is such that they can be detected in various arteries throughout the body. If this occurs, it leads to serious complications. The most unfavorable is a cerebral stroke, which can be associated with aneurysm rupture and blood entering the subarachnoid space.

Cardiac aneurysms in the diagnostic process should not be confused with pseudoaneurysms and coronary artery aneurysms, as well as myocardial rupture. The latter state is often associated not only with a manifold bulge, but also with the presence of a hole in the heart wall.

Treatment of heart aneurysm in children

The main treatment tactic is surgery , which allows restoring the heart wall after preliminary elimination of the aneurysm. Conservative methods of treatment in such cases are ineffective, since it is only possible to reduce the clinical manifestations, whereas the very cause of the disease, the bag-like formation, cannot be removed with drugs alone.

Heart surgery is performed only in a specialized cardiac surgery unit, where there is all the necessary equipment for monitoring the condition of the child and the device for performing the surgical intervention itself. Most often performed in a planned manner, in rare cases - for emergency care. Before the operation and after it, the patient is under the supervision of a cardiac surgeon, as well as a pediatrician, when being at the dispensary account.

The main stages of surgery for heart aneurysm:

  1. Creating an open access to the heart, for which the costal cartilages or sternum are dissected.
  2. The heart-lung machine is launched.
  3. Heart activity stops.
  4. Aneurysm is excised, after which the damaged area lends itself to plastic.
  5. The heart is started and cardiac output is checked along with an assessment of the quality of the sutures applied.
  6. Layer-by-layer wound closure is performed, and the bone components are fixed with brackets or ligatures.

After the operation, a child is carefully monitored for several days, which makes it possible to evaluate the effectiveness of the operation performed.

If, in addition to the heart aneurysm in a child, the aneurysms of other vessels were determined, then at the next stage of treatment they are removed. Especially dangerous is cerebral aneurysm, located in the brain. If you do not carry out its treatment, then after some time the “time bomb” can work and lead to death.

Predictive conclusion after a successful operation is often favorable. Such children have the chance to fully develop and gradually become 100% a member of society. The only thing they always need to remember is that excessive exercise, like professional sports, is contraindicated.

Video: Aneurysm: "time bomb"


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One response to “Aneurysm of the heart in children”

  1. Дарья says:

    От неё можно умереть

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