A special action "Children's Heart Day" took place at the Bakulev Center, the leading Russian cardioclinic. A teleconference was established with the National Center for Cardiovascular Surgery, during which cardiac surgeons from 30 regions of the country were able to tell about their successes in treating children's heart defects.
No longer a sentence
As the head of the center for vascular surgery, chief cardiac surgeon of the Ministry of Health of the Russian Federation Leo Bokeria said in his welcoming speech, the foundation of pediatric cardiac surgery was laid by Alexander Bakulev, who in 1948 performed the country's first surgery for congenital heart disease, his student Evgeny Meshalkin and Vladimir Burakovsky. And so, over the past 60 years, about 1.8 thousand open-heart surgeries for children under one year old have been performed annually in the center of cardiovascular surgery.
In many regions, the level of pediatric cardiac surgery is now also high. For example, in Krasnodar, a unique heart operation was performed on an unborn child. In the baby's chest, doctors diagnosed a tumor and fluid that pressed the heart - because of this, he could be born much ahead of time and, most likely, would die immediately. But thanks to the operation, everything worked out, and by the age of two, the baby had reached the level of development of an ordinary child.
In the Voronezh region, over 250 congenital heart defects are detected per year, of which about 30% are in newborns with critical heart defects. Last year, the children, most of whom were under a year old, underwent 183 heart surgeries.
Depends on vice
Mothers often ask doctors: what will their child be like after the operation, will he be able to go to kindergarten, school, exercise? After all, the statistics is such that 71% of children with critical heart defects are at risk of dying in the first year of life, of which 97% of patients, modern medicine can help to survive. It is best to operate a child closer to the age of one year, when he gets a little stronger.
“Sometimes, in order for a child to live, from the first day, a small hole inside the atria is required. This operation is called Rashkind's operation, we have been doing it for a very long time, - says children's cardiologist Elena Korosan. - Under ultrasound control, doctors insert a catheter, put it into the heart and use a special device to make a hole between the atria. And when the child's condition stabilizes, he is prepared for a radical operation. It happens that a newborn has a closed aorta, and blood may not reach the lower half of the body - the abdomen, kidneys, legs. Therefore, help is needed very promptly."
The child's recovery depends on the severity of the heart defect. For example, an atrial septal defect - a hole between the atria, which the surgeon closes with a patch - is one of the simplest ailments. In the first three to four months, while the chest heals, the child is limited in activity. But a year after the operation, he returns to normal life. Severe complex heart defects require several staged surgeries and corrections to bring the heart back to normal.
The doctor told how one baby underwent three difficult operations, after the first one he lay in intensive care for a long time. And so, three years later, she met him at the sports section. The kid became so active that his parents decided to let him go in for sports. The hospital told about another baby who was operated on about five years ago. At birth, he weighed only two kilograms, severe heart failure was diagnosed, pulmonary hypertension progressed. And when he reached four kilograms, they began to operate on him. Now he is no different from other children.
Home in three days
About 10 babies are now in the cardiac surgery department, each of them has an adhesive plaster on their chest, which means that they have already undergone an operation. Before the operation, one and a half-year-old Omar had severe heart failure, shortness of breath, the child was given strong pills.
“When I saw this child breathing for the first time, it was clear without diagnosis that he had a severe heart defect,” says Elena Korosan. - First, with the help of drugs, his heart failure was corrected, an operation was performed to correct the defect of the interventricular septum, that is, the holes between the two ventricles were closed and the mitral valve was plastic. Given the size of the heart, this is practically a microscopic technique that our pediatric surgeons are fluent in."
Three days after the operation, the baby was in the ward with his mother, and after another three days they should be discharged home.
How does the system work?
Most of all heart defects in children (about 72%) are diagnosed before birth. Why not more? As the doctors explain, not all women are registered for pregnancy, and small heart defects may not be visible due to the peculiarities of the position of the fetus. If a heart defect is confirmed, the woman is under special control and gives birth at the perinatal center.
“A significant leap forward in the treatment of neonatal heart defects occurred with the opening of the perinatal center in 2011,” comments Sergey Bykov, a Voronezh pediatric cardiac surgeon. - If 10 years ago, patients with complex heart defects were sent to the Bakulev center, now almost everyone is operated on here. At the same time, the number of operations for children under one year increased. If we know that a child was born with a heart defect, a pediatric cardiologist immediately looks at him, an ultrasound of the heart, computed tomography is performed. Within 24 hours we receive an accurate diagnosis and know what treatment to carry out."
“The opening of the perinatal center has greatly facilitated the task of transporting newborns, since the buildings are located on the same territory,” adds Elena Korosan. - For this, you need transport containers - they allow you to maintain the desired temperature and humidity. The minute the baby is delivered to us, we already have a heated place ready. The intensive care unit has special equipment for newborns."
But there are also problems. As noted by the chief cardiac surgeon of the regional department of health, the head of the cardiac surgery center of the regional hospital, Sergei Kovalyov, the system of children's rehabilitation has not yet been debugged.
“Many children undergo not one, but several operations, for which they need to be prepared - for this there should be specialized departments,” the doctor said. - The region already has a heart rehabilitation program, there is a program for stroke survivors. But there is no such child rehabilitation yet, but it is needed."