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UDC 616.12-008.318-007.19-053.35
MINOR CARDIAC ABNORMALITIES AND HEART ARRHYTHMIAS IN NEWBORNS
Altai State medical University, Barnaul
N.L. Gurevich, T.M. Cherkasova, O.A. Zenchenko, G.I. Vykhodtseva
The aim of the study was to clarify the structure of minor cardiac abnormalities and heart arrhythmias among neonates in the city of Barnaul, to identify the main possible etiological factors provoking the development of the minor cardiac abnormalities (MCA) and heart arrhythmias in children of this age.
Results and discussion. During examination on the echocardiography, a variety of minor cardiac abnormalities was revealed (37.7%). Cardiac arrhythmias were detected in 59.5% children on ECG. In a significant part of the neonates were revealed the presence of the central nervous system's (CNS) lesions with varying degrees of severity, which is one of the possible extracardiac causes of the minor cardiac abnormalities. The most frequent finding in examined neonates was an open foramen ovale (OFO), less commonly, left ventricular abnormal chord (LVAC) and mitral valve prolapse (MVP) were diagnosed. This abnormality was detected more often in premature infants, that was caused by the immaturity of connective tissue structures. MCA in most cases were asymptomatic and were not accompanied by signs of heart failure. In general, the prognosis by MСA is favorable, but in each specific case, the significance of structural cardiac abnormalities should be considered individually. Key words: minor heart anomalies, heart arrhythmias, neonates, conjunctive tissue dysplasia.
In recent decades, neonatologists, pediatricians and pediatric cardiologists have paid much attention to connective tissue dysplasia (CTD). Connective tissue dysplasia is understood to mean a congenital anomaly of the connective tissue structure of organs, with a decrease in the content or anomaly of certain types of collagen. By CTD, all organs and systems are involved in the pathological process, but primarily, cardiovascular as well as cardiac conduction system [1, 2, 3]. In childhood, in the presence of dysplasia, heart valves, heart walls, chords, or large trunk vessels are often affected, which in some newborns can be regarded as having congenital heart disease (CHD) [1, 2, 3, 6]. In newborns, endogenous and exogenous factors: chromosomal and genetic defects, intrauterine infection, hypoxia, adverse environmental conditions, inadequate nutrition, stress take part in the development of congenital heart disease and/or MCA [4, 5, 6, 7, 8, 9]. All these factors disrupt the processes of morphogenesis and ontogenesis, which can lead to the development of MCA or arrhythmias in newborns [2, 3]. In children with MCA, according to ECG, a high frequency of cardiac rhythm and conduction disturbances has been established [3,7]. Frequently, MCA are detected in both parents and children, which confirms their hereditary predisposition, especially if the mother has phenotypic signs of CTD.
Objective: to clarify the structure of minor anomalies and cardiac arrhythmias in newborns of the city of Barnaul, to identify the main possible etiological factors that provoke the development of
MCA and cardiac arrhythmias in children of this age.
Materials and methods
There were examined 546 newborns treated in the department of pathology and/or neurology of newborns of Children City Clinical Hospital No.7. Criteria for inclusion in the survey were full-term newborns who underwent ECG, echocardiography, ultrasound of the brain and clinical examination (general and biochemical blood tests, urinalysis, radiography of the lungs, consultation of a neurologist, if necessary, endocrinologist, cardiologist). The exclusion criteria for the survey were: premature babies and newborns who were not fully screened.
Results and discussion
In the general group of the examined (546 newborns), boys prevailed - 52%, 48% were girls. The average weight of a full-term baby was 3 kg 320 g ± 230 g. During the examination on echocardiography, in 206 (37.7%) of newborns, various minor cardiac anomalies were revealed, and 325 (59.5%) newborns were diagnosed with cardiac rhythm and conduction disturbances. According to the anamnesis, more than 2/3 of mothers had a pregnancy with gestosis of varying severity. The results of the examination in the general group of children revealed the presence of perinatal CNS damage in 352 (64.5%) newborns. The presence of intracranial hypertension was noted in 81 (14.8%) children. Thus, a significant part of the examined newborns were characterized by the presence of CNS lesions of varying severity, which is one of the possible extracardiac causes of small heart abnormalities or cardiac rhythm and conduction disturbances.
By the examination in the ECG department, 59.5% of newborns (325 out of 546) showed rhythm
disturbances. It should be noted that in the group of children with arrhythmias, children with a burdened obstetric history and/or the presence of perinatal CNS damage prevailed. Thus, the presence of tachycardia syndrome or bradyarrhythmia was found in 21.9% (120) of children, including episodes of non-paroxysmal sinus tachycardia in 48 (8.8%) of newborns. According to ECG, signs of incomplete blockade of the right branch of His bundle were recorded in 19.2% (105) of patients. Heart rhythm disturbances in the form of extrasystoles were detected in 26 (4.8%) newborns. Episodes of attacks of supraventricular paroxysmal tachycardia were recorded in 3 (0.5%) children. The ECG criteria for the shortened P-Q syndrome were observed in 12 (2.2%) newborns. The presence of Wolff-Parkinson-White syndrome was diagnosed in 6 (1.0%) children. ECG signs of transient myocardial ischemia were observed in 4 (1.06%) newborns.
Subsequently, during examination of echocardiography in more than half of the newborns, various minor heart abnormalities were detected, which were regarded as manifestations of connective tissue dysplasia. Most frequently, there was revealed an open foramen ovale (OFO). Thus, in full-term newborns, OFO was noted in 35.7% (195 children) of cases. Open foramen ovale refers to fetal communications, functions in utero and closes after birth. In children, the normal OFO is obliterated in the first 3 months after birth. The timing of the closure of OFO depends on the size of the open foramen ovale and the degree of the baby's full-term. If the OFO continues to function, it is necessary to carry out differential diagnostics with congenital heart defect (CHD), a secondary interatrial septum defect. This child is subject to observation by a cardiologist, who determines the tactics of examination and treatment of the patient.
Mitral valve prolapse (MVP) was detected in 17% (93 children) of newborns. The primary MVP is a valve anomaly, in which one or both mitral valves fold during the ventricle contraction beyond the line of the mitral fibrous ring into the atrial cavity. The main cause of primary MVP is in most cases the presence of a genetic defect in the synthesis of collagen, leading to weakness of the connective tissue of the mitral valve cusps. Aneurysm of the interatrial septum was detected in 2.5% (14) of newborns. Abnormally located chords (ALC) were established by 31.3% (171) children. The abnormally located chord is an intracardiac formation and, unlike true chords, is attached not to the valve cusps, but to the walls of the ventricle, which often form a systolic murmur, which can be regarded as CHD. Abnormally located chords, like other MCA, are often combined with various arrhythmias, which corresponds to the literature data [1, 7].
Conclusion
By history taking, it was revealed that the majority of newborns had a burdened obstetric history or perinatal CNS damage, which could be the cause of cardiac arrhythmias or MCA. The results of the examination of newborns allowed us to establish a variety of arrhythmias and minor cardiac abnormalities in a significant part of the patients, while in most cases, a combination of MCA and arrhythmias was observed. In the first place among MCA, OFO was identified, LVAC and MPV were diagnosed less often. Most often, this anomaly was detected in newborns, which is probably determined by the immaturity of the connective tissue structures. Cardiac arrhythmias and MCA, in most observed cases, were asymptomatic and were not accompanied by signs of heart failure. In general, the prognosis for MCA and extracardiac arrhythmias of the heart was favorable, but in each case, the significance of structural heart abnormalities and rhythm disturbances must be considered individually. Improving the quality of the necessary standard care for newborns (providing medical equipment, introducing modern diagnostic methods) contributes to the early detection of CHD, MCA and cardiac arrhythmias, which will improve the prognosis and course of the disease.
References
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Contacts
Corresponding author: Gurevich Natalia Leo-nidovna, Assistant of the Department of Pediatrics with the course of FVE, Altai State Medical University, Barnaul.
656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 542346. Email: reinarlis@mail.ru
Author information
Cherkasova Tatyana Mikhailovna, Associate professor of the Department of Pediatrics with the course of FVE, Altai State Medical University, Barnaul.
656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 542346. Email: science@agmu.ru
Zenchenko Olesya Alekseyevna, Candidate of Medical Sciences, nephrologist of the consultative and diagnostic clinic of the Altai Regional Clinical Children's Hospital, Barnaul. Tel.: (3852) 559912. Email: lessyz@mail.ru
Vykhodtseva Galina Ivanovna, Doctor of Medical Sciences, Professor, Head of the Department of Pediatrics with the course of FVE, Altai State Medical University, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 566861. Email: science@agmu.ru
