Organization of Cardiosurgical Care for Children with Congenital Heart Diseases in Children Under One Year with Determination of Risk Factors of Surgical Treatment

Abstract

Background: Congenital heart defects are represented by numerous nosological forms. Today is known to be more than 90 variants of congenital heart defects (СHD) and their combinations. In the structure of the CHD 1st place occupies the defect of the interstitial septum, which according to various authors is 30-50% of all congenital defects of the heart, 2nd place - open arterial duct (10%), defect of the interstitial artery, interstitial defect, tetrad Fallo, transposition of main vessels, atrioventricular communication do not exceed 5-7% of each defect. The share of the remaining congenital malformations of the heart is less than 1-2%.

Aim: To study the factors of the condition and organization of cardiac surgery to children with congenital heart defects Center for Perinatology and Pediatric Cardiac Surgery.

Methods: From November 20, 2011 to December 29, 2018, the Center for Perinatology and Pediatric Cardiac Surgery treated 1,098 children aged 1 year, 175 of whom were newborns (15.9%). Of the last 27 were restricted to conservative treatment. Eight (29.6%) of these patients died from hypoxia and / or cardiac insufficiency, which were incompatible with life, as well as from congenital pathology of other organs and systems. In the remaining 148 (81.7%) cases, various surgical interventions were performed.

Results: The comparison of the risk group shows that there was no difference between them in the structure of the main critical CHD. He drew attention to the fact that the increase in the number of risk factors (RF) was associated with an increase in the number of obstructive lesions of the left ventricle and aortic arch. The difference between the groups RF (0) -RF (3), RF (0) -RF (4), RF (2) -RF (3) and RF (2) -RF (4) according to the number of these patients was reliable (r) <0.05). Thus, this pathology was the most dangerous in relation to the accompanying problem. As the number of risk factors increased naturally, the number of patients in the corresponding groups decreased, and the level of mortality increased. Considering all the variants of the outcome (recurrence of postoperative complications, lethality), the most weighted isolated risk factors were “artificial ventilation”, “ intrauterine infection” and “Inconsistency”, with the exception of the 2nd, 2nd and 3rd versions, respectively. 5- 9.9 times. The most dangerous in this aspect are “Syndromes”, “GIEP”.

Conclusion: Risk factors are predictors of specific postoperative complications: outbreaks of encephalopathy occur in cerebral complications in 5.4% of newborns, intrauterine infection, 30%, and 30% of coronary heart disease. Assessment of the significance of the origin of non-surgical factors determines the most “weak link”, and proves the necessity of the mandatory use of algorithms and protocols of individual congenital anomalies of congenital heart disease and congenital heart disease.