In this section, based on long-term observations of children with various acquired heart defects and analysis of modern literature materials, a description of the clinic, features of hemodynamics, diagnostics of various acquired heart defects: insufficiency and stenosis of mitral and aortic valves and combined mitral and aortic defects, insufficiency of tricuspid valves and the narrowing of the right atrioventricular estuary, and also describe the associated vices from which the insufficiency of bicuspid and aortic valves, stenosis of the left atrioventricular orifice and aortic valve insufficiency, mitral-tricuspid and mitral-aortic insufficiency. Particular attention is drawn to the importance of X-ray examination, interpretation of electro-and phonocardiography data. When considering the issue of the etiology of acquired vices, attention is focused on the significance of rheumatic and septic endocarditis, and their clinic is described. A special chapter is devoted to the treatment of heart defects. It discusses dietary recommendations, the importance of the regime, provides data on the use of various medications (antibiotics, salicylates, steroid hormones, cocarboxylase), therapeutic physical therapy, sanatorium and spa treatment in the active and inactive phase of rheumatism, and describes the purpose of regimens, diets, the use of cardiac glycosides, cocarboxylases, diuretics, spironolactones (aldosterone antagonists), oxygen cocktails and other medications with circulatory failure.
The section is designed for pediatricians and rheumatologists.The
Contains 8 tables, illustrated with 30 figures, bibliographic index - 169 titles.
Table of contents
Chapter I. Etiology of acquired heart defects
Endocarditis of different etiology
Chapter II . Flaws of the two-leaf valve
Insufficient two-leaf valve
Narrowing of the left venous mouth (mitral stenosis)
Combined mitral defect
Chapter III . Aortic heart disease
Insufficient aortic valve
Stenosis of the aorta
Combined aortic malformation
Chapter IV . Flaws of the three-leaf valve
Insufficient tricuspid valve
Narrowing of the right atrioventricular orifice (tricuspid stenosis)
Chapter V. Combined heart defects
Insufficiency of bicuspid and aortic valves
Stenosis of left atrioventricular orifice and aortic valve insufficiency
Stenosis of the left atrioventricular orifice and insufficiency of the bicuspid valve in combination with aortic valve insufficiency
Mitral-tricuspid and mitral-aortic-tricuspidal defects
Chapter VI . Insufficiency of blood circulation with acquired heart defects
Chapter VII . Treatment of children with acquired heart defects
Treatment of circulatory insufficiency
During the years of Soviet power, in connection with the constant concern of the Communist Party of the Soviet Union and the Soviet Government for the welfare of the people and for the health of people, great progress has been made in protecting the health of the younger generation.The
Significantly decreased the incidence of many serious diseases, sharply decreased infant mortality.
Directives of the 25th Congress of the Communist Party of the Soviet Union on the five-year plan for the development of the national economy of the USSR for 1976-1980. further prospects for improving the health of children, future builders of communism, are outlined. The decisions of the congress were a powerful incentive for carrying out a set of measures to improve the public health services, especially women and children.
In connection with the creation of a harmonious system of prevention and treatment of rheumatism in our country over the past 15-20 years, great success has been achieved in reducing the prevalence and reducing the primary incidence of this disease in childhood. The number of children suffering from rheumatic heart diseases decreased by more than 2 times. Despite this, the percentage of acquired heart defects in children remains quite high, although in recent years it has become quite stable and amounts to 12-18% according to many authors. According to the data of the Leningrad Cardioremiological Dispensary, for the last 10 years the incidence of heart disease after primary rheumatic heart disease has remained almost the same (16% in 1965, 15.6% in 1975).
Many years of experience in the cardiorherapy department of the hospital. KA Raukhfus and cardiorheromatologic sanatorium "Labor Reserves" indicates that the most common acquired heart disease in children is mitral valve insufficiency (61.8%). second place is combined mitral defect (16.8%), in third place is isolated aortic insufficiency (10%). "Pure" mitral stenosis among the acquired heart defects in children has a very small specific gravity (3.1%).
For proper treatment and the most rational recommendations of the exercise regime, a functional assessment of hemodynamics is very important, in which it is necessary to take into account the degree of compensation of the defect. Therefore, we consider it very useful to indicate the degree of its compensation (for example, for mitral insufficiency, the evaluation of the degree of compensation according to GF Lang) in the formulation of the diagnosis of acquired defect and, of course, the degree of circulatory insufficiency. The decrease in the incidence of circulatory failure (according to our observations, it almost halved in 1974-1976 in comparison with 1972-1973), is apparently due to a decrease in the degree of damage to the valvular heart apparatus as a result of well-delivered stage treatment: the active phase rheumatism in the hospital, the subsequent in the local sanatorium and, finally, the surveillance performed by the cardiorevmatologists of the district polyclinics. No less important is the year-round conduct of bicillin prophylaxis.
The possibilities of providing assistance to patients with acquired heart diseases are now significantly expanded: in addition to a large set of therapeutic measures, surgical treatment has become a success. In this regard, even more important was the accurate clinical diagnosis of acquired heart defects, timely and correct decision of the degree of severity of a defect, the presence of hypertension in a small circle of blood circulation, the stage of circulatory insufficiency, etc. It is of great importance in What period of the disease with rheumatism - active or inactive - is the patient. Only a multifaceted assessment of the condition of a child with heart disease allows us to correctly approach the issue of treatment, in particular, to admit the possibility of using surgical methods. To solve these problems, the pediatrician needs, in addition to knowledge of the features of the clinic of a heart defect, its complications, to be able to analyze the data of additional research methods - X-ray, electrocardiography, phonocardiography.
Therefore, the authors sought to highlight at the level of modern knowledge clinic, diagnosis, prognosis, treatment and prevention of acquired defects in childhood.
The section uses not only literature materials, but also many years of personal experience of the authors. When it was compiled, observations were made of 220 children aged 7 to 15 years with acquired heart defects, who were treated and observed in the cardiorheumatological department of the hospital. KA Raukhfus and in the cardiorheumatological sanatorium "Labor Reserves" in 1972-1976.
In creating their work, the authors believe that it will benefit pediatricians and cardiothoracic surgeons in monitoring children and their treatment.