Ultrasound of the heart in children: when, to whom and how often to do

Indications

The functioning of the cardiovascular system in a child of the first year of life differs from that of an adult. Structural differences, which normally disappear before the age of two, are caused by the peculiarities of intrauterine blood supply to the fetus by the umbilical arteries and veins during pregnancy.

Alarming symptoms that require an ultrasound of the heart for an infant are:

• Sluggish sucking, lack of appetite and frequent regurgitation are caused by insufficient blood circulation in the child's body and a lack of energy in the muscle organs. In other words, the baby is exhausted, he does not have the strength to actively suckle. Parents report poor weight gain.
• Deformities in the chest and heart (sinking and protrusion) - associated with an increase in the size of the organ with combined defects.
• Tachycardia (increased heart rate). The norm for infants is 120-160 beats per minute. An increase in the level of heartbeat is a compensatory reaction of the body when there is insufficient blood supply to the tissues.
• Dyspnea (tachypnea) is characterized in children of the first year of life by a frequency of respiratory movements of more than 60 per minute with the involvement of additional muscles (intercostal and sternocleidomastoid muscles).
• Perioral cyanosis is a bluish tinge to the area around the mouth. This symptom indicates heart or lung failure. Depending on the appearance of cyanosis at rest or during physical activity (breastfeeding, crying), the severity of the disorders is determined.

Older children complain of chest pain, palpitations, swelling of the lower extremities, periodic cooling of the hands and feet.

The basis for the appointment of echocardiography to a child after an objective examination is the presence of:

• heart hump - a specific deformation of the chest;
• pathological intrathoracic murmurs (systolic, diastolic) with different pathways;
• systolic tremor of the chest in the area of ​​the projection of the apex of the heart;
• expansion of the diameter of the heart - determined by the percussion method, indicates an increase in the size of the organ.

In addition, the study is carried out in patients with a burdened family history (the presence of congenital heart defects in relatives) and frequent diseases of the respiratory system.

For what pathologies the study is repeated and how often

Ultrasound of the heart and blood vessels in a young child is most often associated with the presence of congenital defects that were not diagnosed during pregnancy:

• Open Botallov (arterial) duct is a connection between the aorta and the pulmonary artery system, which ensured the release of blood from the pulmonary circulation in the prenatal period. Normally, education should be sclerosed within 1 year.
• An open oval window is a physiological opening between the atria, which must be eliminated in the first hours of a baby's life.
• A defect of the interventricular septum is a pathological connection of the right and left ventricles, which, when deciphering ECHO-KG, is characterized by the presence of a discharge of blood from the left half of the heart to the right with an excessive load of the latter.
• Combined defects (tetrad and pentad of Fallot), which consist of a defect of the interatrial and interventricular septum, hypertrophy (increase in size) of the right ventricle, altered discharge of the great vessels. Such abnormalities require early diagnosis and surgical correction.
• Anomaly of attachment or the presence of an additional chord (muscle bundle) in the cavity of the ventricle.

The main causes of functional or organic murmur in the heart are pathologies of the valve apparatus: stenosis and insufficiency.

Stenosis is characterized by a narrowing of the lumen and a deficient filling of the ventricles with blood. The compensatory reaction is hypertrophy of the muscular layer of the atrium. Insufficiency of the valve apparatus is characterized by the absence of complete closure of the valves. Pathology is associated with the presence of regurgitation - the reverse flow of blood into the atrium during the contraction of the ventricles.

Congenital heart disease treatment involves surgery within the first 3 years of life. Dynamic monitoring of the state of health requires an ultrasound examination 2 times a year before surgery and once a year after it until reaching the age of majority.

Deciphering the results of echocardiography in children

The study is carried out in a standard outpatient setting of a diagnostic center or clinic. The duration of the procedure is no more than 15 minutes, during which the protocol is filled with the obtained parameters.

Deciphering of the obtained results of ultrasound of the child's heart is carried out by specialists who assess:

• the size of the chambers (both atria and ventricles);
• the thickness of the walls of the organ;
• the state of the valve apparatus (mitral, tricuspid, aortic and pulmonary valve);
• cardiac output (the amount of blood that enters the vessels after the heart contracts).

Features of the anatomical structure determine the different norms of ultrasound of the heart in children in the first years of life. The presence of an open oval window with an opening diameter of up to 19 mm and an insignificant blood flow through the Botall's duct is considered the norm until the age of 2 years.

Another characteristic feature of the formation of a conclusion during ultrasound diagnostics in infants is weight accounting. A birth weight of less than 3 kg implies the size of the atria up to 1.7 cm and the ventricles up to 2.2 cm, the blood flow velocity in the pulmonary artery up to 1.6 m / s. A child's weight from 3.5 to 4.5 kg is characterized by an increase in the ventricular cavity up to 2.5 cm and a decrease in blood flow velocity to 1.2 m / s.

Timely diagnosis of pathologies of the cardiovascular system in children allows you to prescribe treatment in the early stages and completely eliminate the symptoms before the onset of critical changes. The most commonly used method in clinical practice is echocardiography, which involves the use of ultrasound waves that are safe for health in order to visualize the structure and functional state of an organ.

The clinical diagnosis is made taking into account the family history, the characteristics of the course of the pathology and the existing symptoms. The conclusion based on the results of the ultrasound procedure is not a final diagnosis, but only an additional research method.

Decoding of ultrasound of the heart in children should be carried out taking into account age and individual characteristics. A competent analysis of the results obtained makes it possible to distinguish the physiological characteristic from a pathological defect and to determine the appropriate treatment tactics.