Pediatric cardiology

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The pediatric cardiology the study of the congenital and acquired diseases of the heart in children. It is an independent branch of paediatrics that is closely linked to pediatric cardiac surgery ( part of surgery ).

In order to correct heart defects as early and as far as possible, before consequential damage occurs, close cooperation between the " cognitive " pediatric cardiology department and clinic with the invasive pediatric cardiology department - which work diagnostically and interventionally in cardiac catheter laboratories - and the pediatric heart surgery department is necessary Define the optimal palliative and curative therapy options in each individual case . An early surgical treatment of congenital heart malformations is possible today (2007) both technically ( heart-lung machine ) and based on the experience of surgeons for most diseases.

Congenital, congenital malformations of the heart or vessels near the heart

  • Heart in general:
    • Atrio-ventricular septal defect (= AVSD - AV canal) - (malformation of the cardiac septum at atrial and ventricular level + malformation of tricuspid valve and mitral valve)
    • Atrial septal defect (= ASD) - atrial septum defect with the characteristics Persistent Foramen ovale (= PFO), ASD II, ASD I and sinus venosus defect (hole in the heart septum between the atria)
    • Ebstein's anomaly (malformation of the tricuspid valve between the right atrium and right ventricle with shifting of the valve plane downwards)
    • Fallot tetralogy (complex heart malformation, consisting of a narrowing of the pulmonary valve (pulmonary stenosis), a ventricular septal defect, the "preparing aorta" and an increase in the cardiac muscle mass of the right heart)
    • Persistent foramen ovale (= PFO) (see also ASD II) (remaining fetal connection in the atrial septum)
    • Pulmonary vein malocclusion
    • Shone complex (complex malformation of the left heart)
    • Single ventricle :
      • with a functionally effective left ventricle. The right ventricle (pulmonary circulation) is not sufficiently developed.
      • with a functionally effective right ventricle. The left ventricle (body circulation) is not sufficiently developed.
    • Transposition of the large arteries (= TGA) - pulmonary artery (arteria pulmonalis) and aorta are connected to the wrong ventricle in the wrong place. This means that the circuits normally connected in series are connected in parallel and the body receives (unless there is an additional shunt ) unsaturated blood. Cannot survive without additional malformations or rapid intervention.
    • Corrected transposition of the large arteries (= CTGA, cTGA or ccTGA) - complex malformation in which the ventricles are reversed: the atria are connected to the "wrong" ventricles, the large arteries also originate from the "wrong" ventricles (Transposition). This double exchange ensures a functioning blood circulation and the child is not cyanotic. Often combined with other defects (e.g. valve malformations, pulmonary stenosis, mitral regurgitation). Symptoms minor to severe.
    • Truncus arteriosus communis (= TAC) (aorta and pulmonary artery are not completely separated, aortic valve is malformed as "truncus valve", ventricular septal defect)
    • Ventricular septal defect (= VSD) (hole in the main ventricular septum )
  • Vascular and valve malformations:

Diseases of the conduction system

Acquired heart and heart-lung diseases

Current situation

While therapies were very limited in the early days of modern pediatric cardiology, various simple surgical techniques emerged after 1950 (e.g. Blalock-Taussig anastomosis ). After the introduction of heart-lung machines for children, things made rapid progress, so that since the late 1980s, with the Fontan operation, even univentricular hearts could be operated on palliatively and both the Ross operation and the Norwood operation can be performed frequently. The diagnosis of congenital heart defects has been greatly improved thanks to the development of good ultrasound devices , and magnetic resonance imaging (MRT) is now also being used to an increasing extent for diagnosing congenital heart defects.

The "modern" operated former children (now 20-40 years old) continue to receive medical care mainly from pediatric cardiologists in heart centers or their own practice. Due to their previous training, cardiologists and internists are not at all or barely familiar with congenital heart defects, so that there may be gaps in care for young and adult patients in the outpatient sector. Meanwhile, there are also more and more heart centers for congenital heart defects, in which special consultations are offered for adult patients with congenital heart defects, and since 2011, three competence centers for adults with congenital heart defects (GUCH) have also been certified in Germany. There, a new “additional qualification EMAH” for specialists and close interdisciplinary cooperation with other specialist clinics can ensure high-quality treatment for patients.

At the experimental stage, there are attempts (2004) to surgically correct some malfunctions of the heart already in the womb in order to prevent consequential damage (for example, to surgically open a valve atresia to avoid ventricular hypoplasia) or to treat cardiac arrhythmias in children prenatally .

In addition to diagnosing and treating congenital heart defects, pediatric cardiology also deals with early acquired heart and vascular diseases as well as arrhythmias . The prevention of later cardiovascular diseases is also one of the goals.

During a normal examination in children, an EKG , auscultation, and sonography are performed.


  • Interventional cardiac catheters :
    procedures that are not restricted to a specific application are listed here:
    • Coils - usually wire structures with which vessels can be closed using cardiac catheters
    • Balloon dilatation of a heart valve or a vessel: the stenotic (narrowed) heart valve or the vessel is charged with the aid of a balloon catheter distended
    • Rashkind maneuver = balloon atrioseptostomy - tearing open the atrial septum using a balloon catheter
    • Stent implantation - stents are small tubes made of plastic or metal that are inserted into a narrowed vessel using a cardiac catheter. You keep the vessel open and can, for. Sometimes "dilated" (stretched) as the child grows.
  • Operations:
    Surgical procedures not limited to one application. The special surgical procedures are usually listed with the individual heart defect descriptions:
    • Blalock-Taussig anastomosis - connection between the large artery (carotid artery) and pulmonary artery to improve the pulmonary blood flow in right heart problems
    • Glenn anastomosis - connection of the upper body vein with the pulmonary arteries, first step to the fountain circulation
    • Fontan operation - surgical technique to separate the circulation, usually in two steps: Glenn + TCPC
    • Pulmonary banding (narrowing of the pulmonary artery by a ribbon in left-right shunt heart defects)
    • TCPC (= total Cavo- Pulmonale Connection) (complete venous-pulmonary artery connection, after connection of the lower body veins with the pulmonary arteries, completion of the fontan circulation.)

Medication for anticoagulant ( anti-coagulation )

With some heart defects, and especially after they have been corrected, patients are given long-term anti-coagulant drugs to reduce the risk of thrombosis .

When orally administered medications are in addition to acetylsalicylic acid ( ASA, aspirin the different acting group) of coumarin ( warfarin, Warfarin® ) are available. All drugs that have an influence on blood coagulation must be used before operations, etc. be discontinued in time.

The third active ingredient is heparin , which is mainly given in the clinic and intravenously or subcutaneously . It works immediately with a very short half-life. Low molecular weight heparin is also injected subcutaneously and has a longer efficacy, so it only needs to be administered once or twice a day and can also be used at home.

The long-term use of coumarins requires regular blood tests, which the patient or his or her parents can usually do themselves. The blood coagulation status, which can fluctuate after the increased consumption of foods containing vitamin K or possibly as a result of infections, must then be balanced by adjusting the drug dose. This problem does not exist with the administration of ASA and heparin.


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