Stenosis of the pulmonary artery in children: what is it?
Most often in children heart diseases are congenital, that is, those that develop in the fetus in the womb. Sometimes they can be detected during fetal development, but most often heart disease detected in newborns. There are many types of congenital heart defects, one of which is stenosis of the pulmonary artery (LA).
What is stenosis?
LA stenosis is a heart defect in which the narrowed pulmonary artery – the large blood vessel that carries blood from the heart to the lungs. This narrowing impedes blood flow, causing the right ventricle has to contract more, which leads to its thickening. Stenosis of LA can be:
- Valve – narrowing affects the valve LA.
- ‘s a supravalvular – narrowing main trunk LA, situated immediately over the valve.
- Subvalvular – narrowing of the output tract of the right ventricle due to thickening of subvalvular myocardium in the region.
- Stenosis of the branches of LA narrowing right, left, or two branches of the LA.
Sometimes pulmonary artery stenosis in children combined with other cardiac defects such as tetralogy of Fallot, atresia of the valve of the pulmonary artery or outdoor botallov duct.
The symptoms of stenosis LA
Most children with LA stenosis of moderate severity generally have no symptoms and appear quite healthy. However, in marked narrowing of the lumen of LA (more than 50%), the child may experience the following symptoms:
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- Shortness of breath.
- Frequent and heavy breathing.
- Rapid heartbeat.
- Swelling in the feet, thighs, face and abdomen.
In severe stenosis of LA in newborn blood, in connection with the increase in pressure in the right heart, through the open oval hole goes from the right atrium to the left. This causes in infants cyanosis – bluish color of lips and nail boxes. Cyanosis is associated with a reduction in the level of oxygen in the blood.
Diagnosis of stenosis LA
To suspect the presence of a congenital heart defect, the doctor may, after carrying out auscultation of the heart. Stenosis LA above it is possible to hear the characteristic pathological noise. To clarify the diagnosis is carried out:
- Electrocardiography – in mild stenosis it is usually normal, but in severe, it is possible to detect the signs of an increase and thickening of the right ventricle.
- Echocardiography is the most important non-invasive examination method, which can be used to identify stenosis of the LA and to assess its severity. It is also possible to detect or to rule out other heart defects.
- Cardiac catheterization is an invasive examination that allows physicians to accurately assess the degree of stenosis of the LA and its localization. For this the heart through a blood vessel is put a tiny catheter, which is inserted through the contrast agent and measured the level of pressure in the chambers of the heart. During cardiac catheterization is also performed pulmonary angiography – radiopaque study LA.
- Roentgenography of organs of a thoracic cavity determines the size and shape of the heart, lungs and pulmonary arteries.
- Perfusion scintigraphy of the lungs – examination, during which the patient is administered a small amount of radioactive drug, and then assess indicators of blood circulation in the lungs.
- Computed tomography with contrast or magnetic resonance imaging.
Treatment of stenosis LA
Treatment of stenosis of the LA depends on its severity and the age of the patient. As a rule, a moderate narrowing in one or two branches of LA does not need treatment. In more severe cases apply:
- Extension by means of the balloon. In this method, in the place of narrowing of the pulmonary artery is put a special catheter with a balloon. After positioning the balloon is gently inflated, thereby expanding the narrowed area. After this, the balloon is deflated and removed. Although most of the children after balloon expansion, the condition improves within a 15 – 20% of cases, with time the pulmonary artery at this location again, narrowing.
- Balloon expansion and stent implantation. To improve the results of balloon expansion, it is supplemented by the implantation of the stent. To the narrowed location of the pulmonary artery a specialized stent system, which is performed after the inflating the balloon to the recommended pressure. This inflated the balloon straightens the stent and implant it in the vascular wall in the place of narrowing. Similar procedure is carried out, for example, in diseases such as renal artery stenosis and ischemic heart disease.
- Surgery. For surgical reconstruction of the pulmonary artery, different methods are used. The proper choice of the operation depends on the characteristics of the stenosis, the properties of nearby blood vessels and other anatomical structures.