Every year around 500 children in Bulgaria are born with congenital heart malformations. These are the most common congenital anomalies and affect between 8 and 10 per 1,000 newborns or 1.3 million children per year worldwide. In order for children with congenital heart malformations to grow up and create their own generation, their timely diagnosis, treatment and lifelong follow-up are of utmost importance. What are the modern methods in the early diagnosis of these diseases, how do they appear and what is their treatment, these questions are answered by Prof. Dr. Anna Kaneva, head of the Children's Cardiology Clinic at the National Cardiology Hospital (NCB).
Prof. Kaneva graduated in medicine in 1979.with excellent success. Since 1980, he has been an assistant in the Children's Cardiology Clinic at the NKB. There are two speci alties - pediatric diseases and pediatric rheumatic cardiology. In 2008, he defended his dissertation on the topic "Results of the surgical treatment of children with subvalvular aortic stenosis operated on in childhood". In 2010, he received the academic title of "associate professor", and since 2017 he has been a professor. Headed the Children's Cardiology Clinic at the hospital in 2014
Prof. Kaneva, tell us a little more about the Children's Cardiology Clinic that you lead
- The Children's Cardiology Clinic has almost 60 years of history. It is a unique structure for the country, in which children with cardiovascular diseases from all over the country are diagnosed, hospitalized, treated and followed up. Congenital heart malformations are the most common, but other cardiovascular diseases in children are also treated - diseases of the myocardium and pericardium, rhythm and conduction disorders, arterial hypertension, infectious complications of the cardiovascular system, etc.
What are the most common congenital heart malformations and what is their clinical picture?
- The spectrum of congenital heart malformations is very wide. On the one hand, their frequency is between 8-10 per 1000 live births. That is, every year about 1% of children born have a congenital heart malformation. In concrete figures for Bulgaria, every year around 500 Bulgarian children are born with a congenital heart malformation. Their spectrum is very wide. There are such abnormalities that are very mild, that are imperceptible and do not cause hemodynamic disturbances.
On the other hand, between 15-20% of newborn children with congenital heart malformations are in such a severe condition that solving their he alth problem must be done in the newborn period. These are the so-called critical cardiopathies. In terms of the clinical spectrum, the most common distinguishing feature is cyanosis. In some congenital heart malformations, there is a mixing of venous and arterial blood and the children have a bluish coloration of the skin. The others are pink.
There is a noise in them, there may be heart failure, but this is not visible at first glance. Otherwise, as the most common cardiac malformation, it is the defect in the interventricular septum.
Prof. Dr. Anna Kaneva
You said that the presence of a cardiovascular malformation is not always visible. What are the modern methods for the early diagnosis of these diseases?
- Extremely great progress has been made in the diagnosis of cardiovascular diseases and especially congenital heart malformations. The main place is occupied by non-invasive - bloodless research methods, such as echocardiography. With the help of echocardiography, congenital heart malformations can be diagnosed in utero - i.e. during the woman's pregnancy, after the 18th - 20th week. And after birth, echocardiography clarifies the diagnosis and allows tracking the evolution - natural, if they were not treated with surgery or interventional methods, or postoperative, if they were operated on, because the operated heart is not a he althy heart.
Other non-invasive methods that are widely used are 24-hour recordings of heart rate and blood pressure, assessment of exercise tolerance with a cardiopulmonary stress test, and magnetic resonance imaging. Without a doubt, X-ray research methods have their place - cardiac catheterization and computed tomography.
Of course, great progress has also been made in treatment
The classical treatment of the vast majority of congenital heart malformations was and largely remains surgical. But after the 1980s and especially after the beginning of the 21st century, the relative share of non-operative interventional methods of treatment - i.e. it is performed in the catheterization room under X-ray control.
What is the role of general practitioners and pediatricians in the diagnosis, treatment and prevention of cardiovascular diseases in children?
- The role is very big and I could look at it in several aspects. First, with regard to congenital heart malformations, which are the most common disorders of the cardiovascular system in childhood, pediatricians and general practitioners must be able to clinically assess the patient. And secondly, which is the main thing, they should refer him for consultation in a timely manner and then follow the recommendations that are given based on the special and specific research methods when the correct diagnosis is made.
Of course, general practitioners should advise patients to follow an environmentally friendly lifestyle, to avoid risky behavior and risk factors for other cardiovascular diseases that can appear in childhood, such as arterial hypertension.
In recent years, there has been talk about the frequent cases of arterial hypertension in children. What are the reasons for this?
- Arterial hypertension in childhood has been talked about in the last few decades, when the regular measurement of arterial pressure with the use of special cuffs in children began
Increased arterial pressure may be a clinical symptom of a disease of another organ or system. This is the so-called secondary hypertension and it occurs at any age, including the newborn child.
What you are asking about is probably cases of primary arterial hypertension. I.e. hypertension, in which no other reason for the increased arterial pressure is found. Indeed, its frequency is increasing all over the world, including in our country, and it is of the order of 5% in children over 10 years of age. One reason for this increase in incidence is lifestyle. Inactivity, overweight, family burden are all factors that cause high blood pressure in adolescence. Excessive use of canned foods, s alt, caffeinated drinks, risky behavior also leads to increased blood pressure. The recommendations are for blood pressure in children over 10 years of age to be below 120/80mmHg.
Is there a covid department in your clinic and what is the situation with small patients infected with coronavirus and suffering from cardiovascular diseases?
- The National Cardiology Hospital has opened covid wards for adult patients. Children with proven acute COVID-19 infection are hospitalized in other places - in the Infectious Diseases Hospital, in the Specialized Hospital for Children's Diseases and in "Pirogov". So we do not treat acute covid patients. But we are starting to treat late complications of covid infection.
It was thought that children were not affected by the virus, or if they were, it was to a lesser extent, and this is indeed the case. Children make up no more than 10% of the sick and those who have relapsed, and the vast majority are mildly ill. But with some of them, the infection affects the whole organism very seriously. A pathological immune response is triggered, a storm that can damage not only the lungs and heart but also the kidneys and brain. In fact, such children come to us. We have already hospitalized four children with serious heart damage after a covid infection.