CHILDREN AND HEART DISEASES
The heart is an organ that pumps blood to all body parts. Fetal heart starts beating at 20 days of gestation and it contracts about 100.000 times each day and pumps 7.000-8.000 liters of blood to the body.
STRUCTURE OF HEART
The heart consists of four chambers. An atrium and a ventricle are located on the right side of the heart, and similarly, an atrium and a ventricle are present on the left side of the heart (Figure 1). The right side of the heart pumps the dark venous blood to the lungs to oxygenate the blood, while the left side of the heart pumps oxygen-rich blood to the rest of the body. There are walls between the right and the left hearts to isolate the oxygenated blood from the dark venous blood. Also, there are four valves in total; two of them are located between atria and ventricles, while the remaining ones are located in the orifice of greater blood vessels. The function of these valves is to ensure smooth forward flow of blood when the heart contracts, while it closes to prevent backflow of the blood while the heart relaxes.
PEDIATRIC HEART DISEASES
Pediatric heart diseases can be divided into two main groups; congenital and acquired. In contrast to adults, congenital heart diseases account for the majority of the pediatric cardiac diseases. These children are born with some structural problems in the heart. Structural disorders are secondary to abnormal heart development in very early pregnancy (heart development is completed at 7 weeks of gestation) and mostly in the period that mother does not recognize that she is pregnant. Although the underlying cause of abnormal heart development is unknown in most cases, it has been demonstrated that some viral diseases (rubeola, german measles, mumps, some microbes that case common cold etc.) play role in this condition. Also, hereditary (through genes) and chromosomal anomalies (the risk of heart disease is 50% in children with Down Syndrome) are considered among the factors that increase the risk of congenital heart disease. In addition, it is reported that some medications (anti-epileptic agents and medications used for neurological disorders) and alcohol particularly in the first trimester of pregnancy cause cardiac developmental disorder. On the other hand, it is not possible to know that whether the disease is caused by these factors or not. Therefore, if there is no definitely proven cause, parents should not feel guilty about that.
The severity of these structural disorders in the heart varies from a simple problem, like a small "hole" between the chambers, to more complex and serious disorders, like absence of one or more chambers or valves.
For each mother, the risk of giving birth to a newborn infant with a congenital heart disease is 8/ 1000 births. Accordingly, approximately 10.000-15.000 children are born with congenital heart disease in our country. Critical diseases that require surgical procedure before the age of one account for approximately half of this figure. If parents have a child with congenital heart disease, the risk will be approximately two folds higher for the subsequent children (16/1000). If the mother or father has congenital heart disease, the risk varies from 2% to 16% for the child. Recently, it is possible to examine heart of fetus and identify major heart anomalies between 16 weeks and 20 weeks of high-risk pregnancies thanks to “Fetal Echocardiography" that is applied by well-trained specialists. However, there is no option of intrauterine treatment yet.