Actual problems of congenital heart diseases in children (review of literature)

The organization of medical care for the population with congenital malformations of the cardiovascular system is an important public health task. The President of the Republic of Kazakhstan, N.A.Nazarbayev, in his message to the people of Kazakhstan, "New Kazakhstan in the New World," noted that one of the directions of state policy at a new stage in the development of our country should be the improvement of the quality of medical services and the development of a high-tech healthcare system. Improving the quality management of health services occupies an important place in the context of the strategic development of Kazakhstan's health care until 2020 [10].

Protection of the health of the child population is one of the conditions for the sustainable development of the future of Kazakhstan. Children with specific needs make significant changes in general health characteristics of the population and impose specific features on the immediate environment: family of relatives, etc.

The urgency and demand for cardiosurgical care in children does not raise any doubts. The problem of reducing mortality and improving the prognosis of life of newborns with anomalies in the development of the heart and blood vessels has always been the most urgent and difficult to solve in pediatric cardiac surgery and remains so today [5,6]. With the accumulation of experience, tactics and methods of treatment were improved, strict indications for performing a particular type of operation were determined [7,8].

Thanks to the implementation of the national project "Salamatty Kazakhstan 2011-2015", Funding and logistics of practical public health have improved significantly, and a preventive course has been stepped up [8]. Modern methods of diagnosis can detect in preterm infants those congenital malformations and anomalies of the heart and vessels that previously were not diagnosed and, as a consequence, not operated. Today the effective organization of care for patients with cardiovascular diseases is hampered by the lack of continuity in the provision of care at various stages of its implementation, the diversity of approaches to children. Studies that assess the need of the population for children under 1 year in certain types of cardiosurgical care in the domestic and foreign literature is extremely small [6,9].

The purpose of this literature review is to examine the contribution of the UPU to perinatal and early childhood mortality, disability and improvement of specialized medical care. Criteria for selecting publications for the review were the presence in them of the features of anatomy, physiology, clinic, diagnosis and treatment characteristic of newborns with CHD, the scientific approach and the results of the conducted studies, the longterm results of surgical correction of the UPU.

Congenital heart diseases are serious cardiovascular anomalies, accompanied by high mortality in the first year of life, and one of the main causes of stillbirth, infant and child mortality [2,4,7,8]. They belong to one of the leading places (stably second - third) and in the structure of children's disability [5,6]. Numerous studies by domestic and foreign authors show that for every 1000 newborns born alive, there are 4-17 children with heart disease [1-3]. The total mortality in congenital heart diseases is extremely high, by the end of the week 29% of newborns die, by the 1st month - 42%, by the year - 87% of children [5,7]. Congenital heart defects with a relatively favorable outcome: open arterial duct, defect of interventricular septum (DMVP), atrial septal defect (ASD), pulmonary artery stenosis; With these defects, the natural mortality rate in the first year of life is 8-11%; Tetralogy of Fallot, natural mortality in the first year of life - 24-36%. Complex congenital heart defects: left ventricular hypoplasia, pulmonary atresia, common arterial trunk; Natural mortality in the first year of life - from 36-52% to 73-97%. The presence of other (extracardiac) malformations, increasing the mortality in children with CHD to 90%.Childhood disability, along with demographic indicators and morbidity, is the most important criterion for the health of the child population [2,4,6,9]. Disability of children is one of the most acute medical and social problems of society [6,8].

Analysis of the structure of UPU among children with disabilities showed approximately equal shares of isolated (48.6%), combined (46.3%) and significantly fewer combined (5.1%) UPU. Among the UPU, a significant share is made by DMZP - 22.9%, tetralogy of Fallot - 14.2% and DMPP - 10.6%. The largest proportion of children with disabilities falls on the age groups 3-6 and 11-14 years (32.9% and 26.1%, respectively). At half of disabled children, the UPU is diagnosed in the neonatal period - 46.6%, every tenth over three years - 11.0%. Operative treatment received 56.2% of the disabled [3]. The level of primary disability in connection with CHD in children of early age is increasing [2].

Conclusions: Thus, the study of medical and social characteristics and factors determining the results of medical care for children with CHD is a very urgent task for modern cardiology, cardiac surgery and public health, the solution of which provides an opportunity for improving the medical care of this category of patients.

References

1. Abramyan M.A. Diagnostics, intensive therapy and effectiveness of radical correction of life-threatening heart defects in the period of newborns: the author's abstract. Dis Dr. honey. Sciences. M., 2012. 36 p.
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