European International Journal of Multidisciplinary Research
and Management Studies
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TYPE
Original Research
PAGE NO.
149-153
DOI
OPEN ACCESS
SUBMITED
24 December 2024
ACCEPTED
26 January 2025
PUBLISHED
28 February 2025
VOLUME
Vol.05 Issue02 2025
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Clinical and Instrumental
Features of Minor Cardiac
Anomalies in Children
Achilova Feruza Akhtamovna
Senior Lecturer at the Department of Propaedeutics of Childhood
Diseases, Samarkand State Medical University, Uzbekistan, Samarkand
Abstract:
Currently, a new term, Connective Tissue
Dysplasia (CTD), has been introduced in pediatric
disease clinics, which influences the child's health in the
long term. Among these conditions are minor cardiac
anomalies (MCA), which involve anatomical changes in
the architecture of the heart and major vessels that do
not lead to severe dysfunction of the cardiovascular
system (1,3,5,10).
Keywords:
Connective Tissue Dysplasia (CTD), heart
rhythm disorders.
Introduction:
Currently, a new term, Connective Tissue
Dysplasia (CTD), has been introduced in pediatric
disease clinics, which influences the child's health in the
long term. Among these conditions are minor cardiac
anomalies (MCA), which involve anatomical changes in
the architecture of the heart and major vessels that do
not lead to severe dysfunction of the cardiovascular
system (1,3,5,10).
To date, studies on CTD have led to the conclusion that
cardiovascular pathology is the most common disorder
in individuals with CTD. Cardiovascular dysfunctions are
among the leading causes of reduced life expectancy in
these patients (2,6). The frequency of detecting heart
rhythm disorders in individuals with CTD ranges from
18% to 91%, according to the literature (3,8,9,13).
Although arrhythmic syndrome in MCA is not life-
threatening, it negatively affects the patient’s quality of
life.
There are only a few studies dedicated to examining the
functional characteristics of the cardiovascular system
in MCA in children. However, a comprehensive
assessment of cardiovascular system changes would
allow for better prognosis and early diagnosis of heart
rhythm disturbances in MCA patients. This, in turn,
would improve quality of life and delay the onset of
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European International Journal of Multidisciplinary Research and Management Studies
disability (7,11,12).
Changes in Cardiovascular Pathology in Children Over
the Last Decade: A Focus on Minor Cardiac Anomalies
Over the past decade, the structure of cardiovascular
pathology in children has undergone significant
changes. There has been an increase in the prevalence
of arrhythmias, cardiomyopathies, and congenital
heart defects. In recent years, conditions associated
with connective tissue dysplasia (CTD) and its impact
on the heart have gained increasing attention.
Among
cardiovascular
pathologies,
functional
disorders and conditions linked to minor cardiac
anomalies (MCA) play an important role. When
specifically searched for, ultrasound methods detect
MCA in 97-99% of children. There are approximately 30
different types of microanomalies in heart
development. On the one hand, these anomalies may
appear relatively "harmless"; on the other hand, they
can lead to various disturbances in cardiovascular
function and significantly impact intracardiac
hemodynamics. It is now widely accepted that MCA is
pathogenetically linked to CTD syndrome, which is a
generalized and progressively worsening condition
over time. Therefore, each microstructural anomaly of
the heart requires an individual prognostic
assessment.
Objective of the Study
Given this, the objective of the present study is to
analyze the clinical and functional manifestations of
MCA in children and to identify the functional
characteristics of the cardiovascular system associated
with this pathology.
METHODS
We examined 52 pediatric patients aged 3 to 15 years
with MCA, all of whom were receiving treatment in the
cardiorheumatology department of a medical center.
A control group of 30 healthy children was included for
comparison.
The diagnosis of MCA was established based on:
•
Medical history,
•
Objective clinical data,
•
Findings from clinical and paraclinical
investigations,
•
Echocardiographic (ECG) parameters.
The clinical examination involved:
•
A detailed history, including early antenatal
developmental indicators,
•
Health status of the mother, pregnancy
conditions, and childbirth history,
•
Information
on
the
child’s
postnatal
development.
Assessment of exercise tolerance in children with MCA
was conducted using the Shalkov test.
An electrocardiogram (ECG) was recorded at rest using
a three-channel electrocardiograph in 12 standard
leads. The ECG analysis focused on:
•
Duration of waveforms and intervals,
•
Presence
of
rhythm
and
conduction
disturbances,
•
Repolarization abnormalities,
•
Signs of cardiac overload,
•
Evaluation of electrical systole (QT interval),
calculated as the difference between the expected QT
and the actual QT, adjusted for age**.
Ultrasound examination of the heart was performed
using one-dimensional and two-dimensional scanning,
combined with Doppler studies in pulsed-wave mode.
Structural analysis of the heart was conducted from
standard imaging positions, utilizing:
•
Parasternal access,
•
Apical access,
•
Subcostal access,
•
Suprasternal access.
This comprehensive diagnostic approach is essential for
identifying early rhythm disturbances and evaluating
the impact of MCA on cardiac function, ultimately
improving long-term prognosis and quality of life in
affected children.
RESULTS AND DISCUSSION
Among the 52 children diagnosed with minor cardiac
anomalies (MCA), the most frequently detected
condition was mitral valve prolapse (MVP), which was
observed in 23 (42.2%) of the cases. Anomalous chords
of the left ventricle (ACLV) were found in 19 (36.5%) of
the children, while combined MCA (MVP associated
with intraventricular formations) was identified in 10
(19.2%) of the patients.
Gender Differences: MVP was more common in girls
than in boys, with 64.3% of cases occurring in females
and 35.7% in males.
Prenatal and Perinatal History:
•
Among children with MVP, 56.5% were born
after complicated pregnancies and deliveries.
•
17.4% of mothers had a history of threatened
miscarriage, while 30.4% had early or late gestosis.
•
Acute respiratory infections and maternal
inflammatory diseases of the urogenital tract were
found in 39.1% of cases.
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•
Among children with ACLV, 54.1% had
perinatal complications, the most common being weak
labor activity (20.8%) and premature rupture of
membranes requiring operative delivery (12.5%).
•
Premature birth, post-term deliveries, and
premature rupture of membranes were observed in
52.3% of children with MVP.
•
In the combined MCA group, 21.05% (18
patients) had a history of premature birth and
umbilical cord entanglement, which was significantly
higher than in the control group (p<0.01).
Clinical Symptoms and Variants of MCA
The clinical presentation of MCA in children varied and
was influenced by autonomic instability, including:
•
Cardiac symptoms: Chest pain (cardialgia) and
palpitations
•
Neurological
symptoms:
Headaches
(cephalalgia) and dizziness
•
Abdominal syndrome
•
Joint pain (arthralgia)
•
Increased fatigue
There were no significant differences in clinical
symptoms between healthy children and those with
isolated MCA. However, in the combined MCA group,
cardiac syndrome (chest pain, palpitations, p<0.01)
and fatigue were more common than in the healthy
children.
Variants of MVP
Two clinical forms of MVP were identified:
1.
Mildly symptomatic MVP (5 children, 21.7%)
o
No complaints from patients
o
Detected
accidentally
during
echocardiography
o
Auscultatory signs included soft systolic
murmurs (48.2%) and isolated clicks (27.7%)
o
Degree of valve prolapse ranged between 4-6
mm, with no mitral regurgitation
2.
Clinically significant MVP (18 children, 78.2%)
o
Palpitations (74.4%)
o
Chest pain (28.2%)
o
Headaches (32.3%)
o
Dizziness (29.8%)
o
History of syncope (14.7%)
Exercise Tolerance
Assessment of exercise tolerance using the Shalkov
test revealed functional impairment in the MVP group:
•
In 72.2% of children, blood pressure and heart
rate returned to normal only by the 7th
–
8th minute
after the 5th and 6th test stages, indicating cardiac
dysfunction.
•
Auscultatory findings showed isolated systolic
clicks and systolic murmurs in 93.7% of cases.
Phenotypic Features of Clinically Significant MVP
Children with clinically significant MVP were more likely
to have:
•
Asthenic div type (28.2%)
•
Low div weight (32.3%)
•
Joint hypermobility (55.5%)
•
Flatfoot deformities (44.4%)
These phenotypic markers of connective tissue
dysplasia (CTD) were significantly less frequent in
children with mildly symptomatic MVP.
Echocardiographic and Electrocardiographic Findings
•
Mitral regurgitation was detected in 54.8% of
children with clinically significant MVP.
•
Arrhythmias were found in 53 (82.8%) of
children with MCA, which was significantly higher than
in the control group (11 children, 36.6%).
•
Comparison of groups showed that children
with MVP+ACLV had a higher prevalence of ventricular
extrasystole, prolonged QT interval, and a tendency for
multiple types of arrhythmias, compared to isolated
ACLV cases.
•
Supraventricular ectopic rhythms and QT
prolongation were also more common in the MVP+ACLV
group compared to isolated MVP cases.
CONCLUSION
The findings suggest that:
•
MVP and ACLV are the most common types of
MCA in children.
•
Prenatal and perinatal complications play a
significant role in the development of MCA.
•
Clinically significant MVP is associated with
higher rates of cardiac symptoms, autonomic
dysfunction, and exercise intolerance.
•
Arrhythmias,
mitral
regurgitation,
and
structural heart abnormalities are more frequent in
children with combined MCA (MVP+ACLV) than in
isolated cases.
•
Early diagnosis and comprehensive monitoring
of MCA in children are essential for preventing
complications and improving quality of life.
Also, on the electrocardiogram (ECG) of the examined
patients, nonspecific changes in the terminal part of the
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ventricular complex were identified in the form of a
decrease in the amplitude of the T waves in standard
and left precordial leads in 38.9% of patients, as well as
a downward shift of the ST segment in 33.3% of
patients. Heart rhythm and conduction disturbances
based on standard ECG data were detected in 47.8% of
children with clinically significant MVP and were
represented by extrasystole in 36.4% of patients,
pacemaker migration in 18.2% of patients, secondary
QT interval prolongation over 440 ms in 18.2% of
patients, and sinus tachycardia in 27.3% of patients.
The study of clinical and laboratory signs in
anomalously located chords of the left ventricle
(ACLV), classified as additional structures in the left
ventricular cavity, revealed an equal frequency in boys
(52.3%) and girls (47.6%). Among 84% of patients with
ACLV, complaints were noted of poor tolerance to
physical exertion in 63.2% of patients, cardialgia in
26.3%, headaches in 21.0%, "respiratory neurosis" in
15.8% of patients, as well as syncope in 10.5% of
patients. Auscultatory examination in ACLV revealed a
characteristic systolic murmur of the “chordal squeak”
type, most frequently registered in the apex of the
heart, without extracardiac conduction.
In children with additional structures in the left
ventricle, the following phenotypic signs of connective
tissue disorders were significantly more common than
in children with MVP: asthenic constitution in 47.4% of
patients, skin hyperelasticity in 57.8% of patients,
myopia in 31.6% of patients. Patients with ACLV had
three or more phenotypic signs of connective tissue
dysplasia. Assessment of exercise tolerance using the
Shalkov test in 68.4% of patients revealed a decrease,
manifested as the restoration of heart rate and blood
pressure at the 8th-9th minute after performing the
6th and 7th tests.
ECG changes in 63.2% of patients with ACLV included
heart rhythm disturbances in the form of
supraventricular extrasystole registered in 21.0% of
patients with this anomaly, ventricular extrasystole in
36.8% of patients, pacemaker migration in 36.8% of
patients, shortened PQ interval in 10.5%, and sinus
tachycardia and bradycardia in 15.8% of patients.
In children with combined MCA, where both MVP and
ACLV and other types of MCA were identified,
complaints were more often associated with cardiac
syndrome (cardialgia, palpitations) in 7 (70%) patients,
headaches and dizziness in 4 (40%) patients,
abdominal syndrome in 1 (10%) patient, and increased
fatigue in 6 (60%) patients.
Phenotypic signs of connective tissue dysplasia were
significantly more frequent, including asthenic
constitution in 30% of patients, joint hypermobility in
40% of patients, skin hyperelasticity in 20% of patients,
posture disorders in 10%, and myopia in 30% of
patients. A systolic murmur of varying intensity,
changing with div position, was found in 100% of
patients in this group.
Comparison of the studied groups revealed that cardiac
syndrome was more characteristic of children with
combined structural heart abnormalities than in
children with isolated ACLV (p<0.05) and isolated MVP
(p<0.01).
Thus, the study of the prevalence of minor heart
anomalies (MHA) in children aged 3 to 15 years revealed
that mitral valve prolapse (MVP) with significant clinical
manifestations was the most common, occurring in 23
(42.2%) children with MVP, followed by anomalously
located chords of the left ventricle (ALCLV) in 19 (36.5%)
cases, and combined MHAs in 10 (19.2%) cases.
According to our research, the genesis of various types
of MHA is influenced by pregnancy and childbirth
pathologies, maternal age, and the number of
pregnancies in mothers of children with MHA.
In children with MHA, physical changes in the heart
were frequently detected, and ECG studies revealed
nonspecific changes in the terminal part of the
ventricular complex, as well as disturbances in heart
rhythm and conduction. The assessment of the
functional state of the cardiovascular system through
exercise tolerance and ECG parameters showed
significant changes in the group of children with
clinically significant MVP and combined MHA.
It is important to note that phenotypic signs of
connective tissue dysplasia (CTD), which also indicate
the presence of MHA, include asthenic constitution,
joint hypermobility, skin hyperelasticity, posture
disorders, and myopia.
The study of ECG parameters in patients with combined
MHA (MVP, ALCLV) revealed a high frequency of
arrhythmias. Notably, in this group, 10 patients were
diagnosed with prolonged QT syndrome, which can lead
to life-threatening cardiac arrhythmias. The frequency
of detected heart arrhythmias increases with the
combination of microanatomical anomalies.
REFERENCES
Ачилова
Ф.А.,
Жалилов
А.Х.
Данные
эхокардиографии при малых аномалиях сердца у
детей. E
- Conference Zone. 2022.
Ачилова
Ф.А.,
Жалилов
А.Х.
Показатели
эхокардиографии при малых аномалиях сердца у
детей. Журнал проблемы биологии и медицины. №1
(93). стр. 33
-
35. 2017 г.
Ачилова Ф.А., Ибатова Ш.М., Абдукадирова Н.Б.
Распространенность малых аномалий сердца у детей
European International Journal of Multidisciplinary Research
and Management Studies
153
https://eipublication.com/index.php/eijmrms
European International Journal of Multidisciplinary Research and Management Studies
по данным эхокардиографии. Международный
журнал научной педиатрии. №5. Стр.11
-15.
Издатель ООО «I
-
EDU GROUP». 2022 г.
Богослав Т.В. Вариабельность ритма сердца у
больных первичным пролапсом митрального
клапана / Т.В. Богослав, В.Н. Медведева, В.В.
Медведев // Вестник аритмологии
- 2002. -
№26
-
С.67
-70.
Буланкина
Е.В.Синдром
дисплазии
соединительной ткани сердца у детей / Е.В.
Буланкина, В.В. Чемоданов, И.С. Горнаков //
Материалы 4
-
го Российского научного форума
«Традиции Российской кардиологии и новые
технологии в кардиологии XXI века».
-
М., 2002.
-
С.
43-44.
Дощицын B.Ж. Ведение больных с неугрожающими
жизни аритмиями сердца // Избранные лекции для
практикующих
врачей.
IX
Российский
национальный конгресс «Человек и лекарство» B.JI.
Дощицын.
-2002.-17-25.
Краснов М.В. Малые аномалии сердца у детей
.
Вестник аритмологии.
- 2000 -
№18
-
С.95.
Куприянова О.О. Нарушения сердечного ритма у
детей с пролапсом митрального клапана / О.О.
Куприянова // Вестник аритмологии.
- 2000.-
№18.
-
С.97.
Меньшикова Л.И. Дисплазии соединительной
ткани сердца в генезе
кардиоваскулярной
патологии у детей / Л.И. Меньшикова, О.В. Сурова,
В.И. Макарова// Вестник аритмологии.
- 2000. -
№19.
-
С.54
-56.
Осадчая Е.В. Электрокардиограмма при малых
аномалиях развития сердца у детей / Е.В. Осадчая,
Е.И. Науменко, Н.Д. Резепова // Вестник
аритмологии,
- 2000.-
№ 15.
-
С. 111.
Achilova F.A., Rabbimova D.T. The structure and
echocardiographic feature of small heart abnormalities
in children. Eurasian journal of medical and Natural
sciences. Innovative Academy Research Support
Center
Basso C. Ventricular Preexitation in Children and Young
Adults Atrial Myocarditis as a Possible Trigger of
Sudden Death / C. Basso, D. Corrado, L. Rossi, G. Thiene
// Circulation.- 2001.- Vol.103.- P. 269.
Colomina M. Prevalence of Asymptomatic Cardiac
Valve Anomalies in Idiopathic Scoliosis / M. Colomina,
L.Puig, C. Godet, C.Villanueva, J. Bago // Pediatr.
Cardiol.- 2002."- Vol. 23.- P. 26-29.
