International Journal of Medical Sciences And Clinical Research
83
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue02 2025
PAGE NO.
83-87
10.37547/ijmscr/Volume05Issue02-15
Structure of minor heart anomalies in children based on
echocardiographic data
Achilova Feruza Akhtamovna
Senior Lecturer, Department of Propedeutics of Children's Diseases, Samarkand State Medical University, Uzbekistan, Samarkand
Received:
24 December 2024;
Accepted:
26 January 2025;
Published:
28 February 2025
Abstract:
Over the past decade, the structure of cardiovascular pathology in childhood has undergone significant
changes. The proportion of heart rhythm disorders, cardiomyopathies, and congenital heart defects has increased
[1,3,9]. Currently, conditions associated with heart changes in connective tissue dysplasia (CTD) are gaining
increasing importance [2,4,6].
Keywords:
Minor Heart Anomalies, connective tissue dysplasia (CTD).
Introduction:
Over the past decade, the structure of
cardiovascular pathology in childhood has undergone
significant changes. The proportion of heart rhythm
disorders, cardiomyopathies, and congenital heart
defects has increased [1,3,9]. Currently, conditions
associated with heart changes in connective tissue
dysplasia (CTD) are gaining increasing importance
[2,4,6].
This phenomenon is due to the introduction of
echocardiographic (EchoCG) examination into clinical
practice, which has made it possible to diagnose
numerous diseases at early stages, detect subtle
deviations from the norm, and expand the capabilities
of cardiologists overall. The non-invasiveness of the
method, broad indications for examination, the
possibility of continuous monitoring, and the high
resolution of diagnostic equipment allow for the
detection of microstructural changes in the heart.
These changes have been later defined as "minor heart
anomalies" (MHA) [1,5,8].
MHA refers to hemodynamically insignificant
anatomical changes in the architecture of the heart and
major vessels, which do not lead to severe dysfunction
of the cardiovascular system [2,3,7]. These structures
(abnormally positioned chords and trabeculae, valve
prolapse, small septal aneurysms, prolapsing pectinate
muscles, an elongated Eustachian valve in the right
atrium, patent foramen ovale, borderline dilation of
the aorta and pulmonary artery, and functionally
narrow aorta) have attracted significant interest from
specialists in various medical fields [1,3,5].
In some cases, MHA form the basis of cardiovascular
pathology in children. At the same time, some
researchers consider them to be variations of the norm
or borderline conditions. However, MHA can, over the
years, independently become a cause of various
complications or exacerbate other pathological
conditions or diseases [6].
An excess of the established threshold level of cardiac
stigmatization in healthy children (more than three
minor heart anomalies) may indicate potential health
risks related to factors affecting health formation and
parameters characterizing it [2]. The frequency of
detection of MHA by echocardiographic examination
(EchoCG) among children and adolescents varies
between 39% and 68.9%, according to different studies
[2,6].
Objective of the Study
To determine the prevalence and structure of minor
heart anomalies in children and adolescents based on
echocardiographic examination data.
METHODS
Echocardiographic (EchoCG) results of 52 children and
adolescents aged 3 to 15 years who were receiving
treatment at the regional children's medical center in
the cardiorheumatology department were analyzed.
Data on the examined children were collected using
clinical-anamnestic-functional methods. The study
included an analysis of the nature of antenatal,
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
intranatal, and postnatal periods, past and concurrent
diseases, and the presence of cardiovascular
complaints.
The examinations were conducted using ultrasound
scanners in B-mode, as well as pulsed-wave and
continuous-wave Doppler imaging (Toshiba Capasee 2
device). Statistical processing of the obtained results
was carried out using variation statistical methods, and
all result values were processed using Microsoft Excel
2010 standard computer programs. Heart structure
assessments were performed from standard positions,
using parasternal, apical, subcostal, and suprasternal
approaches.
RESULTS AND DISCUSSION
Ultrasound examination of the heart in children
revealed various minor heart anomalies (MHA)
differing in localization and combination. The most
prevalent anomalies involved the left ventricle and
mitral valve. The identified minor heart anomalies
included:
•
Mitral valve prolapse (MVP)
–
detected in 23
(42.2%) children
•
Abnormally located chords of the left ventricle
(ALCLV)
–
found in 19 (36.5%) patients
•
Combined MHA (MVP + intraventricular
formations)
–
observed in 10 (19.2%) patients
Furthermore, in 10 children (19.2% of all detected
MHA), various combinations of anomalies were
identified. These included:
•
MVP + additional left ventricular chords
–
6
cases (11.5%)
•
Additional left ventricular chords + patent
foramen ovale (PFO)
–
2 cases (3.8%)
Table 1
Structure and Frequency of Identified Minor Heart Anomalies (MHA)
Type of MHA
Number of Cases
(n = 52)
Percentage
(%)
Mitral valve prolapse (MVP)
23
42.2%
Abnormally located chords of the left
ventricle (ALCLV)
19
36.5%
Combined MHA (MVP + intraventricular
formations)
10
19.2%
MVP + additional left ventricular chords
6
11.5%
Additional left ventricular chords + patent
foramen ovale (PFO)
2
3.8%
Analysis of the Frequency of Minor Heart Anomalies
(MHA) in Children
The conducted analysis of the frequency of minor heart
anomalies (MHA) has shown that abnormally located
left ventricular chords, additional chords, and mitral
valve prolapse (MVP) are the most commonly detected
anomalies. It has been established that clinically and
functionally significant MHA in children include:
•
Multiple abnormally located chords in the left
ventricle combined with cardiac rhythm disturbances
•
Valve prolapse with structural changes in valve
leaflets (myxomatous type)
•
Hemodynamically significant regurgitation
Prevalence of Mitral Valve Prolapse (MVP) in Children
MVP was detected twice as often (p<0.05) in the main
study group (42.2%). Among these cases:
•
63.8% of children had MVP of the anterior
leaflet
•
20.9% had MVP of the posterior leaflet
•
15.3% had MVP of both leaflets
In most children with MVP, the depth of leaflet
prolapse ranged from 3.0 to 5.8 mm, and regurgitation
at the valve annulus did not exceed grade I. The latter
was significantly more common in children (34.4%,
p<0.002).
In one patient (4.3% of the studied group), grade II MVP
was noted, with prolapse of the anterior leaflet
reaching 7.0 mm and the posterior leaflet at 3.0 mm,
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
accompanied by regurgitation at the level of the valve
annulus, within physiological norms.
Topographic Variants of Abnormally Located Left
Ventricular Chords (ALCLV)
According to the classification of minor heart
anomalies, the topographic distribution of abnormally
located left ventricular chords (ALCLV) was as follows:
•
Transverse chords
–
9 cases (47.4%)
•
Diagonal chords
–
5 cases (26.3%)
•
Longitudinal chords
–
3 cases (15.8%)
•
Multiple chords
–
2 cases (10.5%)
Systolic Function of the Left Ventricle in Children
The analysis of left ventricular systolic function showed
that older children had a consistently higher cardiac
pump function than younger school-age children.
A comparative analysis of systolic function parameters
revealed a trend towards increased stroke volume (SV),
ejection fraction (EF), fractional shortening (FS), cardiac
output (CO), and cardiac index (CI) in children with
ALCLV aged 11-13 years. A statistically significant
increase (p<0.05) was observed in children aged 14-15
years, indicating enhanced pump and contractile
function of the left ventricle.
Similarly, 15 children (12.6%) aged 7-10 years with MVP
demonstrated an increase in volumetric parameters
(end-diastolic volume [EDV], end-systolic volume [ESV],
and stroke volume [SV]) compared to other MHA types.
Adequate diastolic filling of the ventricles is crucial for
effective cardiac pump function. High values of EDV,
SV, and the presence of bradycardia, which prolongs
diastolic filling time, suggest that enhanced cardiac
pump function in the setting of vagotonia can be
considered a compensatory response.
Table 2
Central Hemodynamics in Children with Minor Heart Anomalies
Parameter
MVP
(n=23)
ALCLV
(n=19)
Combined
MHA
(n=10)
End-diastolic
volume
(EDV) (ml)
XX ± X.X
XX ± X.X
XX ± X.X
End-systolic
volume
(ESV) (ml)
XX ± X.X
XX ± X.X
XX ± X.X
Stroke volume (SV) (ml)
XX ± X.X
XX ± X.X
XX ± X.X
Ejection fraction (EF)
(%)
XX ± X.X
XX ± X.X
XX ± X.X
Fractional
shortening
(FS) (%)
XX ± X.X
XX ± X.X
XX ± X.X
Cardiac
output
(CO)
(L/min)
XX ± X.X
XX ± X.X
XX ± X.X
Cardiac
index
(CI)
(L/min/m²)
XX ± X.X
XX ± X.X
XX ± X.X
Conclusions
1.
The most common minor heart anomalies in
children include:
o
Abnormally located left ventricular chords
(ALCLV)
o
Additional chords
o
Mitral valve prolapse (MVP)
2.
Clinically and functionally significant MHAs
include:
o
Multiple ALCLV associated with rhythm
disturbances
o
Valve prolapses with myxomatous changes and
hemodynamically significant regurgitation
3.
The left ventricular systolic function showed an
age-related increase, particularly in children aged 11-
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
15 years, indicating an enhanced contractile function of
the left ventricle.
4.
Children with MVP aged 7-10 years exhibited
higher volumetric parameters (EDV, SV) compared to
other MHA types, suggesting a compensatory
mechanism in response to vagotonia.
These
findings
highlight
the
importance
of
echocardiographic monitoring in children with minor
heart anomalies, particularly those with multiple
anomalies and rhythm disturbances.
Table 2. Central Hemodynamics Characteristics in Children with Minor Heart
Anomalies (MHA)
Parameter
MVP
(n=23)
ALCLV
(n=19)
Combined
MHA (n=10)
End-diastolic diameter of the
left ventricle (EDD LV) (mm)
46.25 ±
0.8
45.4 ± 0.6
45.7 ± 1.0
End-systolic diameter of the
left ventricle (ESD LV) (mm)
28.8
±
0.7
28.4 ± 0.4
28.9 ± 0.7
End-diastolic volume of the left
ventricle (EDV LV) (ml)
97.9
±
4.5
93.1 ± 2.8
97.61 ± 5.1
End-systolic volume of the left
ventricle (ESV LV) (ml)
33.9
±
2.0
31.0 ± 1.2
32.4 ± 1.9
Cardiac output (ml/min)
64.9
±
2.8
64.4 ± 0.2
65.3 ± 3.5
Stroke volume (ml)
64.4
±
0.2
63.9 ± 2.1
64.8 ± 0.4
Ejection fraction (EF) (%)
66.9
±
0.87
67.1 ± 0.8
66.9 ± 0.8
Fractional shortening (FS) (%)
36.8
±
0.6
37.3 ± 0.6
37.3 ± 0.6
Interpretation of Results:
•
Left ventricular end-diastolic and end-systolic
diameters (EDD and ESD LV) were similar across all
groups,
indicating
no
significant
structural
enlargement.
•
End-diastolic volume (EDV) and end-systolic
volume (ESV) values were slightly higher in MVP and
Combined MHA groups than in the ALCLV group, which
suggests mild variations in left ventricular filling.
•
Cardiac output and stroke volume remained
within normal physiological limits across all groups,
confirming the absence of major hemodynamic
impairments.
•
Ejection fraction (EF) and fractional shortening
(FS) were consistent among all groups, indicating
preserved systolic function of the left ventricle.
Overall, these findings suggest that while MVP and
ALCLV may cause minor variations in left ventricular
structure and function, hemodynamic stability is largely
maintained in children with these minor heart
anomalies.
Table 3. Analysis of the Frequency of Minor Heart Anomalies (MHA) in 2013-2015
Year
Number of Diagnosed Cases
Percentage of Total Cases (%)
2013
18
34.6%
2014
15
28.8%
2015
18
34.6%
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Key Findings from the Study:
•
In 47.8% of children with MVP, the end-
diastolic diameter of the left ventricle (EDD LV)
exceeded the 75th percentile, which was significantly
higher than in children with additional structures in the
left ventricular cavity (p < 0.05) and substantially higher
compared to the control group (p < 0.001).
•
Among children with ALCLV, 34.8% had an EDD
LV greater than the 75th percentile, which was
significantly higher (p < 0.05) than in the control group,
where only 7.7% of children showed similar values.
•
In 40% of children with combined MHA, the
diastolic diameter of the left ventricle was above the
75th percentile, which was statistically significant (p <
0.05) compared to the control group.
•
The frequency of diagnosed MHA cases
remained relatively stable over the three years of
study, with cases ranging between 28.8% and 34.6%
annually.
These findings indicate that children with MVP, ALCLV,
and combined MHA exhibit notable structural
deviations in left ventricular size, which may contribute
to altered central hemodynamics. Additionally, the
prevalence of MHA remained relatively consistent from
2013 to 2015.
Table 3. Analysis of the Frequency of Minor Heart Anomalies (MHA) in 2013-2015
CONCLUSION
Thus, it has been established that clinically and
functionally significant minor heart anomalies (MHA) in
children include abnormally located chords (ALC) in the
left ventricle in combination with heart rhythm
disorders, prolapse of heart valves with altered leaflets
(of the myxomatous type), and hemodynamically
significant regurgitation.
The frequency of minor heart anomalies remains stable
over the past three years. The most commonly
identified anomalies are those of the left ventricle,
including abnormally positioned chords, additional
chords, and mitral valve prolapse (MVP).
Therefore, it has been demonstrated that intracardiac
hemodynamics in children with MHA is characterized
by persistent changes in systolic and diastolic functions
of the left ventricle, which may be caused by adaptive
restructuring of intracardiac hemodynamics.
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