PATHOMORPHOLOGICAL CHANGES IN THE LUNGS IN CONGENITAL HEART DEFECTS IN CHILDREN

The aim of the research. To study the pathomorphological features of the respiratory system lesions in children with congenital heart defects.

Materials and methods. The study included data from 36 deceased children with diagnosed congenital heart disease at the age from 1 month to 3 years (2.3 ± 4.9 months) with diagnosed congenital heart disease, of which 11 (31%) girls and 25 (69%) boys. Antenatal and postnatal clinical characteristics of the observation group were given on the basis of clinical and anamnestic parameters. Descriptive macroscopic and microscopic characteristics of histological sections of the lung tissue of children with congenital heart defects complicated by heart failure are presented, cytomorphometry of alveolar tissue (length and width of alveoli, thickness of interalveolar spaces) was performed.Statistical data processing was carried out using the Microsoft Excel 2007, Statistica v.10.0 software package.

Results. In the presence of congenital cardiovascular disorders, the development of pulmonary heart diseases was the main cause of death among children. Morphological signs of the presence of congestive heart failure and pulmonary hypertension are intraalveolar and interstitial edema, perivascular fibrosis, peribronchial vessel pericalibration. Signs of remodeling of the wall of the bronchial tree are dystrophic changes in the cells of the mucous membrane, edema of the walls of the bronchi, dilation and plethora of blood vessels, hemorrhages, hypertrophy and hyperplasia of the smooth muscle component. In children with congenital heart defects, the hickness of the interalveolar septa is 2 times greater, the alveoli are reduced in size, their length is 2.6 times and their width is 1.8 times less than in children of the comparison group (p <0.05).

Conclusion. The data obtained indicate the presence of pathomorphological changes in the wall of the bronchi and the architectonics of the alveoli in children with congenital heart disease with hypervolemia of the pulmonary circulation.

1. Bogachevskaya S.A., Kapitonenko N.A., Bogachevskiy A.N. Epidemiological characteristics of congenital heart defects in Russia and the Far Eastern Federal District over the past 10 years. Dal'nevostochnyy meditsinskiy zhurnal. 2016. 1. 96-101. in Russian.

2. Kemel'bekov K.S., Kozhakhmetova U.A., Kosymbetova Sh. K., Kuzenbaeva A.E. The structure of the prevalence of congenital heart disease in newborns in the modern world and Kazakhstan (literature review). Molodoy uchenyy. 2020. 2(292). 59-62. in Russian.

3. Bano S., Akhtar S, Khan U. Pediatric congenital heart diseases: Patterns of presentation to the emergency department of a tertiary care hospital. Pak J Med Sci. 2020. 36(3). 333-337. DOI: 10.12669/pjms.36.3.1592.

4. Gundogdu Z., Babaoglu K., Deveci M. et al. A study of mortality in cardiac patients in a pediatric intensive care unit. Cureus. 2019. 11(11). 6052. DOI: 10.7759/cureus.6052

5. Samsygina G.A. Cough in children. Clinical guidelines. Moscow : GEOTAR-Media, 2017. 176 p. ISBN 978-5-9704-4160-2. in Russian.

6. Strukov A.I., Serov V. V. Pathological anatomy: textbook. 5th edition. Moscow : Litterra, 2010. 880 p. in Russian.

7. Tatochenko V.K. Respiratory diseases in children: a practical guide. 2nd edition. Moscow, 2015. 396 p. in Russian.

8. Verhoeff K., Mitchell J.R. Cardiopulmonary physiology: why the heart and lungs are inextricably linked. Adv Physiol Educ. 2017. 41. 348–353. DOI: 10.1152/advan.00190.2016.

9. Pediatric cardiology. Ed. A. D. Tsaregorodtseva, Yu. M. Belozerova, L. V. Bregel'. Moscow : GEOTAR-Media, 2014. 784 p. ISBN 978-5-9704-2816-0. in Russian.

10. Miklashevich I.M., Shkol'nikova M.A., Gorbachevskiy S.V. et al. Modern strategy for the treatment of pulmonary hypertension in children. Kardiovaskulyarnaya terapiya i profilaktika. 2018. 17(2). 101-124. in Russian.

11. Clinical practice guidelines for the management of children with congenital heart defects. Ed. L.A. Bokeriya. Moscow : NTsSSKh named fater A.N. Bakulev. 2015: 342 p. ISBN 978-5-7982- 0342-0. in Russian.