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Cardiology

 

 

Cardiology is one of our main fields. Individual comprehensive approach of our experts to the treatment of each patient allows to slow the progression of cardiovascular disease, and as a result, reduces the risk of heart attack, stroke, and heart surgery in the future.

 

We select narrow field expert for treatment each specific type of heart disease that makes treatment the most effective and helps improve the quality of life of our patients. In many cases, treatment may include several specialists from different fields of cardiology.

 

Most recommended cardiologists of Israel

 

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Among the main problems of our patients are as follows:

⇒ Arrhythmia

⇒ Coronary Heart Disease

⇒ Vascular stenosis

⇒ Problems aortic and mitral valves

⇒ Cardiomyopathy

⇒ Heart attack

⇒ Endocarditis

⇒ Atherosclerosis

⇒ Hypertension

⇒ Pericarditis

 

Congenital heart disease:

⇒ Patent ductus arteriosus

⇒ Pulmonary valve stenosis

⇒ Mitral valve insufficiency

⇒ Hypertrophic cardiomyopathy

⇒ Ventricular septal defect (VSD)

⇒ Atrial septal defect (ASD)

⇒ Coarctation of the aorta

⇒ Atrioventricular canal defect

⇒ Pulmonary valve stenosis

⇒ Aortic valve stenosis

⇒ Transposition of the great arteries

⇒ Tricuspid atresia

⇒ Persistent truncus arteriosus

⇒ Anomalous pulmonary venous connection

⇒ Сoronary artery anomaly ALCAPA

⇒ Tetralogy of Fallot

 

 

Cardiac surgery
Minimally invasive heart surgery (catheterization)

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Cardiac / heart tumors resection

Cardiac or heart tumor is an abnormal growth of tissue within the heart that can block blood flow, damage the valve, and increase the risk of stroke.

Any type of abnormal growth in the body can be malignant or benign. Malignant tumors grow rapidly and spread to other parts of the body, while benign tumors grow slowly and are often harmless, depending on the location.

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Transposition of the great arteries

Transposition of the great arteries is a rare congenital heart defect in which the two main arteries (pulmonary artery and aorta) connected incorrectly – the aorta extends from the right ventricle and the pulmonary artery from the left ventricle.

Transposition of the great arteries completely changes the circulation, resulting in not getting enough oxygen oraganam. Without an adequate supply of oxygen-rich blood the body can not function properly, causing the child serious complications or death in the absence of treatment.

Professor Avraham Lorber – specialist in pediatric cardiology and pediatric cardiology, director of Pediatric Cardiology and Congenital Heart Defects, Rambam Health Care Campus

Dr. Avraham Matityahu – specialist in pediatric cardiology, Director, Department of Pediatric Cardiology, Kaplan Medical Center

Transposition of the great arteries is usually determined in the first hours or the first few weeks of life. Corrective surgery is usually performed immediately after birth. With proper treatment the prognosis is promising.

Symptoms: The blue color of the skin, shortness of breath, lack of appetite, poor weight gain

Development Factors
Transposition of the great arteries occurs during fetal development, when the heart muscle is formed. At risk are children, whose mothers suffered rubella or other viral illnesses during pregnancy, mothers older than 40 years or those who have diabetes.
Other factors is a family history of transposition of the great arteries or other congenital heart defects, poor nutrition during pregnancy, alcohol consumption during pregnancy, Down syndrome.
Possible complications of transposition of the great arteries include:

The lack of oxygen in tissues (hypoxia), heart failure (condition in which the heart can not pump enough blood to meet the body’s needs), lung damage.
Operation is necessary for all children with transposition of the great arteries at an early age, usually within the first week.
Surgery can cause complications such as narrowing of the arteries that supply blood to the heart (coronary arteries), heart rhythm disturbances (arrhythmias), the weakening of the heart muscle, heart failure, rupture of the heart valve. To avoid complications, the operation should be performed by an experienced practitioner of pediatric cardiac surgery.

Diagnostics
Defect likely to diagnosed before birth.

In order to help we recommend our patients to come to delivery in Israel (up to 36 weeks of pregnancy), so that child could get emergency surgery to remove congenital defect.

For the diagnosis of postpartum our experts use such procedures as:
1. A physical examination of the child
2. Echocardiography (ultrasound of the heart) – play a dynamic image of the heart, for the diagnosis of transposition of the great arteries, according to the position of the aorta and pulmonary artery. An echocardiogram may also identify other related transposition, vices, such as ventricular septal defect, atrial septal defect, patent ductus arteriosus.
3. Chest X-ray. Although it does not give a definitive diagnosis of transposition of the great arteries, it allows the physician to define the size of the heart of child as well as the position of the aorta and pulmonary artery.
4. ECG. An electrocardiogram records the electrical activity of the heart every time it contracts.
5. Coronary angiography (catheterization). This procedure is usually done only when other tests such as echocardiography do not give enough information to make a diagnosis. During catheterization, the doctor inserts a thin, flexible tube (catheter) into an artery or vein in the groin of the child and brings him to the heart. As the catheter is fed contrast agent that stains the blood vessels, which allows the physician to consider in detail the heart and blood vessels and identify any possible anomalies. This routine also measures the pressure in the heart and blood vessels of the child. Using a catheter main vessels may be mounted stent which helps to restore normal blood flow.

Surgery
Before the operation can be assigned medicines in order to strengthen the heart muscle of the child.

Balloon atrial septostomy. The procedure, which is performed if necessary the creation or enlarging of atrial septal defect, in order to facilitate discharge of oxygenated blood from left to right. To do this, the left atrium through the patent foramen ovale injected cylinder and filling it, then pulled back. This can improve the oxygen-rich blood flow to the organs of the child.

Arterial switch. Surgeons usually perform this operation in the first month of life. During surgery pulmonary artery and the aorta is restored to its normal condition and connected correctly to function properly.

If the child has an atrial septal defect it is also adjusted during operation.

After surgical correction child needs constant supervision by a cardiologist who specializes in congenital heart disease. Cardiologist may recommend the child to avoid certain activities, such as lifting weights, because they increase blood pressure and may cause damage to the heart muscle.

Most children undergoing surgery arterial switch do not need further operations. Nevertheless, for some complications, such as arrhythmia, or valvular heart failure, may require additional treatment.

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Atrioventricular canal defect

Atrioventricular canal defect (endocardial cushion defect (ECD)) is an abnormal heart condition in which the walls separating all four chambers of the heart, formed incorrectly or entirely missing. This anomaly is a congenital heart defect.

Causes and risk factors
Endocardial cushion defect occurs during fetal development. Endocardial cushions are two areas of thickening, which eventually are transformed into a partition separating the four chambers of the heart. They also form the mitral and tricuspid valves that separate the atria from the ventricles.

Dr. Samuel Diamond – Director of the Department of Pediatric Cardiology, Medical Center of Dan Tel Aviv (Ichilov)

Dr. Julius Agash – Director of Children’s Cardiology Department, Hospital of Edmond and Lily Safra, Sheba Medical Center, Tel Hashomer

Professor Avraham Lorber – specialist in pediatric cardiology and pediatric cardiology, director of Pediatric Cardiology and Congenital Heart Defects, Rambam Health Care Campus

Atrioventricular canal causes several problems:
Increased blood pressure in the lungs. In children with heart disease abnormal blood flows through the holes from the left to the right side of the heart and then into the lungs. More intensive blood flow increases the blood pressure in the lungs.

Irritation and swelling. This is due to increased blood flow in the lungs.

Heart failure. Because the heart has to pump more blood to the lungs, it has to work much harder than usual. Under these conditions, the heart may increase and diminish.

Cyanosis. As the blood pressure in the lungs, blood flow begins to flow from right to left. Poor blood oxygen mixed with oxygenated blood resulting in poor body receives oxygenated blood. This causes cyanosis, or bluish skin.

Complete endocardial cushion defect includes:
atrial septal defect (ASD)
ventricular septal defect (VSD)

In children with complete endocardial cushion defect there is only one large heart valve (common atrioventricular valve) instead of two separate valves (mitral and tricuspid).

Upon partial or incomplete defect present both valves, but one of them (the mitral valve) often has an opening which blood passes in the reverse direction.

Atrioventricular canal is strongly associated with Down syndrome. However, the exact cause of the defect is not known.

Endocardial cushion defect may also be associated with other congenital heart defects, such as:

Transposition of the great vessels

Tetralogy of Fallot

Symptoms in children at an early age may include: fast fatigue, skin and lips bluish color, slow growth and weight gain, frequent pneumonia, lack of appetite, pale skin, rapid breathing and heartbeat, sweating, swollen legs or abdomen (rare), shortness of breath, especially during feeding.

Diagnostics
The child with endocardial cushion defect may show an enlarged heart and heart murmurs. Children with partial DEP, which have only a small atrial septal defect and normal valves, may not have signs or symptoms of the disorder in childhood.

Tests for the diagnosis of early childhood include:
1. Cardiac ultrasound (ECHO, echocardiography) to assess blood flow.
2. An electrocardiogram (ECG), which measures the electrical activity of the heart.
3. Chest X-ray, which shows an enlarged heart.
4. Magnetic resonance imaging (MRI) of the heart, which provides a clear picture of the heart.
5. Cardiac catheterization (coronary angiography) is used in some cases. During the procedure a thin tube (catheter) is placed in the heart, so that the doctor could see a clear picture of blood flow and accurate measurements of blood pressure and oxygen levels.

Treatment
Operation is necessary to close the holes between the chambers of the heart and the total separation of the valve into two separate – the tricuspid and mitral valves. Terms of operations depend on the child’s condition and the severity of congenital blemish. As a rule, the operation is performed in 3 – 6 months years old. When the defect correction may require more than one surgery.

Doctor may also prescribe medication before surgery if condition of a child is very weak. Medicines will help the child gain weight and strengthen the heart muscle before surgery. Recommended medications such as diuretics, inotropic agents (create a stronger contraction of the heart), such as digoxin.

In the case of a complete defect operation must be performed in the first year of the child’s life before there is permanent damage to the lungs. Children with Down syndrome tend to develop lung disease earlier and consequently the early operation is very important for these children.

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Tricuspid atresia

Tricuspid atresia is a congenital heart defect in which the in tricuspid valve is not formed. 

In such a condition blood can not flow through the heart into the lungs to be enriched with oxygen, as occurs during normal development. As a result, the lungs can not provide the baby with oxygen. Children with tricuspid atresia often have shortness of breath and bluish skin.

Tricuspid valve atresia treated surgically.

Leading Israeli cardiology and cardiac surgery:
Dr. Anat Birk – specialist in pediatric cardiology, Director of Institute for the Heart Study, children hospital Schneider

Dr. Elchanan Bruckheimer – an expert in pediatric cardiology, non-invasive surgery, Head of minimally invasive cardiac surgery, children hospital Schneider

Symptoms: blue tinge to the skin and lips (cyanosis), shortness of breath (dyspnea), fatigue, especially during feeding, slow growth, heart failure, fatigue and weakness, swelling of the legs, ankles and feet, swelling abdomen (ascites), sudden weight gain due to fluid retention, irregular or rapid heartbeat.
Causes of tricuspid atresia are heredity or Down syndrome. Risk factor can also be maternal rubella or other viral diseases in early pregnancy, alcohol drinking during pregnancy, poorly controlled diabetes, use of certain drugs during pregnancy, such as, for example, isotretinoin, a drug for the treatment of acne, and some anticonvulsant drugs.

Complications
The most significant complication of the tricuspid valve atresia is a lack of oxygen to the tissues of the child’s body (hypoxia).

While treatment significantly improves the outcome for infants with tricuspid atresia, they can still have complications later in life, even after surgery. Among these complications: the formation of blood clots that can lead to blockage of the pulmonary arteries (pulmonary embolism), or a stroke, rapid fatigue when participating in sports or other physical activity, heart rhythm disturbances (arrhythmia).

Diagnostics
Tricuspid atresia can be detected before birth. Due to the recent advances ultrasound, our experts can identify the defect during a routine ultrasound at pregnancy.
After giving birth, doctor may suspect a heart defect if child has a blue color of skin or breathing problems. When listening in this case, a specialist hears a heart murmur – an abnormal whooshing sound caused by turbulent blood flow.
For the diagnosis of tricuspid atresia is usually used echocardiography. This test uses sound waves that bounce off the baby’s heart to produce a dynamic image.
Echocardiography detects the absence of the tricuspid valve and right ventricle smaller than that of a healthy child. Since this test monitors bloodstream during it is also possible to measure the amount of blood that flows through the holes in the wall between the right and left sides of the heart. In addition, echocardiography can identify related heart defects, such as atrial septal defect or ventricular septal defect.

Treatment of tricuspid valve atresia
To ensure adequate blood flow through the heart into the lungs to obtain a sufficient amount of oxygen by the body of the child, requires surgery, and sometimes even more than one.

Types of operations for tricuspid valve atresia:
Atrial septostomy. During this procedure, doctor increases or creates an opening between the upper atrium of the heart to allow more blood to flow from the right atrium to the left atrium.

Bypass surgery. Set shunt from the main blood vessel (aorta) leading from the heart to the pulmonary artery to restore adequate blood flow to the lungs. Surgeons routinely implanted shunt during the first four – eight weeks of baby’s life. Nevertheless, children outgrow the shunt, which may result in another operation required in order to replace it. ⇒ More details about CABG

Glenn procedure. Set shunt between 3 to 6 months. This procedure restores blood flow, allowing oxygen-poor blood to flow directly into the lungs and reduces the load on the left ventricle, reducing the risk of damage.

Fontan procedure. This operation is usually performed to achieve a child two years old is to install the shunt, which provides full bypassing the right heart bloodstream thus poor oxygenated blood returning to the heart, goes directly into the pulmonary artery, which blood is then transported to the lungs.

Before the operation the cardiologist may recommend medication prostaglandins, which help enlarge the blood vessels and keep the ductus arteriosus and foramen ovale open.
To monitor the condition of the heart child will need lifelong follow-up, a cardiologist who specializes in congenital heart disease. The cardiologist will tell whether the child to continue taking preventive antibiotics before dental and other procedures. In some cases, the child’s cardiologist may recommend limiting vigorous physical activity.

Short- and medium-term outlook for children, timely past Fontan procedure, as a rule, are promising. The results for those children who have resorted to surgery later in life, usually worse. There may be a variety of complications, which sometimes require additional surgery. If circulation system in accordance with the procedure Fontan does not bring the desired result, may require a heart transplant.

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Persistent truncus arteriosus

Truncus arteriosus (a common arterial trunk, patent truncus arteriosus) is a rare congenital heart defect.

In the normal state, there are two separate vessel extending from the heart – the pulmonary artery and the aorta. If a child is born with this defect, the heart has a one common large blood vessel. In addition, the two lower chambers of the heart are missing part of the wall separating them (ventricular septal defect). As a result blood poor of oxygen which should flow to the lungs, and the oxygen-rich blood which must enter the body are mixed. This creates serious circulatory problems in the child.

If truncus arteriosus untreated this defect can be fatal. Surgery to correct arterial trunk, made our surgeons is successful, especially if the child 2 months old.

Dr. Anat Birk – specialist in pediatric cardiology, Director of Institute for the Heart Study, children hospital Schneider

Dr. Elchanan Bruckheimer – an expert in pediatric cardiology, non-invasive surgery, Head of minimally invasive cardiac surgery, children hospital Schneider

Dr. Samuel Diamond – Director of the Department of Pediatric Cardiology, Medical Center of Dan Tel Aviv (Ichilov)

Dr. Julius Agash – Director of Children’s Cardiology Department, Hospital of Edmond and Lily Safra, Sheba Medical Center, Tel Hashomer

Professor Avraham Lorber – specialist in pediatric cardiology and pediatric cardiology, director of Pediatric Cardiology and Congenital Heart Defects, Rambam Health Care Campus

Dr. Avraham Matityahu – specialist in pediatric cardiology, Director, Department of Pediatric Cardiology, Kaplan Medical Center

Prof. Azaria Rein – expert in Pediatric Cardiology, Director of Pediatric Cardiology, Hadassah Medical Center

Symptoms
Signs and symptoms of arterial trunk appear in the first few weeks of life. They include: cyanosis of the skin (cyanosis), poor appetite and feeding, excessive sleepiness, poor growth, shortness of breath, rapid breathing (tachypnea), irregular heartbeat (arrhythmia), excessive sweating

Please contact us if you notice your child has any of the above symptoms.

Risk Factors
Although the exact cause of congenital heart disease, such as persistent truncus arteriosus unknown, several factors may increase the risk of having heart disease.
Among them:
1. Viral disease during pregnancy. If a woman suffered rubella or other viral diseases in early pregnancy, the risk of congenital heart defects in the child increases.
2. Poorly controlled diabetes during pregnancy. Improperly controlled diabetes increases the risk of birth defects, including heart defects.
3. Taking certain medicines during pregnancy. Many drugs are not recommended for use during pregnancy because of the potential risk to the fetus.
4. Chromosomal abnormalities. Children with the syndrome di Giorgio are at increased risk of truncus arteriosus.
5. Smoking during pregnancy. Smoking during pregnancy increases the risk that a child will be born with a heart defect.

Complications
Abnormal structure of the heart, such as truncus arteriosus, lead to serious circulatory problems. Since the ventricles are not separated and whole blood flow is carried from one vessel, the oxygen-rich and oxygen-poor blood are mixed and the blood does not deliver a sufficient amount of oxygen. As a result, the child has respiratory problems, high blood pressure in the lungs (pulmonary hypertension) due to pulmonary vasoconstriction, increased heart (cardiomegaly), heart failure.

Later in the child’s life may be complications such as progressive pulmonary hypertension, heart valve regurgitation, cardiac rhythm (arrhythmia).

Truncus arteriosus in adults
A person can live with truncus arteriosus through adulthood without treatment in very rare cases only  Nevertheless, people with this diagnosis almost certainly develop heart failure and Eisenmenger syndrome. This syndrome is caused by irreversible lung damage with pulmonary hypertension, which leads to a significant bypass of blood flow of the lung. The only treatment option in this case may be a heart and lung transplantation.

Diagnostics
Physical examination. Performed by pediatrician after birth, as well as regular monitoring in the first weeks of his life. Measurement of height, weight and head circumference to determine possible growth retardation, listening to the lungs to assess the baby’s breathing and detection of fluid in the lungs, irregular heartbeat (arrhythmia) or abnormal whistling sound caused by turbulent blood flow (heart murmur).

Echocardiography (ECHO). Shows the structure and function of the heart.

X-ray. Can determine the size of the heart, abnormalities and excess fluid in the lungs.

Persistent truncus arteriosus treatment.

The main method of treatment for a child with arterial trunk is surgery. Before the operation can be assigned to the drug in order to maintain the heart.

Surgical procedures
Most operations are done up to 3 months old. The procedures selected depend on the condition of the child. In most cases, the following operations performed:
1. Closing the hole between the two ventricles.
2. Branch upper portion of the pulmonary artery of the vessel.
3. The implant tubes and valves to connect the right ventricle to the top of the pulmonary artery – the creation of a new, high-grade pulmonary artery.
4. Reconstruction of the central vessel and creating a new full aorta.
5. Implanting new valve separating the left ventricle and the aorta, if necessary.

After surgical correction a child needs a lifelong monitoring and observation of the cardiologist. Cardiologist may recommend limiting physical activity, in particular, heavy competitive sports. Child may need to take antibiotics before dental procedures and other surgical procedures in order to prevent infections. In general, prophylactic antibiotics are recommended for six months after surgery correction arterial trunk.

Since the artificial channel does not grow with your child, you may need one or more of the following operations to replace the channel into adulthood.

Recently, our surgeons are increasingly use procedures such as balloon angioplasty. This procedure is performed by inserting a catheter into a vein in a child that does not require opening the chest. Cardiac catheterization with an inflatable stent allows to reveal and expand difficult or narrowed arteries, which can delay the need for further surgery.

Women who were operated on in infancy on the truncus arteriosus, before planning pregnancy should be examined by a cardiologist and expert on birth defects in adults, and the obstetrician who specializes in high-risk pregnancies. Depending on the level of lung injury that occurred prior to surgery, pregnancy may or may not be recommended. In addition, some medications taken for the heart, can be harmful to the fetus.

Prevention
In most cases, congenital heart disease, such as truncus arteriosus can not be prevented.

If you have a family history of heart defects or if you already have a child with congenital heart disease, before planning pregnancy, you and your partner can contact our specialists on genetic diseases, as well as a cardiologist specializing in heart diseases.

Before planning pregnancy it is important to take a few steps to help ensure the health of your child:
1. Make all the necessary vaccinations before pregnancy. Some viruses, such as rubella, can be very harmful during pregnancy, so it is important to make sure you are vaccinated before pregnancy.

2. Avoid taking dangerous drugs. Talk to your doctor before taking any medicine if you are pregnant or thinking about pregnancy. Many drugs are not recommended for use during pregnancy.

3. Take folic acid. One of the few steps that you can take to help prevent birth defects, including the spinal cord, brain, and possibly heart disease, is receiving 400 micrograms of folic acid per day.

4. Management of diabetes. If you are a woman with diabetes, talk to your doctor about the risks of pregnancy-related diabetes, and methods of effective management of the disease during pregnancy.

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Coarctation of the aorta

Coarctation of the aorta – a heart defect in which there is a narrowing of the lumen of the aorta in the region where the registered patent ductus arteriosus.

There are two types of aortic coarctation:

1. Congenital type that appears in infancy. It is associated with patent ductus arteriosus, which does not close after birth, with hypoplasia of the aortic arch, as well as with other congenital heart defects.

2. Coarctation aorta which is found in adults – a segmental (local) narrowing of the aorta not associated with heart defects.

Prevalence 1: 1600 newborns. The ratio of male: female = 1.5: 1

Leading pediatric cardiologists Israel:

Dr. Anat Birk – specialist in pediatric cardiology, Director of Institute for the Heart Study, children hospital Schneider

Dr. Elchanan Bruckheimer – an expert in pediatric cardiology, non-invasive surgery, Head of minimally invasive cardiac surgery, children hospital Schneider

Dr. Samuel Diamond – Director of the Department of Pediatric Cardiology, Medical Center of Dan Tel Aviv (Ichilov)

Dr. Julius Agash – Director of Children’s Cardiology Department, Hospital of Edmond and Lily Safra, Sheba Medical Center, Tel Hashomer

Prof. Avraham Lorber – specialist in pediatric cardiology and pediatric cardiology, director of Pediatric Cardiology and Congenital Heart Defects, Rambam Health Care Campus

Dr. Avraham Matityahu – specialist in pediatric cardiology, Director, Department of Pediatric Cardiology, Kaplan Medical Center

Prof. Azaria Rein – expert in Pediatric Cardiology, Director of Pediatric Cardiology, Hadassah Medical Center

Coarctation Causes are multifactorial (including multiple genetic components). There is also a connection with diabetes and high levels of vitamin A. The reason may be congenital heart defects, such as ventricular septal defect (VSD), aortic valve stenosis, transposition of the great vessels (TMS). The reasons are as Turner Syndrome (45, XO), where 35% of newborns suffer aortic coarctation.

Diagnosis of aortic coarctation

In some cases, the disease is detected by ultrasound in the womb. Sonographic findings indicate asymmetry in the center with the increase and enlargement of the right ventricle and the pulmonary artery. But in most cases it is difficult to diagnose fault in the womb.

Signs of heart failure manifest themselves as rapid breathing (tachypnea) and sweating while eating.

Imaging techniques of aortic coarctation – ECG, chest X-ray, ECHO (ultrasound of the heart), CT/MRI angiography.

Treatment of aortic coarctation

After delivery the decision about surgery and terms depends on the severity of aortic coarctation.

Blood supply to the lower part of the body depends on ductus arteriosus condition (it usually closes after birth). Without treatment anemia can occur and thus disturb the function of the intestine, kidneys and other organs.

To maintain a patent ductus arteriosus, usually experts recommend administration of prostaglandins. Drug therapy may be imposed only experienced pediatric heart surgeon or cardiologist.

In cases of cardiac insufficiency and anemia surgical intervention may be appointed.

The operation involves removing the affected area and connect the ends (anastomosis) or bypass surgery (removal of the shunt by subclavian flap angioplasty). In some cases, a stent (metal fiber net, the constriction of the aorta extending to the normal state).

For children who do not have symptoms surgery may be indicated only from 3-5 years of age.

Prognosis 

Early diagnosis and treatment as well as the absence of other defects significantly improves the prognosis. Success of the operation coarctation in Israel is more than 90%. Chance of recurrence – 25% within a few months. In the event of a defect, mortality is less than 1%. Typically, other cardiac defects is in 70% of children. The recurrence rate after surgery performed by our surgeons very close to 0%.

Without treatment the average age at death of 34 years. 75% die before the age of 46 from heart failure (26%), endocarditis (18%), intracerebral hemorrhage (10%), aortic rupture (21%) and other complications of hypertension, including premature coronary artery disease.
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Coronary artery anomaly

Coronary artery anomaly (anomalous left coronary artery from the pulmonary artery (ALCAPA) or White-Garland syndrome, Bland-White-Garland syndrome – congenital heart disease, which is found mainly in infants in approximately 0.5% of all congenital heart defects.

Dr. Anat Birk – specialist in pediatric cardiology, Director of Institute for the Heart Study, children hospital Schneider, Israel

Dr. Elchanan Bruckheimer – an expert in pediatric cardiology, non-invasive surgery, Head of minimally invasive cardiac surgery, children hospital Schneider, Israel

The disease occurs early in pregnancy during the formation of the baby’s heart. In this case, the developing blood vessels of the heart are connected in the wrong way.
In a normal heart the left coronary artery begins in the aorta, the main blood vessel and through which oxygenated blood flows from the heart to the rest of the body. When abnormal discharge of the left coronary artery from the pulmonary artery, the blood from the left coronary artery abnormal delivered to the pulmonary artery and not to the heart, so heart does not receive enough oxygen (oxygen deficiency), whereby the cardiac muscle tissue begin to die that can lead to a heart attack in a child.

Timely diagnosed and properly corrected the defect is of great importance and gives a good prognosis of life. Therefore, it is necessary to treat the disease in its early stages.

Properly executed 3D echocardiography in Israel allows us to estimate as accurately as heart defect, and modern surgical techniques allow to fix the problem and prevent heart attacks in children.

Usually ALCAPA is an isolated anomaly of the heart, but in rare cases, it occurs along with other congenital defects. Among them: patent ductus arteriosus, ventricular septal defect (VSD), Tetralogy of Fallot (TOF), aortic stenosis.

Originally myocardial ischemia is temporary and occurs only during the period of increased activity of the myocardium, for example, when a child eats or crying. Further increases in myocardial oxygen consumption lead to dysfunction of the papillary muscles and mitral valve varying degrees of mitral insufficiency.

Proper circulation between the right and left coronary blood flow system is necessary for normal functioning. Due to impaired blood flow of the left coronary artery, the blood enters the pulmonary trunk because of low pulmonary vascular resistance, there is the so-called leakage, and the heart does not receive enough oxygen. Therefore, the combination of left ventricular dysfunction and significant mitral regurgitation results in chronic heart failure (CHF), the symptoms of which are tachypnea, poor nutrition, irritability, sweating. Inadequate myocardial perfusion causes severe pain in the chest, and the symptoms of myocardial ischemia can sometimes be misinterpreted as normal infantile colic.

Symptoms: abnormal heart rhythm, enlarged heart, heart murmurs, rapid pulse, crying or sweating during feeding, pale skin, poor appetite, shortness of breath, sweating.
These symptoms may occur within the first 2 months of life.
Abnormal discharge of the left coronary artery of the lung may also be diagnosed in an adult.

Diagnostics
Electrocardiogram. Test of the electrical activity of the heart.
Angiography. Evaluation of the structure and location of the blood vessels of the heart using a contrast agent, under the control of CT or MRI.
Diagnostic coronary angiography. Procedure in which a thin tube (catheter) is inserted into a blood vessel of the heart to measure blood pressure and oxygen levels.
MRI (cardiac magnetic resonance imaging).
Chest x-ray.
ECHO. Ultrasound of the heart.

ALCAPA Treatment 
In most cases, the abnormal coronary artery requires surgical treatment. The volume of surgery depends on the child’s condition and size of the involved blood vessels.

If due to lack of oxygen severely damaged mitral valve, the child may also need surgery to repair or replace the valve. The mitral valve regulates blood flow between the left chambers of the heart.

If the heart of a child is seriously damaged due to lack of oxygen, may be considered a heart transplantation.

In some cases, our specialists prescribe medication to support the child’s body for surgery. It may be drugs such as diuretics, inotropic agents (medicines which strengthen the heart muscle), beta-blockers, ACE inhibitors (drugs that reduce stress on the heart).

If a child does not receive proper treatment, it can not survive during their first year of life. Mortality in the first year of life is 90%. However, those children who survive can have serious complications or die suddenly during the following years. Sudden death can occur due to insufficient collateral circulation between the left and right coronary arteries.

Most children do well with timely treatment as well as continue to live a normal life. Nevertheless, they must undergo regular inspection pediatric cardiologist.

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Mitral valve insufficiency

Mitral insufficiency is a condition in which the mitral valve, which connects the left ventricle and left atrium, can not be closed tightly during contraction, causing a reverse flow of blood occurs in the left ventricle.

Leading Israeli experts in heart valves treatment.

Mitral valve insufficiency may be acute or chronic. Reasons for failure of the valve is a damage in any part of the valve. Severe deficiency may be caused by, for example, myocardial infarction, whereby the damaged muscles responsible for the operation of the valve. Furthermore, it could be an injury or infectious endocarditis. Failure may be caused by chronic rheumatic heart disease, mitral valve prolapse, congenital defects of the valve, coronary artery disease and hypertrophic cardiomyopathy.

Chronic failure often occurs as a result of ischemia as well as in patients who have survived a myocardial infarction. In such patients, because of the reverse flow of blood occurs a gradual expansion of the left ventricle and left atrium, which greatly influences the systolic function and also leads to an increase in end diastolic pressure, left ventricular pressure, and pulmonary edema. This causes a significant reduction in cardiac function.

Patients with mitral valve prolapse suffer from degeneration of the valve, usually due to the valve ring enlargement. Doctors believe that mitral valve prolapse in most patients is associated with various diseases of the collagen fibers of the connective tissue. The disease can lead to increased pressure on the heart muscle, the function creates further deterioration of the valve and increase the risk of liver failure.

Typically, the valve prolapse often occurs in women, at a relatively young age (up to 30). The disease may manifest itself in a variety of clinical forms. It should be noted that most patients do not experience symptoms throughout their lives, but some of them may suffer severe arrhythmia or valve failure that requires surgical intervention.

Clinical symptoms in patients with mitral valve insufficiency: fatigue, shortness of breath with exercise, and in the supine position, congestion of the liver, swelling of the ankles, jugular vein enlargement, ascites, damage to other valves, such as tricuspid valve.

Diagnosis of mitral valve insufficiency.

To identify the problem needed a physical examination and visual diagnosis.

Usually, the blood pressure in patients with chronic disease are normal. When listening to the heart can be detected systolic murmurs.

ECG. Electrocardiogram may indicate left ventricular hypertrophy and often indicates atrial fibrillation.

Echocardiography. Used to confirm the diagnosis, determine the degree of prolapse valve, ventricular hypertrophy, and other important characteristics.

X-ray. May demonstrate an increase in size of the left ventricle. Enlargement can be very significant in the later stages of the sickness. Sometimes it is accompanied by edema.

Treatment of mitral valve insufficiency.

Treatment of patients with chronic disease often depends on failure factors. In the case of atrial fibrillation can be assigned to antiplatelet agents to prevent clots. In asymptomatic patients should be carried out to evaluate the function of the left ventricle and atrial fibrillation or pulmonary hypertension. If it is confirmed can be considered valve repair. Although this treatment can also be recommended for patients without atrial fibrillation or pulmonary hypertension. With a significant injury of the left ventricle can also be recommended for valve repair, and if necessary, heart valve replacement.

Patients with significantly lower rates of heart function – ejection fraction less than 30% – increased operational risks and reduced survival prognosis.

The decision to hold valvuloplasty or open surgery depends on the degree of valve dysfunction.

This method is generally the first choice in the treatment and is carried out by catheterization. During the procedure, the doctor inserts a thin tube through a vein in the leg and brings it to his heart. Intralesional special valve mounted ring which discloses a valve that ensure its normal functioning.

Replacement of the mitral valve is carried out on open heart by experienced cardiologist.

Treatment of patients with mitral valve prolapse, which in the past suffered from endocarditis, performed in order to avoid relapse. A patient with chest pain and mild prolapse can be recommended beta-blockers to reduce the load on the heart. Patients who experienced a transient ischemic attack, to be treated for anti-platelet drugs such as aspirin, and, if necessary, warfarin.

Correction of the valve can be recommended only in cases of severe failure of the valve.

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Pulmonary valve stenosis

Pulmonic stenosis is a condition when flow of blood from the heart to the lungs slowing down due to deformation of the pulmonary valve that controls the blood flow.

In adults, this condition is often seen as a complication of another disease, but in most cases, pulmonary valve stenosis develops in the womb and is a congenital heart defect.

We select a narrow field physician to treat each specific cardiac disease, making the most effective treatment and helps to improve the quality of life of our patients.

Anat Birk, MD – specialist in pediatric cardiology. Director of Institute for the Heart Study, children Hospital Schneider

Raphael Hirsch, MD – specialist in congenital heart disease in adults, Director of congenital heart defects in adults, Department of Cardiology Beilinson Hospital

Prof. Ehud Raanani – specialist in cardiothoracic surgery and catheterization, Head of the Department of Cardiac Surgery, Chaim Sheba Medical Center,Tel Hashomer and Assuta Medical Center

Pulmonary stenosis may be mild, moderate and severe forms. Moderate pulmonary stenosis usually not deteriorate with time, but the average degree cases and severe cases may be worse, and often require surgical intervention.

Fortunately, due to Israeli technology and years of experience of our experts, the treatment of stenosis of the pulmonary valve is successful, and most patients born with this disease after surgery have a normal, usual life.

People with moderate pulmonary artery stenosis generally have no symptoms. Those with more significant stenosis often notice the first symptoms during physical exercise. It features such as: heart murmur (a whistling sound heard through a stethoscope caused by turbulent blood flow), shortness of breath, especially during the effort, chest pain, loss of consciousness (syncope), fatigue, heart palpitations.

Ask our experts if your child is experiencing shortness of breath, fainting, and chest pain.

If specialist finds pulmonary stenosis or other heart problems, timely diagnosis and prompt treatment can help reduce the risk of complications in the future.

Pulmonary stenosis usually occurs when the pulmonary valve is formed improperly in utero. At this point it is not known what causes abnormal development of the valve.

Normal pulmonary valve comprises three thin sections of tissue (leaves), arranged in a circle. With each heartbeat the valve opens in the direction of flow – from the pulmonary artery blood flow into the lungs – and then the valve closes to prevent back flow of blood into the right ventricle of the heart. When stenosis of the pulmonary valve, one or more flaps can be damaged or be thickened, or not properly disclosed. In this case, the valve is not functioning properly, limiting blood flow.

Sometimes pulmonary valve stenosis can cause other diseases:

Carcinoid syndrome. This syndrome is a combination of signs and symptoms, including redness and diarrhea. Carcinoid syndrome results in the release of chemical elements serotonin. Tumors called carcinoids localized in the digestive tract. In people with carcinoid syndrome can cause problems with the heart valve.

Rheumatism. This complication is infection caused by streptococcus bacteria, such as strep throat or scarlet fever. Rheumatism can cause damage to the heart valves.

Noonan syndrome. Genetic disease, which is also a risk factor for heart valves.

Complications
Mild to moderate pulmonary stenosis usually do not cause complications. Nevertheless, the stenosis may be associated with the following:

Infection. People with structural heart problems, such as pulmonary stenosis, are at increased risk of bacterial infection of the inner layer of the heart (endocarditis).

Impaired pumping function. As a result of severe stenosis of the pulmonary artery, the right ventricle of the heart becomes harder to pump blood into the pulmonary artery. Increased pressure causes a thickening of the heart muscle and the hypertrophy of the left ventricle. Eventually, the heart can become tough and rapidly weaken.

Heart failure. If the ventricles are relaxed they can not pump blood effectively, then develops a heart failure. This disease causes swelling of the legs and abdomen, as well as fatigue and shortness of breath.

Irregular heartbeat (cardiac arrhythmia, fibrillation). People with stenosis of the pulmonary artery are more likely to have irregular heartbeats. In marked stenosis irregular heartbeat associated with pulmonary stenosis usually is not life-threatening.

Diagnosis of pulmonary valve stenosis
Pulmonary stenosis is often diagnosed in childhood, but sometimes it is also found later in their lifetime. A doctor may suspect pulmonary stenosis, when he hears a heart murmur in the upper right corner of the patient’s chest during a routine check.

Before defining test specialist asks the patient questions along the following lines:
1. When you first develop symptoms?
2. Are the symptoms of prolonged or occur randomly and are short term in nature?
3. Emphasize whether symptoms during exercise? And when patsien is at rest in the supine position?
4. Have there been symptom improvement?

To confirm the diagnosis can be assigned to the following tests:
ECG. An electrocardiogram records the electrical activity of the heart at the time of its contraction. This test helps to determine whether the thickened muscle wall of the chambers of the heart (ventricular hypertrophy).

ECHO. Echocardiograms using high frequency sound waves to produce image of the heart. Sound waves produce moving images that can be viewed as a video on the screen. This test is necessary to study the structure of the pulmonary valve, the location and severity of stenosis and right ventricular function.

Magnetic resonance imaging and computed tomography. Sometimes used to confirm the diagnosis of pulmonary valve stenosis.

Catheterization (coronary angiography). During this procedure, specialist inserts a thin, flexible tube (catheter) into an artery or vein in the groin area and carries it to the heart. Contrast liquid injected through the catheter to be able to see blood vessels under the influence of X-rays. Doctors also use catheterization to measure blood pressure in the heart and blood vessels. This test is usually done only when specialist is suspecting that a patient may be necessary balloon valvuloplasty. Sometimes this procedure immediately goes into operation.

Treatment of pulmonary artery stenosis
Some cases of stenosis of the pulmonary artery is not complicated and does not require treatment. However, if the case is more serious can be carried out valvuloplasty (installation of the cylinder valve for expanding) or open heart surgery.

The decision to hold the balloon valvuloplasty or open surgery depends on the degree of blocking pulmonary valve. Pulmonary stenosis is classified as light, moderate or severe, depending on the measurement of the difference in blood pressure between the ventricle and the pulmonary artery.

Balloon angioplasty (valvuloplasty)
This method is generally the first choice for treatment using catheterization to treat pulmonary valve stenosis. During this procedure, surgeon inserts a thin tube through a vein in the leg and brings it to his heart. The balloon is placed into the damaged valve is inflated by opening the balloon, which increases the area available for flow. Then removed.

If necessary, balloon angioplasty can be performed during pregnancy.

Balloon angioplasty can not be applied in cases where the detected pulmonary stenosis of the pulmonary valve (supravalvular stenosis) or below the valve (subvalvular stenosis). This may require open heart surgery.

During surgery, the doctor fixes the valve, so that the blood could be easier. In some cases, surgeon may replace pulmonary valve.

Some people along with pulmonary stenosis have other congenital heart defects, which can also be adjusted during operation.

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Aortic valve stenosis

Aortic stenosis (aortic valve stenosis) is the malfunction of the aortic valve due to its improper formation in the womb.

We select the narrow field physician to treat each specific cardiac disease, making the most effective treatment and helps to improve the quality of life of our patients.

Dr. Anat Birk – specialist in pediatric cardiology. Director of Institute for the Heart Study, children Hospital Schneider

Dr. Raphael Hirsch – specialist in congenital heart disease in adults, Director of congenital heart defects in adults, Department of Cardiology Beilinson Hospital

Professor Ehud Raanani – specialist in cardiothoracic surgery and catheterization, Head of the Department of Cardiac Surgery, Chaim Sheba Medical Center,Tel Hashomer and Assuta Medical Center

In healthy condition valve has three crescent-shaped flaps and it functions as a door that allow the flow of blood to flow in one direction. Due to this, the blood can flow from the left ventricle into the aorta avoiding flow in the opposite direction – from the aorta to the left ventricle.

Aortic valve stenosis may occur separately or as part of a group of defects on the left side of the heart.

Children with aortic stenosis anatomical characteristics can be expressed as follows:

– the valve has two flaps instead of three;

– thickened folds and therefore the valve does not open fully and correctly;

– valve is located higher or lower than expected.

Malformation of the aortic valve can result in varying degrees of severity of the condition in a child with severe obstruction of the more severe symptoms of heart failure. A child with moderate stenosis appear only some of the symptoms.

Aortic stenosis may be formed during the first eight weeks of pregnancy (birth defect) or develop during the life – in children and adults. In children, in most cases, it is a congenital defect, but there may be rare cases of aortic stenosis caused by arthritis or endocarditis (infection of the heart).

Birth defects of the aortic valve are three to six percent of all congenital heart defects. This disease is three times more common in boys than in girls.

When small stenosis can refrain from operation for many years. But some children stenosis increases as they grow older. In such cases, treatment is necessary.

Symptoms of aortic valve defect

In most cases, the development of a defect in the embryonic stage, severe symptoms in the fetus or shortly after birth. In some cases, the disease is silent, has no symptoms, but appear later during life.

In mild or moderate stenosis, in most cases, no symptoms, and the only symptom may be a heart murmur. Symptoms appear at the moment when it comes to severe stenosis. This symptoms such as fatigue, dizziness on exertion, shortness of breath, increased heart rate and/or irregular heartbeat, chest pain, loss of consciousness during physical exertion.

A child born with severe aortic stenosis should receive urgent medical treatment shortly after birth. Treatment is usually performed by a closed operation (catheterization) for correction of the aortic valve.

Diagnosis of aortic stenosis

Pediatrician can detect abnormal heart murmur (heart murmur) standard listening with a stethoscope. Noise which may indicate a narrowing of the aortic valve, has a special acoustic effect generated when the functioning of the valve. Specialist cardiologist can hear a click during the opening of the valve leaflets.

ECG – a test that evaluates the electrical activity of the heart and detects abnormal heartbeat rhythm and thickening of the heart muscle. ECG device receives electrical signals that pass through the heart muscle and translates them into the scheme of the typical shaped lines. When it comes to mild or moderate stenosis, the test becomes show lines that go beyond the performance standards.

Echocardiography – ultrasound of the heart (ECHO) with an accuracy determines stenosis, including its exact location and severity. This procedure is painless, non-invasive and takes about half an hour. Image created using sound waves. This test is very important because it can detect other problems that often accompany a heart disease such as mitral valve problems and an opening between the ventricles.

Angiography – an invasive test that gives a detailed information on the structure of the heart and its functions. This test is performed under general anesthesia. The test catheter is inserted into an artery leading from the groin to the heart. As the catheter is fed contrast agent used to demonstrate the anatomy of the heart of the child. This procedure at the physician’s discretion, may pass in an operation in which a heart surgeon fixes in place the aortic valve stenosis.

Making a decision about treatment based on such evidence as the age at which a problem is diagnosed, the severity of the defect, the response to drug treatment method.

Children with mild to moderate stenosis can enjoy a normal life and do not require surgery or angioplasty, but they must be under constant supervision of a cardiologist.

Children with more severe stenosis may need a surgery. Nevertheless, the majority of children undergoing surgery or angioplasty, fully restored and normal, healthy life.

Types of operations in arterial stenosis

Balloon angioplasty (balloon expanding installation) – cardiologist inserts a thin flexible tube (catheter) into an artery and from there it leads to the heart. When the balloon catheter reaches the aortic valve the physician expands the balloon, thereby restoring valve function. The procedure is performed under general anesthesia and after the observation is usually required within 24 hours in the ICU.

After performing balloon angioplasty, there is the risk of resumption of aortic stenosis in the process of growth and development of the child. In this case, the child will need additional surgery or catheterization. Sometimes the tissue valve may be damaged as a result until adolescence or complications in the future.

Valvotomy (operation expansion valve) – open heart surgery in which the surgeon opens the valve and separate the sash. This operation is carried out in difficult situations, in the presence of complex defects when balloon angioplasty can not solve this problem. In the case of such a strong stenosis assessment of valve is complicated due to calcium deposits and narrowing of the valve ring.

Aortic valve replacement – operation, during which the patient valve is replaced with a prosthesis. This operation is performed in open heart. There are two types of implants – biological valve made of animal tissue, and mechanical valve. Valve replacement also requires receiving blood thinners (Warfarin) for the successful valve functioning.

Ross procedure (pulmonary autograft) – a complex operation that is performed transposition of the aortic and pulmonary valves of the patient. The newest version of the operation involves replacing the aortic valve and the pulmonary valve prosthesis implant mechanical pulmonary artery. The advantage of such operands are biologically and interoperability of the pulmonary valve, displaced in the aortic position, no risk of its destruction and subsequent replacement. Operation is complicated as it requires simultaneous intervention on two major vessels – the pulmonary artery and the aorta. Ross method is very suitable for infants and young children, as the valve, taken from the pulmonary vein may continue to grow in a natural way, parallel to the growth and development of the child.

Konno procedure (aortic annular enlargement) – performed as an open-heart surgery in those cases that require an increase in the ring of the aortic valve.

As a rule, for the treatment of aortic stenosis, the technique is performed in conjunction with the Ross technique. This operation is the Ross-Konno procedure.

In most cases, children who underwent open heart surgery for stenosis then live a normal life without any problems and without any restrictions.

In some cases, a child may require additional surgery to replace the valve.

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Patent ductus arteriosus

Patent ductus arteriosus (open arterial canal) – a congenital heart defect that occurs in connection with the closing of the artery wrapped around the pulmonary circulation.

Dr. Anat Birk – specialist in pediatric cardiology. Director of Institute for the Heart Study, Schneider Hospital

Ductus arteriosus is in the blood vessels in the chest of the fetus and connects the pulmonary artery to the aorta bypassing the pulmonary circulation. Its function is to supply oxygen to the blood of mother to child in the womb until his lungs do not work yet and he can not breathe on their own.

In the normal case it is closed after the birth because of its role has been performed. However, in children born very early (28 weeks gestation or less) duct may remain open. In most cases, the presence of small holes in the channel is not shown any symptoms or behavior changes of a child. The problem can be detected by listening to heart murmurs which indicate the flow of blood through the open channels, which can be the result of the development of heart failure.

As a general rule, the closing flow during the first three months of life. Very rarely duct closes itself by passing three months, so that in this case may require surgical intervention. The operation depends on the degree of heart failure.

Drug therapy can be effective only in the first few days after birth. In such situations, typically clinicians recommend aspirin or ibuprofen.

Upon admission to the surgery for children specialist examines child, measures blood pressure, pulse, temperature, weight and growth of the baby. He also collects health information that includes: medical history, presence of previous surgeries, hospitalizations and drug sensitivity. In conclusion, cardiac surgeon explains the operation and respond to parents’ questions.

The anesthesiologist in turn explains the process of anesthesia, gives detailed information about analgesics after surgery.

Before the operation, carried out such tests as: chest X-ray, ECG, echocardiography (if necessary) and blood tests.

The operation is performed under general anesthesia and the baby for a few hours before the operation should not eat. Anesthesia child perceives no contact with the body. Anesthetic drug enters through the mask into the airway of a child or intravenously. One parent can accompany the child to the operating room and stay with it until the baby falls asleep.

If there are no other defects, except for the open flow, the operation is performed by the closed method, through a catheter into a vein and does not require mechanical ventilation. The operation consists in a compound of the blood vessels open (PDA). Continuing operations for about an hour.

After surgery the child is transferred to the intensive care unit for observation. He is there at least a day, but he can stay there longer.

In the absence of any complications baby discharged 6 days after surgery.

Subsequent pain control is carried out with the help of drugs. Highly-trained medical staff provide all necessary assistance for postoperative pain relief, so the children are very relaxed and almost do not not feel pain.

Our experts recommend a gradual return to an active life, in accordance with the instructions of the cardiologist. Parents of children older than one year must be constant monitoring of a number of things over a period of two months after operation due to the very slow recovery of the sternum. Necessary to avoid cycling, ball games, jumping and sudden movements.

Return to a full physical activity should be gradually and under the constant supervision of a cardiologist.

The success of the operation to close the ductus arteriosus – more than 97 percent. The majority of the operations conducted in children premature infants weighing 500 to 700 grams.

As with any surgery in after the closing of the ductus arteriosus can be complications. Heart surgeon and anesthesiologist provide parents with the information about complications.

In most cases, the child can begin to eat 24 to 48 hours after surgery. First meal should be light (drinking), but the child can return to a normal diet very quickly.

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Endocarditis

Invective endocarditis is an inflammation of the inner lining of the heart, particularly the heart valves, resulting in an infection that usually caused by bacteria, but may also result from other pathogens (fungi).

Our cardiologists are leading Israeli experts in the treatment of heart problems.

We recommend a narrow field physician to treat a certain type of heart disease, making it the most effective treatment and helping to improve the quality of life of our patients.

At the moment, there is a great variety of methods of diagnosis and treatment options of this disease in Israel – enhanced visualization capabilities, massive antibiotic therapy and surgical treatment (replacement heart valve).

Endocarditis leads to the formation of bacterial colonies on the heart valves, which may cause serious damage to cardiac function and systemic embolism associated with the spread of infection to various organs.

In the past, the main cause of this disease was rheumatic heart disease as a result of the treatment of streptococcal infections with antibiotics. But now the main causes associated with long life expectancy are operations on the heart valves (bacteria prosthetic valves, mechanical and biological), the installation of a pacemaker, or other causes, such as injecting drug use.

This disease is considered by our specialists as an acute and severe. In this situation, the majority of patients developed fever with rapid deterioration, which can lead to death. The disease can occur in subacute condition that develops slowly, has less severe clinical symptoms and generally causes less damage to the heart valves and embolism.

The mechanism and causes of endocarditis
The endothelium is the innermost layer, lining the heart, including cardiac valves. In normal endothelium is resistant to bacteria. But with significant damage to the endothelium the bacteria can begin intensive breeding, for example when they were entered on the endothelium through a blood clot that occurs for various reasons (aortic stenosis, mitral insufficiency, ventricular septal defect and other conditions of blood clots). This condition called bacterial thrombus endocarditis (NBTE).

The bacteria can be separated by the method of contact with the endothelium. Such as streptococci, staphylococci, Haemophilus influenzae, cardiobacteria, gram negative bacteria (HACEK) fall through the throat and upper respiratory tract. Enterococci come from the circulatory system of the genitourinary system. Bovis streptococcus (S. Bovis) falls from the gastrointestinal tract and associated with tumors and polyps of the colon.

Among the most common drug bacteria causing endocarditis are streptococcus, staphylococcus, which usually fall to the right side of the heart (tricuspid valve). Coxiella Burnetii bacterium also causes fever and endocarditis can result in chronic phase.

Patients with mechanical or biological artificial valve are at risk for endocarditis, especially during the first few months after surgery.

Symptoms of endocarditis, such as fever and heart murmur, in some cases, chills and sweating, heart failure (as a result of the participation of the valve), abscesses, fistulas, embolism, loss of weight and appetite, back pain, arthritis, enlarged spleen, neurological symptoms, confusion, weakness on one side, bleeding in the brain, seizures, Janeway syndrome , Roth spots, Osler’s nodes, anemia, hematuria (blood in the urine).

Diagnosis of endocarditis
The diagnosis of infective endocarditis is carried out in accordance with the criteria of Duke (Duke), approved by the Research Service of the University of endocarditis Duke, USA.

The main criteria:
1. Positive blood cultures as a result of several tests under certain conditions. There is a critical value for the bacteria that cause disease. For proper treatment and prevention should appreciate cultures taken at 24 hours from different parts of the vein.
2. Echocardiography is needed to determine the abscess, the mass of the heart or regurgitation of the valve.
3. Transthoracic echocardiography (through the chest wall) can demonstrate defeat only in some patients. Therefore, most often performed transesophageal echocardiography (transesophageal). TEE can determine endocarditis more than 90% of patients, and if not defined but suspected endocarditis, the study repeated throughout the week.

Minor criteria
1. Risk factors for endocarditis: previous cardiac problems (valve prosthesis, etc.) or a history of injecting drug use.
2. The body temperature of over 38 degrees.
3. Evidence of vascular lesions – large arterial embolism, myocardial infectious origin, aneurysm, cerebral hemorrhage, bleeding of the conjunctiva, Janeway syndrome.
4. Evidence of the involvement of the immune system – glomerulonephritis, renal dysfunction, rheumatoid factor, Osler nodes, Roth spots.
5. Microbiological evidence – positive blood culture, which does not meet the above criteria or serological evidence that there is an active infection associated with infective endocarditis.
6. Laboratory tests: increasing CRP, anemia, a large number of white blood cells in some cases (leukocytosis) antibody complexes in blood and low levels of the complement system, which can be seen in the accumulation of antibodies.
7. Hematuria (blood in the urine), in some cases it may be kidney embolism.

Treatment of endocarditis
To ensure effective treatment is necessary to destroy all the bacteria that cause the disease. Typically, this is achieved by taking a long course of antibiotics. In most cases, treatment may be intravenous, within a few weeks. During the third week of treatment may have an allergic reaction to the medication, so it is very important control of the attending physician, who will be able to appoint a suitable medication in a timely manner to prevent toxic levels.

Surgical treatment
In some cases our specialists may recommend surgery to avoid complications that can lead to serious injury or death.
The operation can be immediate (in severe and life-threatening situations, such as acute aortic regurgitation, pericardial injury) or planned (in situations that do not require rapid surgical intervention, but has to be held in the near future – for example, the presence of a fungal infection or exacerbation valve function). An exception to this may be situations neurological problems arising after infection (e.g., septic embolism, cerebral aneurysm), which may deteriorate after surgery.

The indications for surgery are as follows:
Heart failure due to valve dysfunction, results of operations which show a better prognosis for patients.

Partial displacement of the valve prosthesis as a result of the infection.

Inability to cure the infection (fungal infection associated with Brucella, for example), or resistance of some bacteria (Enterococcus, Gram-negative bacteria). As an indication for surgery in this context is a poor response to treatment aureus, in the case involving the aortic or mitral valve.

Staphylococcal infection (Staphylococcus aureus) in the valve prosthesis complications in the heart associated with a high mortality rate, and in this case may be indications for surgery.

Recurrence of endocarditis in prosthetic valve, despite optimal medical therapy.

Infection that spread to all the valves of the heart. The main symptoms – does not decrease the temperature, despite treatment with antibiotics, there is an arrhythmia(as a result of infection associated with the conduction system of the heart) or pericarditis.

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Hypertension

Hypertension (or high blood pressure) is a chronic disease. The disease is sometimes called the “silent killer” because the person suffering from it often do not know about it.

Hypertension can cause long-term damage to blood vessels sensitive tissues such as the heart, blood vessels, eyes, and nervous tissue of the brain, and is one of the risk factors for heart attack, heart failure and leading risk factor for chronic kidney disease (CKD).

Criteria for diagnosis of hypertension. Normal blood pressure – 120/80 (120 systolic, 80 diastolic). People with systolic blood pressure between 120-139 and diastolic between 80-89 is in increased risk of developing hypertension in the future.

In Israel, thanks to years of experience and proper control, our physicians were able to reduce significantly the problem. Competently composed the course of treatment to help our patients maintain normal blood pressure throughout the entire time, which greatly improves the quality of life of patients and prolong life.

Two basic levels of hypertension:
Hypertension Class I – between 140-159/90-99
Hypertension Class II – more than 160/100

There are some groups, such as diabetics or patients with renal disease (eg, chronic renal failure). In these patients hypertension is considered in case of a blood pressure of 130/80. This is due to the fact that among these groups there is a high risk of cardiovascular disease.

Also known situation in which blood pressure is higher than 140/90 measured normal, but less than 125/80, as measured by Holter.

To determine whether the patient is actually high blood pressure, it is necessary to conduct two blood pressure measurements. Unable to approval of hypertension on the basis of a single test. Primary hypertension, which accounts for 90% of cases, as a rule, is the result of certain medical conditions (such as catecholamine-secreting tumors, such as pheochromocytoma, aldosteronism, etc.). Situations in which the suspected secondary hypertension is the beginning of a very relative increase in blood pressure at a young age or in old age, when the patient has symptoms of endocrine diseases or different specific disorders.

Risk factors for hypertension
Lifestyle, namely smoking, chronic alcohol use, drug abuse, eating habits, a diet high in salt or fat, obesity or abdominal obesity, lack of physical activity. All these factors are risk factors for the formation of arterial hypertension.

Gender: men are more likely to suffer from hypertension than women.

Age: men older than 55 years is a risk factor for hypertension, and women – more than 65, although hypertension often also occurs at a young age.

Various diseases such as hyperlipidemia, diabetes, metabolic syndrome.

Family background, stress, socio-economic status.

Attitude to drugs: long-term use of birth control pills, steroids, NSAIDs, amphetamines, cocaine, cyclosporine. Dietary supplements can increase blood pressure, if used in large doses.

There are certain groups of patients who have hypertension require unique medical intervention. Among them:
Pregnant women with high blood pressure. They should be carefully screened for high blood pressure because of the risk to the mother and fetus. The same applies to women who have high blood pressure during pregnancy appeared. Our physicians may recommend medications that reduce blood pressure during pregnancy.

Diabetic patients with hypertension often requires a combination of two or more drugs to achieve a pressure of less than 130/80. These drugs reduce proteinuria and help protect the kidneys.

Elderly patients (over 65 years) who are at risk of hypertension and cardiovascular disease. Such patients to monitor blood pressure may initially be assigned to the low dose diuretics.

Diagnosis of hypertension
To determine the cause of hypertension research conducted primary standard, which includes:
1. Consultation with a specialist in internal medicine, examination and medical history.
2. Blood test
3. Echocardiography (ECHO)
4. Ultrasound carotid arteries
5. Ultrasound renal arteries
6. Consulting with cardiologist
Based on this initial assessment will be determined by the need for additional procedures and the appropriate treatment.

Prevention and treatment of hypertension
There are several ways to prevent high blood pressure or high blood pressure reduction: reducing excess weight and exercise (such as walking), reducing the use of sugar and salt, reducing smoking and alcoholic beverages, decreasing stress, DASH – approach with diet

Changing eating habits can help reduce blood pressure. A diet rich in vegetables, fruits and low fat dairy products and a limited amount of saturated fat in the menu can help lower blood pressure.

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Pericarditis

Pericarditis is an inflammation of the pericardium (outer lining of the heart or heart sac).

Our cardiologists are leading Israeli experts in the treatment of heart problems.

Pericarditis is often accompanied by myocarditis – inflammation of the heart muscle. Pericarditis and myocarditis often occur simultaneously and are caused by the same factors.

Cause of the disease

The most common cause of inflammation of the pericardium and myocardium are cardiotropic viruses. The disease can also be caused by connective tissue disease, inflammatory bowel disease, the effects of radiation therapy or drug use.

1. Infections that cause pericarditis:

Viruses: Coxsackie A and B, Echoviruses, Epstein-Barr virus (EBV), CMV – cytomegalovirus, human herpes virus 6 (HHV6), adenovirus, influenza virus type A and B virus, Lyme B19, hepatitis B and C, human immunodeficiency virus (HIV), the virus chickenpox (Varicella), mumps virus (mumps), measles, rubella, polio, rhinovirus, vaccinia virus.

2. The most common bacteria that cause pericarditis: tuberculosis (4-5%), Coxiella Burnetii.

3. Other bacterial infections (more rare): pneumococcal, meningococcal, gonococcal, staphylococcal, Haemophilus influenzae, Chlamydia, Leptospirosis, Listeria.

4. Fungal infections are rarely the cause of pericarditis. In patients with a weakened immune system (immunosuppression) agents may be aspergillosis, blastomycosis, candidiasis.

5. It is very rare pathogens can be echinococcus and taxoplasma.

6. Infectious causes meningitis, autoimmune heart, condition after injury syndromes myocardial membrane (after myocardial/pericardial injury syndrome), after acute myocardial infarction syndrome, pericardial condition after surgery.

7. Pericarditis after catheterization, pacemaker, ablation.

8. The inflammation of the blood vessels (vasculitis), and connective tissue diseases: systemic lupus erythematosus, rheumatoid arthritis (rheumatoid arthritis), systemic scleroderma (systemic sclerosis), sarcoidosis, Churg-Strauss disease, acute rheumatic fever, Sjogren’s syndrome, Behcet disease, Familial Mediterranean fever (FMF), inflammatory bowel disease: Crohn’s disease, ulcerative colitis.

9. Pericarditis of malignant tumors. Primary tumor (rare): pericardial mesothelioma. Metastatic breast cancer, lung cancer, lymphoma.

10. Metabolic causes: uremia, myxedema

11. Pericarditis after radiation therapy

12. After drug therapy (rare): procainamide, hydralazine, phenytoin (eg, the syndrome of systemic lupus erythematosus), isoniazid, penicillin (pericarditis hypersensitivity with eosinophilia), doxorubicin, daunorubicin, methyldopa, methysergide, sulfonamides, cytarabine, phenylbutazone, cocaine.

Clinical manifestations of the disease

The disease manifests itself as a typical viral infection with fever, systemic effects, muscle aches, sore throat, diarrhea, vomiting. Further development is pleuritic chest pain, difficulty breathing, weakness, lack of stamina, heart palpitations.

Different viruses tend to defeat several areas that could determine the course of the disease.

Patients with B19 virus infection (parvovirus B19), as a rule, ask help earlier than other patients because of severe pain in the chest. Cardiac function in these patients is only slightly reduced or maintained.

While infecting human herpes virus 6 (HHV6) clinical picture looks as heart failure and reduced heart function.

Diagnosis of pericarditis

In most cases involving pericarditis pericardium and myocardium. According to the recommendation of an experienced specialist can be conducted the following studies:

Echocardiography. Necessary to assess the condition of the heart muscle.

Medical examination specialist.

Electrocardiography (ECG).

Laboratory tests. Contents cardiac enzymes, such as creatine or troponin, can be increased, depending on the degree of damage to the heart muscle.

Inflammatory markers – ESR and C-reactive protein (CRP). Usually rise in inflammatory diseases of the pericardium and myocardium, but there are rare cases of pericarditis with normal CRP.

A blood test nuclear components antibodies (ANA). Performed for suspected systemic disease.

Blood cultures. Can help in cases of purulent pericarditis.

Magnetic resonance imaging of the heart. (MRI) helps to identify changes in cardiac tissue, typical of pericarditis and myocarditis.

The test is performed with injection of contrast material gadolinium. The contrast agent passes through the blood vessels. Due to the contrast agent, the expert can detect the injury of the heart muscle.

Coronary angiography. Some patients are less prone to pain is necessary to exclude coronary artery disease. To do this, performed computed tomography (CT) or coronary angiography.

CT chest. Performed for suspected tuberculosis, cancer, or systemic diseases.

Mammography. Helps to eliminate the presence of liquid membrane of the heart, in the light of malignancy.

Biopsies were frequently used to diagnose myocarditis, but now hardly used for several reasons: firstly, biopsy is an invasive procedure, accompanied by complications. Secondly, a biopsy is usually taken from the muscle of the right ventricle, and myocardial infarction can be in various areas. In addition, MRI and isotope scanning of the heart, to evaluate the state of the heart is not invasive.

Treatment for pericarditis

Patients with suspected pericarditis or myocardial recommended to be hospitalized for evaluation, research and monitoring.

Initial treatment may be a non-steroidal anti-inflammatory drugs (NSAIDs), a long course of treatment to full normalization of CRP. Such drugs may be acetylsalicylic acid (aspirin), indomethacin, ibuprofen. Medications must be assigned by an experienced physician. Reduced doses of aspirin and other NSAIDs should be gradual. During treatment requires regular assessment of the level of C-reactive protein in the blood.

Colchicine is recommended for the treatment of recurrent pericarditis bursts (recurrent pericarditis) and may be effective in acute inflammation of the heart membrane (acute pericarditis), and acute heart meningitis.

Patients with renal insufficiency colchicine is not recommended.

Prednisone may be appointed in cases of intolerance to other means of treatment failure or contraindications of NSAIDs.

Monitouring 

Need to limit physical activity for 6 weeks and be re-echocardiography at 1, 6 and 12 months, especially in patients with impaired cardiac function and heart failure receiving inhibitors of the enzyme conversion (ACE inhibitors) and beta-blockers.

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Congenital heart disease

Congenital heart disease is the defect resulting from abnormal development of cardiac function.

Congenital heart defects occur in approximately 8: 1000 births.

Raphael Hirsch, MD – Head of Congenital heart defects Department, Beilinson Hospital

Leading Israeli expert on congenital heart disease in adults

Leading cardiologists Israel

There is a wide range of cardiac abnormalities and they can range from asymptomatic and clinical fatal. In most cases, congenital heart disease have a number of causes (multifactorial defects), but in some cases they are associated with chromosomal abnormalities (Down’s syndrome, Turner syndrome, trisomy 13 and trisomy 18), defects in specific genes, teratogenic disorders or metabolic diseases of mother.

Congenital heart disease:

Patent ductus arteriosus

Pulmonary artery stenosis

Mitral insufficiency

Hypertrophic cardiomyopathy

Ventricular septal defect (VSD)

Atrial septal defect (ASD)

Coarctation of the aorta

Atrioventricular cushions

Aortic valve stenosis

Transposition of the great arteries

Tricuspid atresia

Arterial trunk

Anomalous pulmonary venous connection

Abnormal discharge of the left coronary artery from the pulmonary artery – ALCAPA

Tetralogy of Fallot

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Cardiomyopathy

Cardiomyopathy is a group of diseases associated with functional, mechanical or electrical problems which lead to ventricular hypertrophy or enhancement of cardiac muscle.

This is due to a variety of reasons, most of which are genetic. Cardiomyopathy is defined as a distinct disease which has arisen as a result of no other causes of heart muscle damage, for example ischemic heart disease, valvular heart disease or high blood pressure.

Clinical symptoms include shortness of breath and fatigue. In view of the different genes and hereditary diseases that cause cardiomyopathy and hypertrophic cardiomyopathy, a very important clinical parameters such as:

  • the cases of sudden cardiac death in the family;
  • muscular dystrophy;
  • a family history of pacemaker implantation.

What are the types of cardiomyopathy?

Dilated cardiomyopathy

It is the most common form of the disease. It develops slowly over many years, while cardiac contractility decreases with time. The reason for this is not clear, but there are cases when the disease is caused by genetic factors, viral infections or autoimmune diseases, toxins.

By decreasing cardiac contractility cardiac occupancy pressure increases and, consequently, the heart enlarges. As a result of increased heart pressure, pulmonary edema occurs, which is accompanied by shortness of breath. This is a serious disease, which in many cases can lead to death.

Two-thirds of cases of cardiomyopathy due to coronary artery disease enlarged. Another third is due to non-ischemic conditions, such as uncontrolled high blood pressure, the effects of alcohol, idiopathic causes or infection.

Hypertrophic cardiomyopathy

It is a genetic disease that can occur at any age. It is caused by the components responsible for the mechanism of muscle contraction of the heart (eg, damage to the cell-type chain myosin). As a result, this enlarging the heart (cardiac hypertrophy). Left ventricular hypertrophy leads to asymmetries of the interventricular septum, and usually entails blocking of the aortic valve. Symptom of the disease is atrial fibrillation.

Restrictive cardiomyopathy

It is a rare disease that is characterized by a decrease in ventricular response, causing it to be filled with blood are not fully. The disease is usually caused by other diseases associated with inflammation of the heart muscle. For example, sarcoidosis and amyloidosis.

The main symptoms of  cardiomyopathy

Cardiomyopathy has various signs and symptoms:

  • background ventricular arrhythmias, especially in young patients with no symptoms before the age of 35 (including athletes);
  • cardiac insufficiency and angina pectoris: shortness of breath, often accompanied by angina, can lead to progressive heart failure even with normal sinus rhythm and the systolic function;
  • atrial fibrillation (atrial fibrillation) or chronic atrial attack, worsening heart failure, and poses a risk of thromboembolism and stroke;
  • blockage of the left ventricle;
  • diastolic dysfunction;
  • concentric hypertrophy;
  • ischemia of the heart muscle (myocardium);
  • autonomic dysfunction (autonomic dysfunction);
  • mitral valve insufficiency.

Diagnosis of cardiomyopathy

In addition to a medical examination by a cardiologist, the diagnosis is made by echocardiography and CMR.

Patients diagnosed with hypertrophic cardiomyopathy should undergo genetic counseling, which also recommended for first-degree relatives. Genetic tests are an important tool to confirm the diagnosis and to identify relatives carrying the gene.

Also performed ECG and Holter monitoring heart.

In some cases, our experts can also recommend pass the stress-test to assess functional capacity, risk assessment and response to treatment.

Patients who complain of pain in the chest, can be tested for coronary stenosis (as indicated by the doctor). Patients with high risk factors for coronary artery disease is often recommended diagnostic coronary angiography (cardiac catheterization).Patients with a low chance of obstructive coronary artery disease may be recommended CTA (CT angiography). Echocardiography in such cases is not enough.

Family members – carriers of the disease should undergo periodic clinical examination, ECG and echocardiography.

Tests should be done every 12-18 months, aged 12-18 years. The rating is up to 12 years of age is required only in cases of strict family history for children involved in sports, or in the case of the onset of clinical symptoms.

Treatment of cardiomyopathy

Asymptomatic cardiomyopathy

Patients and carriers of the disease in order to reduce risk factors for coronary heart disease need:

  • to stop smoking,
  • to control blood pressure,
  • to carry out prevention of diabetes mellitus,
  • to perform hyperlipidemia analysis,
  • to control a healthy weight and diet, as well as maintain a healthy lifestyle.

Asymptomatic patients are also recommended regular exercise at low intensity. In some cases, our doctors prescribe medications to maintain hydration and to avoid situations which might cause the enlarging of peripheral blood vessels.

Medication for symptomatic cardiomyopathy

Drug therapy is prescribed by an experienced cardiologist, individually for each patient, based on carefully conducted survey. A new generation of drugs, their correct dosage and compliance rate prescribed by experienced specialist, allow our patients to get rid of the symptoms as well as prevent the development of disease and possible complications.

Invasive procedures for symptomatic cardiomyopathy

In some instances, the mini-invasive procedures for reducing the thickness of the interventricular septum, and hence alleviate the symptoms. They are generally recommended for patients with a gradient greater than 50 mm Hg (at rest or under stress), which did not react to an optimal pharmacological therapy.

This procedure is performed by catheterization (ablation). During her failure occurs pathological cardiac muscle portion. Procedure is performed by an experienced cardiac surgeon, in closed sertce, through the vein of the patient, and does not require a long hospital stay and recovery.

Some patients are recommended mitral valve replacement with a view the decrease of the pressure gradient in the left ventricle.

As a rule, patients with reduced left ventricular function are treated similar to patients with heart failure. Patients with heart failure class 3-4, no obstruction of the left ventricle, may be recommended implantation of a pacemaker, if there is no contraindication.

Patients with end-stage heart failure may be candidates for a heart transplant.

Prevention of sudden cardiac death

All patients with hypertrophic cardiomyopathy are evaluated the risk of sudden cardiac death. Components of risk include:

  • history of ventricular fibrillation,
  • ventricular tachycardia or sudden death in the family,
  • the transition loss of consciousness without explanation,
  • thickening of the left ventricle of more than 30 mm.,
  • abnormal blood pressure response during physical exertion.
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Atrial septal defect (ASD)

Atrial septal defect (ASD) is a common heart defect that occurs most often in women.

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Ventricular septal defect (VSD)

Ventricular septal defect (VSD) is a congenital heart disease, which is a hole in the partition that separates the left ventricle from the right ventricle.

Ventricular septal defect (VSD) is one of the most common birth defects.
In the normal heart blood with low oxygen content of the body returns to the right atrium and comes to the right ventricle. Then ventricular blood enters the lungs to be filled with oxygen and then into the left atrium and the left ventricle, before it performs a full circle around the body. When there is a defect – the hole in the septum between the right and left ventricle, low oxygen blood from the right ventricle is mixed with rich oxygen blood from the left ventricle. As a result, the oxygenated blood is pumped back into the lungs to receive oxygen. Thus, the heart has to cope with large amounts of blood. This may lead to increased pressure in the blood vessels of the lungs. If a large defect is not treated in time, blood vessels may be damaged due to the increased pressure that eventually leads to right ventricular failure and death.

We cooperate with the leading Israeli cardiac surgeons for adults and children, who are heads of cardiac surgery departments and research institutes, and who specialize in congenital heart diseases.

Symptoms of ventricular septal defect
The child can breathe quickly, and it can be observed tachypnea, tachycardia due to sympathetic activity, sweating (especially on the forehead due to the large amount of sweat glands in children). Signs of heart failure – mainly various swelling in children are different from adults. Babies’ liver can absorb a lot of liquid, so that child may have an enlarged liver. Child is unable to eat normally due to rapid breathing (tachypnea) and palpitations (tachycardia), and therefore not gaining weight. This process is gradual and depend on resistance to light.

Diagnosis of VSD
Definition elements are the size of the defect (using echocardiography – ultrasound imaging) and pulmonary resistance.

The diameter of the aortic annulus (aortic rings) of the child is 10 mm – diameter defect measured by echocardiography and computer attitude of the aorta.
Up to 30% – a small defect (aortic diameter) – app. 2 mm
Between 30-60% – medium – app. 5 mm
More than 60% – large
One of the methods of diagnosis is to listen and chest radiograph.

VSD Management
If a child with a medium or high degree of defect, parents should implement the recommendations of the physician about nutrition. About 60-80% of ventricular septal defects are reduced during the first year of life (especially small ones).

Drug therapy is recommended by experts on the basis of a thorough examination, in order to relieve the load on the heart, restoring contractility, afterload. These effects are caused by a variety of drugs that are prescribed by an experienced pediatric cardiac surgeon. If treatment assignment correctly, in compliance with all recommendations the child calms down and begins to grow and gain weight, and the hole starts to close. If medicinal methods reach a maximum but the child does not respond, it may be recommended surgery (child should be minimum 2-3 months old).

Operation to close the opening of the interventricular septum is one of the most modern achievements of Israeli medicine. This is a mini-invasive procedure, which is performed in a closed heart (without section of the chest). Senior pediatric cardiac surgery injects tools using a catheter into a vein in hand and closes the hole using the patch (patch). The success of this procedure in Israel is 95% – 97%.

Such an operation is performed on the basis of a state hospital in Israel. After closing the ventricular septal defect quality and longevity show high performance.

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Heart valve replacement

Heart valves play a key role in the passage of blood through the heart. As the blood flows in one direction only, changing the pressure on both sides of the valve causes it to open at the right time to let blood, and then tightly closed to prevent the backflow of blood. Therefore, without a proper operation of the valves, a full human life becomes impossible.

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Coronary heart disease (CHD)

Coronary heart disease (CHD) – a narrowing of the coronary arteries and blood vessels that supply blood to the heart muscle. Typically, this is due to the accumulation of plaque in the artery walls causing atherosclerosis. Plaques are made up of fatty deposits of cholesterol – rich collagen and other proteins.

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Arrhythmia

Arrhythmia – is any deviation from the normal sequence of electrical impulses of the heart. While electrical impulses may occur too fast, too slow, or uneven – causing the heart to beat too fast, too slow or irregular. When the heart does not beat properly, it can not pump blood efficiently. When inefficient pumping of blood, lungs, brain and all other organs can not work properly, which could lead to breach of their functions.

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