The value of a comprehensive assessment of extracardiac pathology in children with congenital heart and blood vessels
Objective. To conduct a retrospective analysis of maps of pathomorphological studies (protocols) of patients with congenital heart and blood vessels (CHD) for the period 2011 to 2019 to assess the effect of comorbidity in CHD. Material and methods. As a material, 295 pathomorphological studies (autopsies) of patients with CHD and patient histories for the period 2011 to 2019 were analyzed. All patients underwent a complex of clinical, laboratory and histological studies. Among the analyzed patients, 37 (12.5%) were preterm to the term of gestation and low birth weight newborns. From the anamnesis, in the remaining 258 (87.5%) cases - children with CHD were full-term by the term of gestation. Results. The structure of extracardiac pathology in the deceased patients was as follows: 140 (47.5%) somatic pathology (infections, diseases of the blood, respiratory organs, and others), 113 (38.3%) multiple congenital malformations (MCP), 28 (9.5%) - genetic and hereditary syndromes, acute surgical pathology 12 (4.1%). Significantly common among comorbidities: MCP (95% confidence interval (CI) 32.6-44%), intrauterine infection (IUI) (95% CI 13.8-22.8), various lung diseases (95% CI 1.5-5.9). 173 patients were operated on (openheart surgery in 114 (65.9%) of cases, closed operations - 29 (16.8%) and in 30 (17.3%) operations on the gastrointestinal tract, central nervous system and diaphragm). In 2% of cases, patients underwent simultaneously at the stage of hospitalization of the operation and on the heart and on the gastrointestinal tract and lungs, the central nervous system (laparotomy, craniotomy, correction of diaphragm defects). In the structure of the studied patients, a comparative analysis of the assessment of the base scale of Aristotle and comorbidity in CHD was performed. Conclusion. The presence of comorbid diseases in patients has a significant impact on the course of the underlying disease, outcome, and development of complications. Comprehensive analysis of the course and complications in pediatric cardiac surgery and cardiology is necessary to improve the quality of treatment. Along with the Aristotle baseline assessment scale for the complexity of procedures in pediatric cardiac surgery, the search continues for modern scales of predicting the development of complications and mortality. Diagnosis of associated extracardiac congenital defects and extracardiac pathology is important for clinical practice in determining the timing and stages of heart or other organs surgery, prevention of complications, and prediction of the patient's clinical status in the history. Risk assessment in a patient with CHD prior to surgery should be carried out using the Aristotle scale and with the mandatory inclusion of the significance of comorbid pathology.