Additional, false chord of the left ventricle of the heart in a child: what is it?

The child and the heart In some children, during routine examinations and examinations, an anomaly such as an additional chord in the heart is discovered. In special cases, this anomaly requires treatment, but, fortunately, in most children, a false chord in the heart is only a feature of the body that does not in any way affect the life and health of both the child and the adult.

Description

An additional chord is formed in utero during the formation of the heart muscle.
Doctors often detect left ventricular solitary chord (LVSD) on a routine ultrasound. At birth, the child is diagnosed with a congenital anomaly of the heart chambers. In infants, a false chord in the heart is often combined with other pathologies - the presence of excess trabecula or the opening of the oval window. The reason for the development of anomalies is associated with deviations in genes located on the X chromosomes. The more of them, the greater the likelihood of developing an accessory chord in a child.

Important! The trait is transmitted through the maternal line in 90%, and through the paternal line in 10%.

It is not the chord itself that is inherited, but the factors that cause it. Even in the first months of the baby’s intrauterine development, additional tissue is laid down.

During the formation of the interventricular septum, “extra” tissue often becomes part of it. A child with a hereditary history of heart abnormalities is born without LVDC.

But the action of a number of factors during pregnancy contributes to the fact that the “excess” tissue degenerates into an additional chord. This:

Is the presence of additional chords in a child’s heart really dangerous?

An additional chord may appear during the intrauterine formation of the fetus. If we talk about what it is, LVDC in children, then the additional chord looks like a thread-like cord of connective tissue. Sometimes the LVDC may have muscle or tendon fibers.

As a rule, accessory chords can be identified in a child shortly after his birth or before he reaches adulthood. But, since this anomaly manifests itself weakly or almost neutrally, most people may not even be aware of their diagnosis. A person can learn about this structural feature of his heart only after a thorough professional examination. medical examination or as a result of treatment for a completely different disease that worries him much more.

If you think that by doing a heart cardiogram, you will get answers to all your questions, then you are mistaken. No ECG can make a detailed diagnosis about the structure of your child's heart.

Causes

The vast majority of cases of the appearance of an additional chord of the left ventricle are a hereditary predisposition. The pathology is transmitted through the maternal line. For this reason, if a woman knows about her anomaly in the development of the heart cavity, then after the birth of the child she needs to worry about additional examination of the child to study the functioning of the heart.

Many experts agree that there are a number of factors that can provoke the formation of such an anomaly during pregnancy:

bad habits, especially smoking;
difficult environmental situation;
stress;
unbalanced or insufficient nutrition;
intrauterine infections;
weak maternal immune system.

The action of these factors can lead to pathological changes in the formation of not only the fetal heart, but also other organs and systems, so the expectant mother must take care in advance to eliminate them as much as possible.

The child is born with additional chordae. They persist throughout life.

An additional chord in the left ventricle most often appears due to a genetic predisposition. It is transmitted in 95% of cases from mother to child.

MARS develops in utero, and the catalyst for this process is a failure during the formation of connective tissue in the cavity of the left ventricle. For this reason, women who have been diagnosed with this need to have their children examined for the presence of this anomaly.

Also, the reasons for the development of additional chords may be:

poor environmental situation in the region;
physical and nervous overstrain;
drinking alcoholic beverages and smoking.

An abnormal chord of the left ventricle is a hereditary anomaly, which in 92% of cases is inherited through the maternal line (in rare cases, through the paternal line), and develops in utero due to a failure in the development of connective tissue. That is why mothers who have previously been diagnosed with this disease are recommended to have their child examined.

It is possible that the following unfavorable factors may be the reasons for the appearance of an additional chord:

bad ecology;
smoking or drinking alcohol and drugs;
nervous and physical stress.

Structure of the heart

The heart is a muscular organ that pumps blood to peripheral tissues. It is located in the chest and consists of 4 chambers: 2 atria and 2 ventricles. The right and left sections are delimited by a special partition.

The large colo of blood circulation begins from the left ventricle, from where oxygenated blood enters the aorta. Then it goes through the main arteries to the arterioles and peripheral capillaries, where gas exchange processes occur. From the capillaries, blood saturated with carbon dioxide enters the veins, through which it flows into the right atrium. From there, blood flows through the tricuspid valve into the right ventricle, which sends it to the pulmonary arteries. Back it (already again saturated with oxygen) enters the left atrium, and then through the mitral valve into the left ventricle.

The wall of the heart consists of several balls, which are shown in the following photo:

endocardium - a layer of epithelial tissue that covers the internal cavity of the chambers of the heart;
myocardium – is a striated muscle tissue;
epicardium - a thin layer of connective tissue that covers the myocardium;
The pericardium is the outer “bag” of the heart, which is separated from the epicardium by a small cavity filled with fluid.

Kinds

Classification of additional chords is carried out according to several criteria:

quantity;
tissue structure;
places of their attachment;
nature of the location.

The quantitative criterion divides all additional cords into two groups. These are single chords (there is one abnormal “thread”) and multiple (two or more). In the first case, it is often located separately from normal fibers. With the second option, it is possible to place them either separately or between normal cords.

Based on the nature of the tissue from which these anomalies are formed, several groups can be distinguished.

Connective tissue. Occurs in most cases. They are cords consisting entirely of elastin fibers and primary collagen.
Tendon chords. Consist only of secondary collagen fibers.
Muscular. Normal muscle growths.
Mixed chords. They contain various components of muscle and connective tissue. Among other anomalies, they are rare.

There can be three places for attachment of anomalous chords. The most common is the apex of the heart. In the left ventricle, this is the part of the cavity farthest from the valve. The option of attaching to one of the walls is possible. Basal fixation of abnormal chordae is very rare. When it (they) are fastened at one end in the area of the septum separating the ventricle from the atrium.

The nature of the location of the anomalies can be either parallel to the normal strands or different from their direction. If the LVDP deviates no more than 25-35 degrees, it is said to be oblique or diagonal. When the angle is more than 40 (even 90) – the chord is in a transverse position.

An additional chord in the left ventricle of the heart can be of the following type:

muscular, fibrous or fibromuscular;
with longitudinal, transverse, diagonal connecting fibers;
with single or multiple strands;
median, basal or apical.

The most dangerous are the transverse chords. They can block blood flow and pose a danger to the human body. In other cases, these MARS are considered harmless and do not cause any burden on the heart.

The additional chord can be located in different parts of the left ventricle and have a different structure and structure. Cardiologists distinguish the following types of chords:

by histological structure: fibrous, fibromuscular, muscular;
in the direction of the connective tissue fibers: longitudinal, transverse, diagonal;
by the number of threadlike strands: single, multiple;
by place of attachment: apical, middle, basal.

What are the types

All chords in the heart can be:

hemodynamically significant - affect blood flow and can cause problems in the heart;
hemodynamically insignificant - do not affect blood flow. Currently, it is often referred to as a variant of the norm.

Extra chords in the heart can be located:

longitudinally;
transverse;
diagonally.

Types of chords in the heart

Features of the disease in children

No doctor can predict whether this pathology will cause any complications or not. Experts give a good prognosis to patients who have been identified with an additional thread in the left ventricle. In most cases (90% of patients), the left trabecula does not require treatment. A less comforting prognosis is given when diagnosing transverse and multiple chordae.

Normalization of heart function in children diagnosed with LVAC requires daily physical activity, adherence to dietary nutrition and daily routine. Possible physical activities for such patients include:

daily walks in the air;
gymnastics;
dancing;
riding not cycling.

All types of physical activity must be approved by a cardiologist. The doctor should also emphasize the need for proper nutrition. The patient's diet should include:

dried apricots, raisins and other dried fruits;
dairy products;
hard and soft cheeses;
nuts;
bananas.

For a child with a false chord, the daily routine is especially important. Parents should rationally allocate time for rest and activity. A full night's sleep is required. It is advisable to limit computer activities and the use of other gadgets - all this can be compensated for by a walk in the fresh air.

The specificity of the formation of this pathology is associated with a failure in the formation and development of the connective tissue of the heart muscle during pregnancy. Thus, during the embryonic period of heart development in a child, the muscle is pierced by several threads.

In normal condition, the notochord in children is a muscle that connects the sides of the left ventricle of the heart. With abnormal development, additional chords with an atypical structure appear. The older the child becomes, the less influence the additional chords have on his lifestyle. Gradually the heart grows and the abnormal formations shift.

Identified additional chords of the left ventricle in newborns require constant patronage during the first six months of the child’s life, then until the child is one and a half years old, the child is registered with a cardiologist.

Then the heart undergoes control examinations at the ages of 3 and 7 years, when it becomes necessary to determine the health group before entering kindergarten and school, respectively.

The localization of the problem makes parents whose children are diagnosed with “additional chordae” seriously worry. But in reality, people can live their whole lives into old age with this pathology and feel great.

Typically, such an anatomical anomaly in a child’s heart makes itself felt in adolescence. Children begin to complain of constant fatigue or heart pain. It is necessary to treat such child complaints with maximum responsibility and undergo an examination. Even in the absence of manifestations and treatment, there are limitations:

Create a proper daily routine so that the child has enough time to rest.
All physical activity must be carefully controlled. It is impossible to overload a child with such a diagnosis.
The patient's diet must be properly planned. Children should receive all the necessary nutrients, this is very important for cardiac function.
Emotional stress can also negatively affect the condition of the heart, so any stress is contraindicated for such a patient.

There are certain sports that are acceptable for children with this diagnosis. Doctors often recommend gymnasts, since the loads characteristic of this type of sports activity will only benefit children.

Recommendations for accessory chord in children

Encourage your baby to alternate and adhere to a regime of active activity and rest;
Monitor your diet and quality of nutrition;
Take your child to physical therapy classes;
Temper your baby;
Make sure your child is often outside;
Limit your children from stressful situations;
Get enough sleep;
Don't let your toddler or teen engage in strenuous or forceful sports;
Do not give your baby medications without consulting your doctor first:
Talk to your cardiologist or pediatrician about extracurricular activities.

Symptoms

Single chords in the left ventricle are generally not accompanied by any external manifestations. If the anomaly is located in the right ventricle or there are multiple formations in the heart, their presence can be suspected by the following symptoms:

constant causeless weakness and fatigue;
fast fatiguability;
decreased endurance;
accelerated heartbeat;
dizziness;
psycho-emotional instability;
tingling in the heart;
heart rhythm disturbances.

Most often, these symptoms are observed during adolescence, when intensive growth of muscles and bones occurs. If you do not pay attention to such signs, then the situation can only get worse with age.

Therefore, you need to be attentive to adolescent health complaints, and at the slightest suspicion of heart pathology, undergo a full examination by a cardiologist. If an additional chord is discovered in childhood and the child is already registered with a specialist, by the age of 11–12 years it is worth visiting a doctor more often for preventive purposes in order to prevent the development of undesirable consequences.

What to do and how to treat

As a rule, a pediatrician may suspect an additional chord in a baby when listening to the chest with a stethoscope, since in many babies this feature is accompanied by a heart murmur (“Heart murmur in a child”). After this, the specialist sends the baby for examination to confirm (or refute) his suspicions. Instrumental diagnostic methods - ECG, EchoCG, ultrasound, etc.

Child examination

If the additional chord does not interfere with the baby and does not threaten his life, then the specialist, as a rule, recommends periodic preventive examinations to monitor the false chord and its position in the heart.

Treatment of a child

However, if the doctor sees a threat to the health or life of the baby, he prescribes treatment. As a rule, treatment consists of taking certain medications - vitamins, beta blockers, metabolic drugs, nootropics, etc.

Important! In particularly serious cases, surgical intervention may be prescribed, as a result of which the additional chord is removed.

Diagnostics

Directly at the appointment, the doctor conducts a conversation, visual examination and listens to the heart. Some experts argue that in the presence of an additional chord of the left ventricle, specific murmurs can be heard.

However, only ultrasound can give the true picture. Even an experienced doctor must first give a referral for an ultrasound examination, and only based on its results make a diagnosis and prescribe treatment.

Carrying out ultrasound in children has a number of its own characteristics. Only from the age of 6 can one count on the child’s adequate perception of the examination situation.

Therefore, one of the parents or close people accompanies the child to the ultrasound. The office must be equipped with toys and take into account the age characteristics of patients.

Small children, and especially newborns, should not take off all their clothes; it is enough to expose the chest to access the required area.

Modern ultrasound examination includes 2 procedures. The first is called echocardiography.

With its help, you can examine the structure of the heart with maximum accuracy and characterize hemodynamics. In addition, echocardiography allows you to calculate indicators of most cardiac functions.

The second cardiac ultrasound procedure is a Doppler study of intracardiac hemodynamics.

Today, cardiac ultrasound is performed in two-dimensional space, which makes it possible to assess dynamic changes in real time. Ideally, the test is performed with the patient lying on his back.

However, in the case of small children, this is difficult to achieve, so you can put the child on his right side, stand him up or sit him down. The main thing is to achieve a calm position, but do not forget about subsequent correction of the results depending on the examination position.

The examination is carried out through the anterior wall of the chest, on the left side of the sternum. In this area the heart is as open as possible.

The installation of the sensor depends on the age of the child; the younger it is, the higher the device is installed. In the case of newborns, the sensor can be installed directly on the sternum.

To identify an additional chord of the left ventricle, a four-chamber position is usually used, in which abnormal areas appear as linear formations.

The examination procedure, as well as interpretation of the results, takes about 40 minutes. Ultrasound of the heart allows you to assess the condition of the chambers, the size, as well as the integrity of the organ and its structures, the characteristics of blood circulation, the specifics of the pericardial sac and the characteristics of the fluid.

All indicators are significant. They may indicate not just the presence of an abnormal appearance of an additional chord, but also concomitant heart diseases.

It is impossible to detect additional chords in the heart based on complaints and during a routine medical examination. There is only one reliable diagnostic method - ultrasound examination of the heart (echocardiography or ultrasound of the heart).

According to existing standards, this study should be performed on all newborns in the first month of life. The method is safe and reliable.

Therefore, all children and adults with an abnormal chord in the heart should undergo cardiac ultrasound at least once a year. Advanced diagnostics include electrocardiography (ECG), blood pressure measurement, Holter monitoring, and stress tests.

All of these diagnostic tests cannot detect additional chords of the heart, but they determine the functional abilities of this organ.

Modern ultrasound examination includes 2 procedures. The first is called echocardiography.

The second cardiac ultrasound procedure is a Doppler study of intracardiac hemodynamics.

The diagnosis is made after an ultrasound of the heart. The patient is first listened to for the presence of systolic murmurs. To make sure that the anomaly is harmless to the child’s body, a classic and stress ECG may be prescribed. The doctor decides which specific diagnostic methods to use after examining the patient.

A pediatrician (in adults, a therapist) can suspect the presence of an extra chord in the heart by listening to the heart rhythm. The diagnosis can be confirmed or refuted only after receiving the ultrasound results.

The absence of complaints and symptoms of cardiac pathology is very common: an adult may first learn about the presence of a minor cardiac anomaly during preventive echocardiography. In children, autonomic dysfunctions are possible, which cannot be an objective and accurate sign of pathology.

As the child’s body grows and against the background of sports activities, the following complaints may appear:

pressing or aching pain in the left side of the chest;
feeling of rapid heartbeat with light exertion;
dizziness;
rapid onset of fatigue and general weakness;
emotional and psychological disorders.

An experienced therapist or cardiologist, through auscultation, will be able to detect a noise of a musical timbre of moderate intensity, which changes with physical activity or a change in body position. Identification of this sign in a child is the basis for the following studies:

electrocardiography;
ultrasound scan of the heart;
Doppler.

Typical ECG signs are:

WPW syndrome, indicating acceleration of atrioventricular impulse conduction;
early repolarization syndrome, which increases the risk of ventricular tachycardia;
arrhythmic disorders (extrasystole, ectopic rhythm).

Multiple chords in the left ventricle, especially those located transversely, can create a lot of problems with the functional activity of the ventricles in diastole. This will be the main factor in reducing tolerance to physical activity: sports with this variant of MARS are contraindicated.

During an ultrasound, the doctor will see the following signs:

the presence of thin and dense linear structures and formations that have no connection with the atrioventricular valve;
increased echo density of muscle tissue at the attachment points of the notochord, caused by local myocardial hypertrophy;
acceleration of blood flow in the extra chord, detected by Doppler.

The detection of a false trabecula in the heart is the basis for a complete diagnosis of the child’s body: the presence of MARS indicates the likely presence of congenital anomalies in other organs and systems.

Treatment

An additional chord in the left ventricle is corrected only if there is a negative effect on the functioning of the heart. The most radical method is surgical intervention. There must be compelling reasons to carry it out.

Additional pathological chord of the left ventricle, as a rule, does not require drug treatment in the traditional sense. In such a situation, the doctor can only prescribe a regular visit to a specialist, and an ultrasound of the heart to monitor the dynamics of possible changes.

If the patient is bothered by unpleasant symptoms from the cardiovascular system, then the following may be prescribed:

vitamin therapy, mainly with B vitamins;
magnesium and potassium preparations;
antioxidants;
nootropic drugs.

Drugs are dosed according to an individual scheme and only by a specialist!

As the main measures of prevention and vital activity when making a diagnosis in general, a number of rules should be noted. If you follow them, you can maintain your well-being at the proper level and avoid possible complications:

carry out regular hardening procedures depending on the degree of preparedness of the body;
eat rationally, including as many vitamins and microelements as possible in your diet;
set aside enough time every day for walks in the fresh air (at least an hour);
maintain sleep/wake, rest/work schedules;
include feasible physical activity in your daily routine.

Modern scientists in the field of medical science have developed several useful measures for people with the described pathology:

practice dancing in which the rhythm is quite slow;
learn and practice drill exercises;
install a wall bars and do several exercises on it;
jump rope;
run short distances;
regularly take massage courses;
take care of your psycho-emotional state.

All these procedures have a positive effect on the cardiovascular system, and also normalize the functions of the nervous system, improve mood and generally tone the body. Each person is able to take preventive measures independently, but under the supervision of the attending physician.

It is he who can determine the quantity and quality of physical activity and adjust the patient’s daily routine. The main recommendation is regular examination by a doctor.

If additional chords do not appear in any way, treatment is not required. It may be indicated if a child or adult has symptoms of cardiac dysfunction. For help, contact a cardiologist.

Drug therapy for additional chord is needed only if the patient is bothered by discomfort in the heart area. For diseases such as atrial fibrillation or paroxysmal tachycardia, detailed diagnosis and treatment in a hospital are necessary.

In severe cases, when the examination reveals that the structure of the false chord includes myocardial pathways, surgery is usually indicated: cryodestruction (destruction by cold) or excision of the chord.

If the patient's condition does not pose a threat to his life, maintenance medications are prescribed.

The anomaly does not require treatment with drugs. Medicines are prescribed if the patient has clinical signs of an additional chord. The patient is also scheduled for observation by a cardiologist and an ECG.

Medications are prescribed if the patient exhibits symptoms that are related to cardiovascular function.

If an additional chord is detected, which is accompanied by symptoms or hemodynamic disturbances, in addition to the recommendations described above and more stringent restrictions on physical activity, drug therapy is recommended.

These children may be prescribed the following medications:

vitamins B1, B2, PP - prescribed to improve myocardial nutrition, taken for a month, the course of treatment is repeated twice a year;
Magne B6, Magnerot, Potassium orotate, Panangin - are prescribed to improve the conduction of nerve impulses and prevent arrhythmias, drugs are selected depending on age and taken in courses for a month or more;
L-carnitine, Cytochrome C, Ubiquinone - prescribed to normalize metabolic processes in the heart muscle;
Nootropil, Piracetam - are prescribed when symptoms of neurocirculatory dystonia appear.

Indications for immediate hospitalization in a cardiology hospital may include the following severe heart rhythm disturbances:

paroxysmal tachycardia;
atrial fibrillation;
Wolff-Parkinson-White syndrome;
Morgagni-Adams-Stokes syndrome;
extrasystole.

They can develop with multiple or transverse chordae and require detailed examination and subsequent treatment.

In rare cases, muscle fibers of the cardiac conduction system may be included in the structure of the accessory chord of the left ventricle. Such cardiac abnormalities can cause ventricular arrhythmias and ventricular fibrillation. To eliminate them, the following surgical interventions are indicated:

cryodestruction;
excision of the chord.

The absence of symptoms and normal heart function against the background of additional trabeculae in the ventricle requires medical supervision without drug therapy. Preventive measures and restrictions on physical activity will be mandatory.

Symptomatic drug treatment is carried out for arrhythmias and blockades; surgical intervention for excision or cryodestruction of the chord is necessary for conditions that threaten the child’s life.

In each specific case, treatment methods are selected individually depending on the type of pathology, the severity of symptoms and the possible risk of complications.

Symptoms (may or may not exist)

There are no specific symptoms specific to accessory chordae in the heart. Moreover, this cardiac anomaly can cause complaints and manifestations in only 5–10% of cases. The remaining 90–95% of adults and children do not show any complaints and learn about the anomaly only after an ultrasound examination of the heart.

If the additional chord is located transversely in the cavity of the ventricle, interferes with blood circulation or disrupts the functioning of the valves, then a child or an adult experiences:

Pain in the heart area (mainly during exercise, but can be at rest).
Frequent heartbeat (feeling of interruptions).
Fatigue and shortness of breath during exercise.
Dizziness.
Heart rhythm disturbances (paroxysmal tachycardia and extrasystole).
Murmurs when listening to the heart.

Even if the additional chord is accompanied by the listed symptoms, they only slightly disturb the general condition and motor activity of the patient (it may be difficult to perform heavy physical work). Children with this cardiac anomaly grow and develop without any abnormalities. Most often, manifestations arise and intensify during periods of active growth and puberty.

If a child or an adult has severe symptoms of heart damage (severe pain, shortness of breath with light exertion, severe rhythm disturbances, swelling) and an additional chord is detected during examination, do not think that it is causing them. Such a patient should be comprehensively examined to exclude other cardiac pathologies. An additional chord may not cause such serious manifestations, but can be combined with any diseases and anomalies.

Consequences

The symptoms of the disease are quite scarce. For many years, a person may not know about the presence of such a pathology. As a rule, signs of an additional chord of the left ventricle appear if its location interferes with the functioning of the heart or the pathology is multiple. So the main symptoms of the anomaly are reduced to the following manifestations:

fast fatiguability;
attacks of dizziness up to fainting;
pain of varying intensity in the heart area;
tachycardia;
heart rhythm disturbances;
frequent mood swings.

Considering that the disease is genetic in nature, it is impossible to prevent its occurrence. If an additional chord is detected in an adult or child, you must follow the specialist’s recommendations in this regard.

To avoid complications, in older age you should monitor the amount of cholesterol consumed and your own weight. Excess body weight creates additional stress on the blood vessels, causing the heart to work harder.

Physical therapy classes are needed for children with an additional chord. They help strengthen the heart muscle, preventing the development of all kinds of pathologies.

Most doctors do not advise people with excess chordae to participate in sports at a competitive level. Long swims, practical training at a flying club, and diving can harm people with this anomaly.

But sprinting, yoga and bodyweight exercises will make your heart muscle stronger.

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Are there any complications?

Complications with an abnormal chord, as a rule, do not develop. If for any reason the patient may experience heart rhythm disturbances, then thromboembolic complications (pulmonary embolism, ischemic stroke, etc.) may develop. Cardiac arrest may also occur due to fatal disturbances of ventricular conduction (ventricular fibrillation and paroxysmal ventricular tachycardia).

Prevention and treatment

In most cases, an additional chord of the left ventricle appears due to a hereditary predisposition, and it is almost impossible to prevent its development in the prenatal period.

Despite this, scientists do not exclude the possibility of the development of such a minor cardiac anomaly under the influence of certain unfavorable factors. That is why pregnant women are recommended:

Eat properly.
Stop smoking, drinking alcohol and drugs.
Avoid heavy physical activity.
Prevent stress.
Walk in the fresh air and do gymnastics.

If an additional chord of the left ventricle is detected in a child, parents should pay close attention to his health, follow all the doctor’s recommendations, but not completely protect him from society. An important measure to prevent complications will be the timely treatment of chronic diseases that can be complicated by heart disease.

Children with an additional chord are recommended to regularly engage in physical therapy, which involves individual selection of the load. Wall bars exercises, dancing, gymnastics, sprinting, jumping rope - these activities will help strengthen the heart muscle and prevent the development of complications.