Dr. Navdeep Singh Articles
MENDING TINY HEARTS
Written by Super User
Congenital heart diseases (CHD) are the most common birth defects, responsible for nearly one‑third of all congenital birth defects. Ironically there is a widespread misconception that heart problem is predominantly a disease found in adults and is practically non-existent in children. Statistics however tell us that approximately 10 out of every 1000 babies born have some or the other form of congenital heart defect. It is estimated that well over 2 lakh children are born with CHD each year in our country and roughly one‑fifth of these babies have critical heart defects requiring very early intervention. In fact CHD accounts for 10% of all infant mortality in India. This poses a tremendous challenge for the families, society and health care system as most middle and low income countries lack such advanced levels of care required for these children.
Myriads of myths surround this disease entity, one of which is that these children either do not survive at all or are likely to live with major disabilities for the rest of their lives. Contrary to this, if access to screening, early diagnosis, and treatment is available, over 90% of patients born with CHD survive to adult life with good long‑term outcomes. In fact advances in the modalities of pediatric cardiology and cardiac surgery have made it possible to repair or palliate most of the CHDs including the complex ones. Not only do these children survive and lead reasonably healthy lives, but there are innumerable instances where these children have grown up to contribute as productive and dynamic citizens of society.
Heart diseases in children are very different from heart diseases in adults. Their clinical presentation, course and outcomes vary immensely. Signs and symptoms may sometimes be so subtle that they may require a high index of suspicion from both the parents and doctors to be picked up early. Often a child specialist may have noticed an abnormal heart sound on routine examination of an apparently healthy child following which he sends the patient to the pediatric cardiologist for evaluation. But not infrequently, it is the alert parents who note certain symptoms and bring them to the attention of the treating physician. They may have noticed that their baby is a poor feeder who tires easily and sweats profusely while breast feeding. The baby suckles for a while but may soon unlatch itself from the breast and gasps for breath, typically referred to as the ‘suck-rest-suck cycle’. The child may also have poor weight gain with respect to children of similar age or may appear irritable and cries excessively. Children may also present with frequent chest infections or pneumonia or may have very rapid rate of breathing requiring repeated hospital admissions. Occasionally an older child may complain of an abnormal perception of heart beat or the parents note that their child’s heart beat seems fast. The child may also appear lethargic and tire easily during play activity. Some observant parents may even have noticed that the skin or nails of their child appear blue.
Children’s heart diseases include a wide array of conditions typically present at birth. One of the most common ones encountered are holes in the heart (Atrial and Ventricular septal defects) and extra connections outside the heart (Patent Ductus Arteriosus). Other diseases may be narrowed valves of the major arteries of the heart (Aortic and Pulmonary stenosis) or obstruction to the flow of blood in the major artery supplying blood to the body (Coarctation of Aorta). Besides these, certain other conditions like irregular heartbeat varying from a very fast heart rate of more than 200 per minute, to a complete heart block may be present in the fetus, newborn or sometimes in older children. These may result in sudden loss of consciousness or sometimes even fatal outcomes. Children having bluish discoloration of skin, nails and lips are termed as having cyanotic heart diseases. Most commonly encountered disorders in this group are Tetralogy of Fallot’s, Transposition of Great arteries etc. The heart may have just two or three chambers instead of the normal four or there may be a severe obstruction to the flow of blood or occasionally complete absence of major vessels or valves of the heart.
In addition there are certain acquired heart ailments which develop at variable intervals after birth like diseases involving heart valves (Rheumatic Heart Disease), pulmonary hypertension (high lung pressures), Kawasaki’s disease (disease affecting the arteries of the heart), myocarditis (disease affecting the heart muscles), cardiomyopathies etc.
Echocardiography test of the heart is a pre-requisite for arriving at an accurate diagnosis. Now fetal echocardiography is helping us in detection of heart diseases in the unborn baby while it is still in the mother’s womb. This proves invaluable for planning the delivery to take place in an institute where the newborn can be provided the requisite cardiac care promptly. Beside this, other diagnostic modalities like ecg, angiography and CT scan are also useful tools for detection and planning the management of these maladies.
Recent advancements have ensured that many of these conditions can be cured without resorting to surgery. Button or umbrella like devices are now widely used all over the world to close these holes and extra connections. Balloons and stents are also used to relieve obstructions in the path of blood flow. These procedures obviate the need for prolonged hospital stay and potential ugly scars on the chest. The “blue babies” generally require surgery to correct their heart defects.