Depending upon the severity of the CHD, symptoms may be visible either at birth or soon after or during early childhood
According to global figures, amongst congenital diseases (i.e. disorders present since birth), congenital heart disease is the problem in 1 out of every 3 cases. In India, it is estimated that >2,00,000 children suffer from congenital heart disease every year. In 1 out of every 5 such cases, the defects are severe enough to warrant early treatment.
Congenital heart disease is the cause of 10% of all infant deaths in our country. But over the past several decades, diagnostic and treatment facilities for congenital heart defects (CHDs) have improved tremendously, increasing survival rates and allowing these children to lead healthy and fulfilling lives.
What are CHDs?
A child born with a CHD has a problem in the structure of his or her heart. Our heart is divided into chambers by inner walls called septa (singular septum). The two smaller upper chambers are called atria are divided by the atrial septum and the two lower and larger ones are called ventricles and are separated by the ventricular septum. The left side of our heart contains oxygen-rich blood while the right side contains oxygen-depleted blood.
The flow of blood within our heart is unidirectional and is controlled by four gates or valves (atrial, tricuspid, pulmonary and mitral). Depending on the area affected (the septa or the valves or the connecting blood vessels or a combination of these), there are several types of CHDs.
Some of the common CHDs in India include ventricular or atrial septal defects (hole in the atrial or the ventricular septum), atrioventricular septal defects (holes in atrial/ventricular septa along with defects in the valves between the upper and lower chambers), patent ductus arteriosus (an abnormal connection between the two major blood vessels arising from the heart i.e. the aorta and the pulmonary artery), coarctation of aorta (narrowing of the aorta, the blood vessel that supplies oxygen-rich blood from the heart to the rest of the body) and aortic stenosis (narrowing of the aortic valve). Due to CHDs, the normal flow of blood through the heart is affected and it is unable to function properly. If severe and left untreated, CHDs can lead to complications and can be life-threatening.
When can you suspect that your baby may have a CHD? What are the common symptoms?
Depending upon the severity of the CHD, symptoms may be visible either at birth or soon after or during early childhood. Babies with severe CHD may have pale gray or bluish skin (also called cyanosis), swollen legs/belly or swelling around the eyes, may exhibit rapid breathing and may become breathless during feeding causing inadequate weight gain.
Less serious CHDs may be detected in early childhood when your child is unable to exert himself or herself and becomes easily breathless or tired or faints during exercise or activity. Your child may also have swollen ankles, feet or hands. Several commonly available tests (e.g. echocardiogram) can help your doctor identify the problem.
Though the exact causes of CHDs are not well-established, some genetic and environmental factors that increase their risk include genetic/family history (e.g. some CHDs are associated with Down’s syndrome), smoking, drinking or the presence of uncontrolled diabetes during pregnancy, contracting rubella (also called German measles) during pregnancy and consuming certain medications which can harm the foetus when pregnant (e.g. thalidomide, angiotensin-converting enzyme inhibitors, statins, isotretinoin and certain antiepileptic/antianxiety drugs).
What are the treatment options for CHDs?
Though some medications can help with the symptoms of CHDs, surgery remains the mainstay of treatment. Depending on the type and severity of the CHD, open-heart surgery or more recently minimally invasive surgery can be carried out to repair the defect. In some patients, valve repair or replacement is done via a non-surgical procedure where the doctor inserts a thin, flexible tube called a catheter through a blood vessel in the leg to reach the heart.
In infants with defects such as patent ductus arteriosus, a tiny device (as small as a pea) called an occluder is inserted via a non-invasive procedure to plug/correct the defect and restore the heart’s function. These cutting-edge, non-surgical processes help reduce risk and promote faster recovery in infants with CHD.
So stay away from harmful habits/medicines and visit your doctor regularly to have a healthy and safe pregnancy. Post-delivery, stay alert to any changes in your baby to ensure timely intervention in case of any problems. Early detection and prompt treatment can help in saving your newborn’s life.
The author is Senior Consultant Pediatric Cardiologist, Rainbow Children Hospital, Bangalore. Views expressed are personal
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