Congenital Heart Disease

Congenital heart disease or a hole in the baby’s heart is one of the most common congenital (present since birth) anomaly and occurs in 9 of every 1,000 babies born. This is a structural problem which occurs during the development of the baby’s heart when the baby is in the mother’s womb. Development of the baby’s heart starts after conception and is nearly complete by 8 weeks of gestation. A series of specific steps should occur for normal development of the heart, one of the steps not happening at the right time results in development of congenital heart disease. For E.g. Incomplete formation of a dividing wall leaving behind a hole in between two chambers of the heart or narrowing of one of the valves of the heart resulting in decreased flow to the body.

Parents are often apprehensive about will if something they did during the pregnancy caused the heart problem. Although some of the congenital heart diseases are genetic in origin or can occur due to some medications (like anti-seizure or antiacne medications or even alcohol and substance abuse) taken by the mother during pregnancy, in most cases, no specific cause can be found.

Heart disease could be classified into three different types:

Holes in various positions of the heart allow oxygen-rich blood that should be traveling to the body to recirculate through the lungs. This results in increased flow as well as pressure in the lung arteries. These babies usually have symptoms of heart failure like difficulty in feeding and breathing, recurrent cough and cold and poor weight gain. Some of these are

Holes in the between the lower chamber of the heart along with narrowing of the lung arteries results in less amount of blood to pass through the lungs. Thus impure blood (low oxygen and high carbon dioxide) recirculates in the body vessels. The babies with this heart disease have bluish discolouration of their lips and finger nails. They may have “cyanotic spells”. These spells usually occur just after baby gets up from sleep or after trying to pass stools, the baby becomes irritable, breathes fast, has inconsolable cry with increase in bluish discolouration. Unlike the babies with too much blood flow, these babies are usually well grown and do not have feeding or breathing difficulties.Some of these are

Blockages in the main artery of the body, underdeveloped chambers or narrow valves of the heart could prevent proper amount of blood from traveling to the body. More often than not these babies are very sick and require surgery very early after birth. Some of these are

Some cases could have a mixture of several heart defects creating a more complex problem. Some of these are

Most of these congenital heart disease can be diagnosed in the mothers womb by doing a specialised test called the Fetal Echocardiogram.

Considering a birth prevalence of congenital heart disease as 9/1000, the estimated number of children born with congenital heart disease in India is more than 200,000 per year. Of these, about 40,000 (20%) are likely to be critical requiring intervention in the first year of life. Currently advanced cardiac care is available to only a minority of such children. Although, a number of cardiac centres have been developed in India over the last 10 years, most of them are in private or corporate hospitals concentrated in metro cities like, Mumbai, Delhi, Bangalore, Hyderabad, Kolkata and Chennai. Challenges to paediatric cardiac care include financial constraints, health-seeking behaviour of community, and lack of awareness. Government of India is taking a number of steps for improving health of children through its various program and schemes that are likely to benefit children with congenital heart disease, especially those who are vulnerable and marginalized.

Babies with congenital heart defect require meticulous diagnosis, surgery and post-operative care. This is usually done by a team of doctors consisting of a paediatric cardiologist, paediatric cardiac surgeon, paediatric cardiac anaesthetist and paediatric cardiac intensive care specialist.

A paediatric cardiologist diagnoses the heart disease and help manage them before and after surgery, he also can treat certain congenital heart diseases with minimal invasive procedures like the device closure of various holes or balloon dilatation of narrow arteries and valves. In the western world, a new subspecialty within cardiology is emerging who care for adults with congenital heart disease. In some countries the ratio of adults with congenital heart disease is even greater than the number of babies born with CHD. A similar trend has now started emerging in India as well. This improved survival is a result of advances in diagnostic procedures and treatment interventions. Other subspecialities in paediatric cardiologist are

The surgery by itself is done by the paediatric cardiac surgeon with assistance from paediatric cardiac anaesthetist (doctor who puts the baby to sleep) and paediatric cardiac intensive care specialist (manages the baby in the ICU after surgery).

Babies with congenital heart defect require meticulous diagnosis, surgery and post-operative care. This is usually done by a team of doctors consisting of a paediatric cardiologist, paediatric cardiac surgeon, paediatric cardiac anaesthetist and paediatric cardiac intensive care specialist.

Almost 20% of the congenital heart diseases are critical which require surgery to be done within the first few months or even days of life. If not treated most of these children would succumb to infections or heart failure. Those that survive infancy often are frail with poor weight and limited in functional capacity.

Yes, Most of the children with congenital heart disease if treated in time could lead a near normal life. Very few children require multiple surgeries or have to be on lifelong medications.