Pediatric Heart Diseases
Pediatric Cardiology has been a neglected specialty in the country despite a massive disease burden. Factors like Consanguinity, viral infections like mumps, measles and rubella, absolute lack of awareness, high treatment costs contribute to the high disease burden. It is estimated that eight children out of every thousand live births are born with heart diseases every year and less than 5% of them get optimal care on time. Most of these children succumb to the disease without celebrating their first birthday, but in contrast if these children receive treatment on time they grow up to become normal adults. Studies conducted in parts of South India like Mysore reveal an increase in the number of congenital heart diseases (CHDs).
There is very little data available on CHDs across India due to lack of knowledge. Studies conducted by AIIMS (All India Institute of Medical Sciences) reveal that 10% of infant mortality can be accounted for by CHDs alone. In this way every year a large number of children are added to the total pool of cases with CHDs.
The study also says that India has sizable adult cases with CHD mainly due to lack of health awareness and dedicated facilities. There are very few dedicated pediatric cardiac centers in India and only 12 pediatric cardio thoracic surgeons and 25 pediatric cardiologists for an OPD of 6500 children per year. (Study published in Indian Journal of Pediatrics,Vol 2005).
Congenital Heart Diseases ( BIRTH DEFECTS OF HEART)
Types of Congenital Heart Diseases & Surgeries
INCIDENCE: At least 8 of every 1000 infants born have some form of heart defect. In India, approximately 1-1.5 lak children are born with some form of heart defect every year. The symptoms vary from mild with a apparently normal child to very severe becoming sick soon after birth. Some of the common pediatric cardiac problems have been listed below to provide a basic introduction to the problems and their treatment.
Ventricular Septale Defect (VSD):
VSD is a hole in the heart between the left and right ventricles (lower chambers). This is the most common heart defect in children. These holes can vary in their size. Babies with large holes develop heart failure, increase in lung pressure, and quite often not grow well.
These large holes need early surgery and can be closed with very little risk. Babies with small holes close on their own and rarely require surgery. Location of holes, their size and number determine whether they close spontaneously or require surgery.
Patent Ductus Arteriosus (PDA):
A PDA is an abnormal opening communication (tube) between the aorta and the pulmonary artery. This opening causes too much blood flow to the lungs, and gets the lungs all wet.
Kids with a PDA can get winded pretty quickly, and babies with a large PDA may not grow normally. A PDA can be easily ligated by a heart surgeon. Small PDA’s can be closed with a catheter using special devices.
Atrial Septal Defect (ASD):
ASD is a hole in the heart, located between the left and right atria (upper chambers). This type of “hole in the heart” can be readily closed by a special device that is placed to plug up the hole or can be closed by a heart surgeon.
Not all ASD’s are suitable for device closure and such cases can be closed surgically. Surgery for ASD’s can be performed through a right posterior thoracotomy approach (back of the chest for girls), which gives a cosmetically appearing scar compared to midline sternotomy scar.
Tetralogy Of Fallot (TOF):
There are four major defects in TOF. The two defects of importance are the VSD and the narrowing in the pulmonary artery (pulmonay stenosis). The other two are hypertrophy of the right ventricle and over riding of the Aorta.
This condition requires surgical repair to fix these abnormalities and is recommonded at 3-4 months of life. In exceptionalcases, a severly blue child or a very scik child , a minor surgery called BT shunt is performed.
Transposition Of The Great Arteries (TGA):
In TGA, the two great vessels swap their positions with the heart chambers (ventricles), such that the aorta is where the pulmonary artery should be, and the pulmonary artery is where the aorta is.
TGV is repaired by “switching” the position of the two great vessels, thereby bringing them to normal position with the chambers and is performed soon after the diagnosis without much waiting.
Coarctation Of The Aorta (COA):
A coarctation is an abnormal narrowing in the main blood vessel of the body, called the aorta. A coarctation can be readily repaired by a surgeon and can be opened with a balloon catheter by a Cardiologist without surgery.
Certain types of narrowing of Aorta can be better managed by surgery alone.
In truncus, the pulmonary arteries come off the aorta instead of the right ventricle. In addition, there’s also a large hole in the heart, called a VSD.
Truncus is repaired by dividing the pulmonary artery off the aorta and connecting it to the right ventricle with a valve conduit. The VSD is also closed to get the circulation back to normal.
Aortic Stenosis (AS):
Stenosis means narrowing and aortic stenosis is narrowing of the aortic valve or narrowing of the aorta directly above (supravalvar) or below (subvalvar) the aortic valve.
Depending on the severity of the stenosis, surgery is needed to correct the defect. Another option may be a balloon valvuloplasty if the narrowing involves valve alone. This procedure is done by the cardiologist.
Pulmonary Stenosis (PS):
PS is a narrowing of the pulmonary valve. Normally the pulmonary valve opens to let the blood flow from the right ventricle to the lungs where the blood gets oxygenated. Because of the narrowing the right ventricle has to work harder to get past the stenotic valve.
This can sometimes lead to enlargement of the right ventricle. Depending on the severity of the pulmonary stenosis, open heart surgery may be indicated to correct the defect. Another option is balloon valvuloplasty. This procedure is done in the cardiac catheterization lab.
Total Anomalous Pulmonary Venous Return (TAPVR):
Pulmonary veins normally bring oxygenated blood back from the lungs to the left atrium. In total anomalous pulmonary venous connection all the pulmonary veins drain into the right atrium. Open heart surgery is needed in early infancy.
Early open heart surgery is needed for this condition.
Atrio Ventricular Septal Defect (AVSD):
In this condition, there are holes in the upper and lower chambers (ASD and VSD) along with common atrio ventricular valve (instead of two valves – Tricuspid and Mitral).
Early surgery is the treatment of choice, where in the surgeon closes both the holes and reconstruct the common valve into two valves (Tricuspid and Mitral).
Detecting Congenital Heart Diseases
The Pediatric Cardiologists at the Heart Institute in Apollo Health City use various diagnostic procedures to determine the heart diseases in children. The congenital heart defects can be diagnosed even when the child is in the mother’s womb through Fetal Echocardiography.
The following diagnostics are generally carried out
- ECHO-The pediatric cardiologist performs the echo to determine the heart disease.
- Chest X Ray
- TEE Transesophageal Echocardiogra
- PET CT – In most scenarios the consultants use the help of PET CT which gives accurate results. Apollo Health City has the PET and 16slice, please browse the site to know more about the Apollo Gleneagles PET CT Centre
- Lab Investigations
- Cardiac Catheterization
- Balloon Valvotomy
- PDA Device closures
- Patent Foramen Ovale Closures