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From the womb – when the heart is found wanting!

 
  By : , Kochi , India       27.9.2018         Phone:0484 669 9999          Mail Now
  Kuttisahib Road, Near Kothad Bridge, South Chittoor, Cheranalloor, Kochi, Kerala 682027
 
 
 

Dr Sajan Koshy,
Senior Consultant Paediatric Cardiac Surgery,
Aster Medcity, Kochi

Congenital mean present from birth and Congenital Heart Disease (CHD) therefore refers to a disease or a physical abnormality of the heart that is present from birth. It results from abnormal development during pregnancy and is the most common congenital disorder in newborns. In Kerala, the occurrence is estimated to be as per the global patterns with 6 to 13 CHD per 1000 births. This means around 5000 babies are born in the state every year with congenital heart defects. Those which require surgical intervention in the first year of life are referred to as ‘Critical CHD’ and comprise about a quarter of all the CHDs. As with most other diseases, early diagnosis can lead to proper treatment at a tertiary center reducing mortality and morbidity.

Types of Congenital Heart Disease

CHDs are of two types – Cyanotic, where the child has bluish discoloration, especially of lips and fingertips, and Non-cyanotic CHD.

Risk Factors

A doctor should suspect and check for CHD if there is, i) a family history of CHD, ii) existing genetic syndromes like Down’s syndrome and premature births, iii) Mother is suffering from diabetes, hypertension, obesity, thyroid disorders or epilepsy, and iv) Mother is a smoker and drinker and these are associated with cardiac defects, v) Babies born using reproductive technology like fertility medication and in-vitro fertilization (a slight increase in risk), vi) infection inside the uterus, like rubella, herpes virus, etc.

Signs and Symptoms

After birth, it is usually the mother who realizes something is wrong. She may notice difficulty with feeding, fast or hard breathing that gets worse with feedings, or a persistent cough. A doctor can also suspect CHD if there are color changes or child is very pale, if there is excessive sweating particularly on the head and with poor weight gain. Inactivity or excess sleeping or delay in the growth milestones can also lead a doctor to suspect CHD. Routine examination can lead a doctor to discover presence of a cardiac murmur, or absence of peripheral pulses could point to diagnosis.

Diagnosis of CHD

Pulse oximetry is a simple and inexpensive method to diagnose CHD. The test helps to detect reduced oxygen saturation level in the blood. Routine diagnostic methods like a chest X-ray and ECG also help a doctor make an accurate diagnosis in. CT scan and MRI will help to reveal the details of the defect. Rarely, invasive methods like cardiac catheterization are used.

Types of Heart Defects

There are many kinds of heart defects depending on the valve and location affected, of which the bicuspid aortic valve (BAV) defect is the most common. The aortic valve is the main valve between the heart and the aorta which takes blood from the heart to all over the body. This is not usually diagnosed in infancy.

The next most common defects are ventricular septal defects (VSDs) and atrial septal defects (ASDs, which are defects in the walls of the heart chambers. Fourth is the Tetralogy of Fallot (TOF) which is the most common cyanotic CHD.

Treatment

Surgery is the gold standard to correct the defect. The timing of starting treatment is an important aspect. Early treatment and management makes all the difference in children with critical CHD. Conditions like ventricular septal defect (VSD) can be repaired after 3 months unless some life threatening situation arises in the meantime. Common condition like ASD is repaired as child enters school going age. Advances in modern surgery allows some defects can be treated by cardiac catheterization based treatment.

Surgery allows the child near normal life expectancy and quality of life, if not permanent cure. Patients who present in adulthood (Grown up congenital heart disease or GUCH) can also be treated.

Prevention

Prevention may not always be possible but following a healthy life style, attending regular checkups and avoiding unnecessary medications mothers at risk can reduce the chance of CHD developing.




TAGS: Congenital Heart Disease,   CHD,  




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