Congenital heart disease

By Dr. Sarat Ku Sahoo, Department of Cardiac Sciences HOD, SUM ULTIMATE

Congenital heart defects (CHD) are heart abnormalities present at birth that can affect how the heart works. Congenital heart disease is the most common birth defect, with an estimated prevalence of 8 in 1000 live births. These are the most common birth defects responsible for a third of congenital birth defects. The number of children born with coronary heart disease in India is 2,40,000. 10% of infant mortality rate in India is due to coronary heart disease. These heart defects can affect the shape of the heart or how it works and can be simple or complex.

Congenital heart defects can affect the baby’s heart, including the heart walls, septum and heart valves, and can cause blood vessels to become malformed and affect the arteries. Some babies will have a combination of defects. It can also cause complex CHD – calculus of defects in heart valves, heart walls, and blood vessels. The presence of such heart defects in a child can impair blood flow, causing the child’s blowing flow to slow down or block, or cause it to flow in the wrong direction. It can also lead to the child’s blood not having enough to cover the body.

Some heart defects do not require treatment or can be treated easily. But others, like some critical CHDs, may require years of surgery. There are two types of CHDs. The first is cyanotic congenital heart disease. It is a form of critical congenital heart defect (CCHD) that reduces the amount of oxygen delivered to the baby’s body. It causes blue discoloration of the skin and the baby also experiences breathing difficulties. Cyanotic coronary artery disease is usually present at birth and due to complex heart defects affecting multiple heart structures, the baby would need immediate surgery after birth to correct this condition and improve blood flow to the lungs and rest. from the body.

The second type of congenital heart disease is acyanotic congenital heart disease. Acyanotic heart defects are congenital heart defects that affect the atrial or ventricular walls, heart valves, or large blood vessels. The condition is present at birth but may not cause any symptoms or problems until later in life. It causes a pinkish discoloration of the skin. A hole in the heart wall is a kind of acyanotic heart defect.

In some cases, symptoms of coronary heart disease will appear shortly after birth. Symptoms that present soon after birth are bluish lips, skin, fingertips and toes, shortness of breath, feeding difficulties, low birth weight, chest pain, growth failure and large clubbed or rounded fingers. In other cases, symptoms appear many years after birth. Symptoms can be abnormal heartbeat, dizziness, shortness of breath, fainting, swollen feet, and fatigue, to name a few.

Causes of Coronary Artery Disease

Coronary artery disease occurs due to a developmental problem in the structure of the heart. The causes can be:

  1. Some babies have heart defects due to changes in their chromosomes or genes. Certain genetic changes (also called mutations) are linked to heart defects. Genetic factors can run in the family. Certain genetic syndromes are associated with coronary artery disease. For example, Down syndrome and Turner syndrome.
  1. Taking certain medications during pregnancy
  2. Drinking alcohol during pregnancy or smoking before or during pregnancy
  3. Exposure to toxic chemicals
  4. Viral infection of the mother during the first trimester of pregnancy
  5. Maternal diabetes mellitus.

Advances in pediatric cardiology and cardiac surgery have made it possible to repair or palliate most coronary artery diseases, including the most complex ones. If access to screening, early diagnosis and treatment is available, more than 90% of patients born with coronary artery disease survive to adulthood with good long-term outcomes.

Treatment for congenital heart defects in children depends on the specific type of heart problem and its severity. Treatment may involve medications, heart procedures or surgeries, or heart transplantation. Medications may be given to treat symptoms or complications of a congenital heart defect. Some babies have mild abnormalities that heal on their own over time. A small ventricular septal defect (VSD) or small atrial septal defect (ASD) can often be left alone, but larger ones may require heart surgery or surgery to close them.

Serious congenital heart defects require treatment soon after diagnosis. Cardiac procedures and surgeries performed to treat congenital heart defects include:

Catheter Procedure (Percutaneous Cardiac Intervention) – This is a safe method and is performed by making small holes in the arteries and veins without surgically opening up the chest and heart. The procedure is done by inserting a small tube into the heart through the arteries or veins. When there is a hole inside the heart (ASD, VSD, PDA), it can be closed with umbrella-shaped devices that are dislodged through the defect. This procedure leaves no scars on the breast. It has a shorter hospitalization period and the patient can return to normal activities within 2-3 days. Most holes inside the heart can be closed by this method.

When a valve is blocked, it can be opened by inflating a balloon over the valve using procedures such as aortic valvotomy and pulmonary valvotomy. When the heart vessels are blocked, it can be opened by putting stents like coarctation aorta stenting and pulmonary artery stenting.

Most acyanotic coronary heart disease can be treated with this catheter procedure without open-heart surgery. Few cyanotic coronary diseases can be treated with catheter procedures to make the patient fit for open heart surgery.

Open heart surgery is done when a catheter procedure is not enough to repair a congenital heart defect. Open-heart surgery is performed in cases of complex coronary artery disease, in fact cyanotic coronary artery disease. If a serious heart defect cannot be repaired, a heart transplant may be needed. Implantable cardiac devices like pacemakers and implantable cardioverter defibrillators are also an option for treating coronary heart disease.

As we know little about the causes of congenital heart disease, the emphasis is on prevention. Women who are pregnant or planning to become pregnant can take certain precautions to reduce the risk of giving birth to a baby with coronary artery disease.

  • Avoid taking medication without consulting a doctor
  • Control your blood sugar.
  • Get vaccinated against rubella or German measles
  • If you have a family history of coronary artery disease, get genetic testing.
  • Avoid the consumption of alcohol and illegal drugs during pregnancy.

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