Closing congenital heart defects both in small kids and adolescents with microsurgery and special emphasis on foetal echocardiography

Congenital heart defects (CHDs) comprise a dangerous congenital pathology reported in around one out of every 100 live births, and can range between mild and life-threatening. Thanks to improved diagnostics and access to better healthcare, more and more cases of CHD are being detected over the last few decades.

Some common types of CHDs

# Atrial septal defect (ASD): An ASD is a hole in the partition between the heart’s upper chambers or atria, resulting in oxygen-rich blood mixing with oxygen-poor blood. This is often a simple defect that may close on its own. Larger ASDs can put strain on the heart, elevating the risk of pulmonary hypertension, heart failure, stroke or organ damage. Such defects can be closed by surgery or catheter-based procedures, if required.

# Ventricular septal defect (VSD): A VSD is a hole in the wall between the heart’s lower chambers (ventricles), causing blood to mix. While small VSDs often close on their own, larger ones force the heart and lungs to work harder, resulting in pulmonary hypertension and heart failure. Surgery is used to fix this.

# Patent ductus arteriosus (PDA): In this defect, a connection between the aorta and pulmonary artery fails to close following birth. For larger openings, surgery may be needed to avoid complications.

# Pulmonary stenosis: This condition is a narrowing of the pulmonary valve, constricting blood flow from the heart to the lungs. Severe cases are treated with balloon valvuloplasty or open-heart surgery, both with very good outcomes.

# Tetralogy of Fallot (ToF): This is a complex cardiac condition combining four defects – pulmonary stenosis, a large VSD, a misplaced aorta and right ventricular hypertrophy or thickened muscle. These defects force the heart to work harder, resulting in low oxygen levels and needing early surgery.

Closing congenital heart defects

Closing congenital heart defects entails an array of treatments, ranging from foetal intervention to surgery/catheterization in children and teenagers. Foetal echocardiography plays a critical role in early diagnosis, risk assessment (predicting postnatal needs), directing delivery and also planning foetal/neonatal procedures, for instance stenting or balloon dilation to augment long-term results.

Microsurgery for CHDs involves advanced, minimally-invasive techniques, using small cuts or catheter-based methods (transcatheter) for repairs, minimising trauma, pain and recovery time, compared to traditional open-heart surgery, with instruments guiding through blood vessels or small ports to fix holes, constrictions or other problems. This approach yields excellent outcomes for many complex conditions in infants and children.

How does it work?

# Minimally invasive cardiac surgery (MICS): Doctors use small incisions and specialised tools for direct heart access, often involving robotic assistance, to repair defects.

# Catheterization or transcatheter: A catheter (thin tube) inserted in a blood vessel (from the groin) directs tiny instruments or closure devices to the heart, fixing issues without cutting open the chest.

# Hybrid procedures: These procedures combine both catheter-based and surgical techniques.

It is used for:

Fixing holes (ASD, VSD).
Treating constricted areas.
Repairing complex defects in infants.

The benefits

Less trauma.
Swifter recovery.
Less pain and scarring.
Excellent outcomes.

Foetal echocardiography: The key to early management

# Early detection and prognosis: Detects CHDs before birth, identifying severity, predicting postnatal instability and directing transfer to specialized centres for immediate care.

# Dynamic assessment: Analyses physiology of the foetal heart to comprehend disease impact on the developing brain and predict neurological outcomes.

# Intervention planning: Guides foetal interventions like balloon atrial septostomy and helps plan postnatal management, including timing and approach for surgery or catheterization.