The occurrence of Congenital Heart Disease is roughly one in every 100 live births anywhere in the world. They can range from simple ones like the hole in heart, abnormal communication between chambers of heart or blood vessels. There are some with blockage at some level in heart. More complex ones are a combination of different problems in the heart. Most difficult ones are those where there is an absence of one of the pumping chambers of the heart or gross misconnection at multiple levels in the heart.
They come to notice of medical practitioner at various time. Some of them are detected during routine ultrasound of a pregnant lady. Some present immediately after birth. Some at various stages of life even in adulthood. They can be detected incidentally when a child visits a doctor for another illness or during routine check-ups. They can produce symptoms at various stages of life depending on the nature and severity of the disease.
Congenital Heart Diseases are mainly of two broad variety, with cyanosis i.e. bluish discoloration of the body or without cyanosis. With cyanosis, there is generally mixing of blue impure blood with less oxygen and pure oxygenated red blood somewhere in heart and big blood vessels. In cases without cyanosis patients present with breathing and feeding difficulty, poor weight gain, frequent cough, cold fever, etc.
Investigations are X-Ray Chest, ECG, and Echocardiogram. Some need additional CT scan, MRI, and Cardiac catheter. Once diagnosed and assessed treatment involves various methods. Some need only regular follow up or some form of medications. Some are treated by catheter intervention without open surgery. More than half of these children require open heart surgery during some stage of life. Many diseases are virtually cured by single intervention or surgery. Few of them require multiple surgeries. Timing of operation is also variable – some need urgent operation within a few days to weeks of birth. Most of them need intervention/surgery in the first year of life.
Any intervention or surgery even simple ones carry certain risk due to the use of the heart-lung machine. Reasons for a high risk are the complex disease, delay in seeking treatment, advance secondary changes in the body and particularly in lungs with damage to the lungs due to high pressures. Some other actors are patient’s pre-surgery weight, age, nutritional status, basic health, access to the medical facility, etc. Timely treatment at the specialist congenital cardiac center can help reduce risk. Over the years cardiac surgery has become less risky than what it was 15-20 years back. But some degree of risk always remains. Risks include – bleeding, infection, organ damage to kidney, brain, liver, etc., heart block, pacemaker. If there are complications, ICU and hospital stay can prolong and there is also a risk of death.
Risk of surgery depends on the type and complexity of the disease. It also to a large extent depend on the timing of surgery. Many patients who otherwise need relatively simple surgery at low risk becomes a very high-risk surgical candidate if surgery is delayed for too long. This can happen due to various reasons – late detection, access, and finances to avail such relatively expensive treatments.
Finally, treatment and surgery should be carried out at the well-equipped center with experienced staff. Better awareness among people, improvement in their nutrition and basic health, better access to tertiary care and follow up facility are important. Also, finances and funding and support are also important. All the above-mentioned issues related to Congenital Heart Disease make significant differences between success and failure.
Dr. Dipesh Trivedi | Sr. Consultant Paediatric Cardiac Surgery | SRCC Children’s Hospital, Mumbai