Pediatric Cardiology & Congenital Heart Defects

PEDIATRIC CARDIOLOGY

“Intervention for Congenital Heart Disease without surgery is a miracle of Medical science!”

WHAT IS CONGENITAL HEART DISEASE (CHD)?

CHD are defects in the structure of the heart or its great arteries and is present right from birth. 10-14 out of 1000 children born have some form of CHD. Approximately 250 000 new cases per yr of CHD are added to the pool in India. About 25% of CHD are critical, requiring intervention in the 1^st mo of life. About 32% of deaths <1 mo of age & 10% of deaths in children < 1 yr are due to CHDs.

WHAT ARE COMMON HEART DEFECTS?

CHDs are classified into Acyanotic, Cyanotic or obstructive.

CATHETER BASED TREATMENT OF CHD:

Many CHD can be treated by transcatheter means without “major open heart surgery”.

Transcatheter treatments (i.e. approaching the heart from arteries or veins without open heart surgery) can be classified into

DEVICE CLOSURE: Closing the holes e.g. ASD, VSD, PDA etc using special materials called “devices”.
BALLOON VALVOTOMIES: Opening blocked valves e.g. pulmonary valve, aortic valve etc using special balloons.
STENTINGS: Keeping the arteries or veins with the help of stents that are narrowed from birth or after any surgical procedure: e.g coarctation of aorta- narrowing of the main artery supplying blood to lower part of body, branch pulmonary artery- arteries of lungs.

Some procedures are performed as a part of preparation for next stage surgery by keeping the PDA opened with the help of a stent; in TGA to prepare the left sided heart for final operation called Arterial Switch Operation, in VSD – PA situations for final intracardiac correction.

SEPTOSTOMY: In condition like TGA, smaller hole is made larger for better oxygenation with the help of balloons.

HOW IS THE PROCEDURE PERFORMED?

We have various channels called arteries and veins in our body for supply of blood out or in to the heart. These are used to enter into the heart as well! Specialized tubes called sheath and catheters are used to enter through these channels .Through these sheaths various materials like devices, balloons, stents etc are carried to the heart for interventional procedures (Fig 1)

Fig. 1

WHAT ARE DEVICES??

Devices are structures made of nickel – titanium metal alloy that has a special characteristic called “memory”- when taken them through sheaths, it becomes elongated once out of the sheath its regains its shape ( Fig 2 & 3).

Fig 2: ASD Device Closure

Fig 3: PDA Device Closure

PRECAUTIONS AFTER CATHETER BASED TREATMENT:

In majority cases the patient is discharged 1or 2 days after the procedure & can resume normal work school) within a week. There is no diet restriction. Only in few cases long term medication is required. They are followed up at 6 monthly for the initial few years only.

ADVANTAGES OF CATHTER BASED TREATMENT:

Like any other minimally invasive procedure these procedures have cosmetic appeal, lower morbidity and mortality, shorter hospital stay, earlier return to work & activities.

Avoiding open heart operation early in life preserves tissues and lowers the risk of Re-do surgery if required for any acquired heart disease later in life, e.g. valve replacement or by-pass ( CABG) surgery etc .