Congenital Heart Disease – Simplified !!

Most of us know what Febuary 14 signifies, yes you are right!!

It is valentine’s day, but do you know that it is also the “ Congenital Heart Defects Awareness Day”

Nearly 1,80,000 babies are born with heart disease in India every year. Of these 60,000 to 90,000 babies are born with critical heart disease requiring early intervention and treatment. Around 10% of Infant mortality in India are due to Congenital Heart Disease.

Due to lack of health awareness and inadequate health care facilities there are also a population of adults with uncorrected congenital Heart disease. The incidence in India 4 for every 1000 live births.

What is Congenital Heart Disease?

Congenital heart disease is caused by the developmental anomaly of the heart during pregnancy when the baby is in uterus.  Congenital heart disease may present with symptoms soon after birth, or in infancy or childhood or some even adulthood.

In contrary to the belief that once a Heart defect child is always sick (even after surgical correction) I have added a few patients photos who were severely sick before surgery and have gained weight and are leading a normal toddler life now 🙂

I sincerely thank the parents who permitted me to post the photos in MyLittleMoppet

Here I am detailing what are the different types of Congenital Heart Defects and the treatment modalities

Classification of Congenital Heart Disease

In simple terms, Congenital Heart Disease may cause one of the following

1. Increased Blood flow to lungs
2. Decreased blood flow to lungs.

Based on this, the CHD can be further classified based on the complexity of the disease

1. Simple Congenital Heart Disease

Patients with simple CHD present with only lesion or problem like

• Presence of a hole in either upper (ASD) or lower (VSD) chamber of the heart.
• Presence of anomalous connection that causes mixing of pure and impure blood.

2. Complex Congenital Heart Disease

Patients with complex CHD present with more than lesion or problem, a combination of two or more of the below lesions might occur

• Presence of Hole in both Chambers (ASD and VSD)
• Hole in lower chamber with Obstruction of blood flow to lungs (TOF)
• Leak in the heart valves associated with hole in the heart (AVSD)
• Reversal of the main artery connections (TGA)
• Combined origin of the great arteries with a single valve (TA)

Symptoms of Congenital Heart Disease

1. Repeated Respiratory tract Infections – In defects with increased blood flow to lungs, the blood flow to lungs is double the normal flow and thus lungs will be wet and more susceptible to infection  like pneumonia, they may be even very severe requiring hospital admission.

2. In defects with increased blood flow to lungs, the other parts of the body receive very less blood and hence it may lead to the following symptoms.

• Decreased Weight Gain
• Difficulty in feeding
• Delay in milestones.
• Easy fatigability

3. In defects with decreased blood flow to lung, the blood is not 100% purified leading to less oxygen levels in blood which may in turn cause

• Bluish discoloration of lips, finger tips and tongue
• Difficulty in doing any activity due to decreased availability of O₂ to body cells

Age of Presentation of symptoms depending on Severity

1. Severe Type

The severe form of CHD presents immediately after birth and is called the Blue Baby Syndrome.

2. Moderate Type

It usually presents after 3 months of birth and may present as not gaining weight, Difficulty while    feeding, increased respiratory rate and repeated respiratory infection.

3. Simple Type

They present from 9 months to 1 year and may present with the same symptoms like the moderate type.

Treatment of Congenital Heart Disease

1. Treatment without surgery

Certain types of ASD and VSD  and extra connection ( PDA ), can be closed with a button like device instead of an open heart surgery. It can be closed by injecting the button through the artery in the thigh and placing it in the heart without anaesthesia. There will not be any scar and the patient can be discharged on the same day

2. Open heart Surgery

Open heart surgery is done for patients with complex types or Simple type which cannot done with button like device and  with some  complications. Open heart surgery to be done at appropriate time to correct the abnormality and  to make the heart  anatomically near normal. It may require a single surgery or 2 or 3 follow up surgeries depending upon the type of the severity of the disease. Timing of surgery is to be decided by the severity of the CHD.

3. Combined Procedure

Some of the complex CHD are treated initially without surgery by procedures through the artery from the thigh and the final surgery can be done at an ideal age.

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Author Bio

Dr Gopi Nallaiyan M.S, M.ch, DNB  is a Pediatric Heart Surgeon of more than a decade of experience in the pediatric cardiac field and has operated on simple and complex congenital heart defects of new born babies and adult congenital disorders. If you have any queries on pediatric heart problems you can contact Dr Gopi Nallaiyan at [email protected].