DR. K. SIVAKUMAR
Non-surgical procedures reduce the need for open-heart surgery in children.
Birth defects of the heart affect eight to 10 out of every 1000 children in the country. Earlier, most had to be operated upon by open or closed heart surgery. However, in recent years, non-surgical procedures that require minimal hospitalisation are available.
What is congenital heart disease?
Congenital heart diseases are defects present since birth. It can be a hole in the walls between the right-side chambers carrying blue deoxygenated blood, and left-side chambers carrying pink oxygenated blood; narrowed heart valves or narrowed blood vessels. These result in enlargement of heart chambers, heart failure, poor growth, and frequent chest infections in the growing child.
What causes these defects?While research is still underway on the exact cause, we know of some contributory causes: maternal alcohol intake, anti-epilepsy drugs, infections like German measles, deficiency of vitamins like folate and certain genetic and chromosomal abnormalities.
How common are these conditions in India?The estimates are 0.8 per cent of all live births or around 25,0000 babies each year. Roughly one third have critical heart defects and may not survive beyond early childhood, if not corrected.
How many need some form of surgery or intervention after birth?At least 50 per cent will need some form of treatment to enable them lead a better life. For a majority of children, the quality of life after treatment is better and they can participate in activities and enjoy normal growth and development.
Is open-heart surgery the only option?In many cases, non-surgical catheter-based treatments are available. The number of conditions amenable for such non-surgical intervention is increasing, thanks to technological advances and increasing experience of surgeons.
What do non-surgical procedures involve?The child is given local anaesthesia in the groin. Then a small catheter measuring 2-3 mm is passed through the blood vessels and advanced into the heart. The holes (defects) are closed using specially designed devices. In the case of narrowed blood vessels and valves, these are dilated using balloons and stents selected to suit the appropriate area of use.
Does this mean use of foreign materials?Yes, the closure of heart defects uses devices made of nitinol alloy and polyester or PTFE patches. These are tested in various animal and human tissue models before being accepted for permanent human use. After 3-6 months of implant, a thin layer of endothelium (like a soft skin from the interior of the heart) grows over the devices and seals the defects permanently. This ensures permanent closure of holes.
What are advantages of non-surgical treatment over open surgical procedures?After open surgery, a patient needs hospitalisation for seven days. Since it involves an incision in the chest, the patient needs to be anaesthetised and requires artificial mechanical ventilation in ICU for a couple of days. Full recovery takes two months. On the other hand, the non-surgical method eliminates incisions. There is generally no need for general anaesthesia. There is no bleeding, so no blood transfusions are needed. There is no major pain after the procedure. They can go home the next day. The most significant advantage is that there is no scar. Scars left by open surgery may be embarrassing for growing children, especially girls.
What are the heart defects that can be corrected without surgery?Atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) can be treated. Children with narrowed valves and blood vessels like aortic and pulmonary valve stenosis, and aortic coarctation can also be treated with balloon dilatation and stenting.
What happens if these are not treated?They lead to progressive enlargement of heart chambers, heart failure, growth failure, pulmonary hypertension and irregular heartbeat (arrhythmia). They may be life-threatening too. Some babies may develop serious lung infections, to which they might succumb.
What are the signs of such ailments?Poor growth, frequent chest infections with cough and colds, breathing difficulty, bluish discoloration of tongue and nails and increased chest pulsations over the heart. Check with a doctor if these symptoms persist. The earlier, the defect is detected and treated, the sooner the patient will recover.
The writer is a Paediatric Interventional Cardiologist based in Chennai.