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Congenital and Pediatric Heart Surgery In India At Affordable Low Cost

Congenital and Pediatric Heart Disease

Heart diseases that are present at birth are called “congenital heart disease”. Congenital heart disease is a type of defect or malformation in one or more structures of the heart or blood vessels that occurs before birth. 

Some of these require no treatment as they are self correcting while others may require either minor or major reconstructive surgery of the heart.

Types of Congenital Heart Disease

Congenital heart disease changes the normal flow of blood through the heart because some part of the heart didn’t develop properly before birth.

Atrial septal defect(ASD) :

An atrial septal defect (ASD) is a hole in that septum. Atrial septal defects are one of the most common heart defects seen. When an atrial septal defect is present, blood flows through the hole primarily from the left atrium to the right atrium. This shunting increases the blood volume in the right atrium which means more blood flows through the lungs than would normally. If left untreated, atrial septal defect may cause problems in adulthood. These problems may include pulmonary hypertension (which is high Blood Pressure in the lungs), congestive heart failure (weakening of the heart muscle), atrial arrhythmias (which are abnormal rhythms or beating of the heart) and an increased risk of stroke.

Ventricular septal defect (VSD) is a hole (defect) in the wall that separates the lower chambers of the heart. VSD is a congenital heart defect, which means that it is present at birth. In children with a VSD, blood usually flows through the defect from the left ventricle to the right ventricle. This causes extra blood (called volume overload) in the pulmonary arteries and lungs, and in the left atrium and left ventricle.

Atrioventricular canal defect is a combination of several abnormalities in the heart present at birth (congenital). This defect includes a hole between the chambers of the heart and problems with the valves that regulate blood flow in the heart. Atrioventricular canal defect may also be called endocardial cushion defect or atrioventricular septal defect.

Patent ductus arteriosus (PDA) :

Patent ductus arteriosus (PDA) is a defect in which the temporary blood vessel connecting the left pulmonary artery to the aorta in the fetal heart fails to close after birth. In the fetal heart, blood bypasses the lungs and gets oxygen from the placenta. But when the newborn's lungs take over at birth, the body stops producing the chemicals that keep the ductus arteriosus open, and it closes naturally.

Stenosis means narrowing. Aortic stenosis is then a narrowing of the aortic valve or a narrowing of the aorta directly above (supravalvar) or below (subvalvar) the aortic valve.Normally, oxygen rich blood is pumped from the left ventricle, through the aortic valve and into the aorta. The aorta is the main artery that sends oxygen rich blood to the body. In aortic stenosis, it makes it very hard for the heart to pump blood to the body. Depending on the severity of the stenosis, open heart surgery may be needed to correct the defect.

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Pulmonic (pulmonary) stenosis is a narrowing of the pulmonary valve opening that increases resistance to blood flow from the right ventricle to the pulmonary artery. It is often present at birth (congenital) and thus affects children. 

Pulmonic stenosis, which is rare among adults, is usually due to a birth defect. When the stenosis is severe, it is usually diagnosed during childhood, because it produces a loud heart murmur. Severe pulmonic stenosis occasionally causes heart failure in children but often does not produce symptoms until adulthood. Symptoms include chest pain (angina), shortness of breath, and fainting.

Ebstein's anomaly is an abnormality in the tricuspid valve. The tricuspid valve separates the right atrium (the chamber that receives blood from the body) from the right ventricle (the chamber that pumps blood to the lungs).

In Ebstein's anomaly, two leaflets of the tricuspid valve are displaced downward into the pumping chamber and the third leaflet is elongated and may be adherent to the wall of the chamber. These abnormalities cause the tricuspid valve to leak blood backwards into the right atrium when the right ventricle contracts and as a result, the right atrium becomes enlarged and. If severe enough, congestive heart failure can result.

Aortic coarctation is a narrowing of part of the aorta (the major artery leading the heart). It is a type of birth defect. Coarctation means narrowing.

Coarctation of the aorta is localized narrowing of the aortic lumen that results in upper-extremity hypertension, left ventricular hypertrophy, and malperfusion of the abdominal organs and lower extremities. Symptoms vary with the anomaly's severity and range from headache, chest pain, cold extremities, fatigue, and leg claudication to fulminant heart failure and shock. A soft bruit may be heard over the coarctation site. Diagnosis is by echocardiography or by CT or MR angiography. Treatment is balloon angioplasty with stent placement, or surgical correction. .

Tetralogy of fallot :

Tetralogy of Fallot is the most common heart defect in children. The condition causes mixing of oxygen-poor blood with the oxygen-rich blood being pumped out of the heart and into the circulatory system of blood vessels.

The blood leaving the heart has less oxygen than is needed by the organs and tissues of the body, a condition called hypoxemia. Chronic (ongoing, long-term) lack of oxygen causes cyanosis, a bluish color of the skin, lips, and membranes inside the mouth and nose.

Tricuspid atresia is a type of congenital heart disease in which the tricuspid heart valve is missing or abnormally developed. The defect blocks blood flow from the right atrium to the right ventricle. The tricuspid valve, normally located between the right atrium and the right ventricle, does not develop properly during pregnancy.

The signs and symptoms of tricuspid atresia depend on the presence and size of the ventricular septal defect, and the relationship of the great arteries. Most commonly, the great arteries are normally related and there is either no ventricular septal defect, or only a small ventricular septal defect.

Pulmonary atresia :

Pulmonary atresia is a rare congenital heart defect that usually presents itself along with other malformations such as VSD, tricuspid atresia, or complete transposition of the great arteries.

Pulmonary atresia is the failure of the pulmonary valve to develop with the normal development of the right ventricular chamber. Arterial pulmonary atresia is the failure of the development of the main pulmonary artery, pulmonary valve, or the right ventricular chamber. Normal right heart circulation is not possible. Circulation depends on the patent foramen ovale or ASD and a PDA.

Hypoplastic left heart syndrome :

This is a congenital heart defect in which there is under development of left side of the heart (left ventricle, aortic valve, and aorta). This is one of the most serious congenital heart defect which needs attention almost immediately after birth. In this defect no blood goes to the left side of the heart and therefore whole systemic circulation suffers. Life persists only on some connection between right side and left side either through a patent ductus or atrial septal defect. Spontaneous closure of this connection especially the ductus leads to severe circulatory embarrassment and death of the child.

Transposition of the great vessels is a congenital heart defect in which the 2 major vessels that carry blood away from the heart -- the aorta and the pulmonary artery -- are switched (transposed).

The heart is forming during the first 8 weeks of fetal development. The problem occurs in the middle of these weeks, allowing the aorta and pulmonary artery to be attached to the incorrect chamber.

Total anomalous pulmonary venous connection (TAPVC) is a relatively uncommon congenital defect representing approximately 2% of all congenital heart anomalies. TAPVC encompasses a group of anomalies in which the pulmonary veins connect directly to the systemic venous circulation via persistent splanchnic connections. This abnormality results from failed transfer, in the normal developmental sequence, of pulmonary venous drainage from the splanchnic plexus to the left atrium.

Truncus arteriosus is a rare congenital heart defect in which an opening is still present between the two ventricles (a ventricular septal defect), and the trunk of arteries, called the truncus arteriosus, is still undivided.

Symptoms associated with truncus arteriosus usually emerge in the first week of life. When an infant is born, there is a higher degree of pulmonary resistance, meaning it's more difficult to pump blood into the lungs, which have not been used in utero. However, over the first week of life, as the child breaths, the resistance in the lungs gradually drops, changing the pressure gradient across the heart's outflow. Today, physicians are more likely to recommend surgery within the first week of life, or as soon as feasible.

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