Congenital Cardiac Disease Is No Longer Insurmountable

Was your baby born with a heart defect? Don’t worry. The child can live a perfectly normal life — medical advancements ensure that most congenital heart problems can be fixed either inside the womb or soon after birth.

September 29 is World Heart Day – dedicated to creating awareness about heart ailments. The focus is usually on adults. Not much is discussed about paediatric heart diseases even though globally, around 10 of 1,000 babies born every day have congenital (by birth) heart defects.

Unfortunately, many families want to abort the foetus if they come to know that the child has a defective heart. They lack the awareness that with advanced medical technology, around 80% of congenital heart defects can be corrected, sometimes even inside the womb, or just after birth, and the baby can lead a normal life. In most cases, there is no need for aborting the defective foetus.

Renowned paediatric cardiologist and director of Rainbow Children’s Heart Institute, Dr Koneti Nageswara Rao, talks about various congenital heart diseases, risk factors and treatment options. A pioneer in his field, the doctor has patented a device called KONAR-MF (multi-functional), which is widely used across 80 countries in Asia and Europe for closing holes in the heart (VSD).

Common congenital heart defects (CHD)

Ventricular Septal Defect (VSD) or a hole between the two lower chambers (ventricles) of the heart accounts for around 25% of all congenital heart defects. Children born with VSDs present with heart failure symptoms like feeding difficulties, breathing problems and poor weight gain. Untreated children may develop complications like frequent pneumonia, pulmonary hypertension (high lung blood pressure) and infection of the heart (endocarditis). These complications may cause significant morbidity and mortality and therefore the holes need to be closed. The good news is that this defect is 100% curable and the babies can live a totally normal life.
Another common curable CHD is the condition is known as ‘Blue Baby.’ It constitutes about 10% of cases. It can be of two subtypes — tetralogy of fallot and transposition of the great blood vessels (pulmonary artery and aorta). Due to the wrong positioning of the blood vessels, the good (oxygen-rich blood) and the bad blood (poor in oxygen) get mixed up and circulated in the body.

Valvular Obstruction is the third type of CHD, which is not uncommon, though not as common as VSD and Blue Babies. It presents as serious blocks in the aortic and pulmonary valves. The chambers of the heart become dysfunctional after birth and the baby usually dies within a few days of birth if not treated at the earliest. High heart rate or Tachyarrhythmia can be challenging too and has to be treated before birth, otherwise, the baby can die due to fluid development in the lungs, brain and abdomen.

Factors leading to congenital heart diseases

Maternal malnutrition – When the pregnant mother’s diet is deficient in folic acid, Vitamin B 12, other minerals and trace elements.

Extremity of age of pregnant mother – This can relate to both early and late pregnancies – when the mother is below 21 years and not physically and psychologically ready for pregnancy, with the internal milieu insufficient for the normal growth of the foetus; and  pregnancies above 35 years of age, when the chances of complex congenital birth defects like Down’s Syndrome and Endocardial Cushion Defect are enhanced.

Consanguineous marriages – Marriage between cousins and close relatives is a practice among certain communities and regions of Southern India. Due to genetic sharing, there are high chances of defects in the foetus. Maternal infection during the first trimester due to viral attacks especially Rubella Virus may lead to congenital Rubella Syndrome in the baby.

Certain medications and exposure to radiation – Consuming certain psychiatric drugs and exposure to radiation can damage the embryo. Smoking and alcohol consumption can cause Ventricular Septal Defect (VSD) and other complications in the baby.

Pesticide fumes – Spraying of chemical fertilizers on crops in rural areas is a risk to newly pregnant women, who, unaware of the pregnancy, may go to the fields and thus inhale the toxic fumes.

Genetic micro-mutation – Research is going on to establish the connection between micro-mutation in generic make-up and congenital birth defects.

Diagnosis of CHD

Foetal Echocardiography is the ultrasound tool for diagnosis of CHD. It has to be performed by trained personnel. “The diagnosis time is usually between 15 and 30 minutes and any foetal defects can be identified within 18 to 22 weeks of pregnancy,” says Dr. Rao. “If genetic testing indicates that the foetus also has brain defects and the child will suffer from mental health issues, sometimes parents opt for aborting the foetus,” he adds. Eighty percent of paediatric heart diseases can be completely cured. Around 10 to 20% of the diseases do not have complete treatment but babies can be given partial palliative treatment, he says.

Treatment choices

In most cases, treatment can be started between 24 and 26 weeks, the cardiologist says. The earlier the treatment starts, the better for the child. In most cases of CHD, after a few weeks or months of rest post treatment, the child can continue routine activities and take a normal diet. Sometimes blood thinners are prescribed for a while.

Elaborating on the treatment modules, Dr Rao says, “VSD, the commonest congenital heart disease, can be corrected without an open-heart surgery. The Konar-MF is used for rectifying the defect. Another common CHD — Blue Baby — can be diagnosed before birth and the corrective procedure can be initiated within a week of birth. Again, this is curable and the baby can live a normal life.

Ventricular Septal Defect or a hole between the two lower chambers (ventricles) of the heart accounts for around 25% of all congenital heart defects. Children born with VSDs present with heart failure symptoms like feeding difficulties, breathing problems and poor weight gain. — Dr Koneti Nageswara Rao, paediatric cardiologist and director of Rainbow Children’s Heart Institute