Congenital heart diseases: Prevention, diagnosis and cure

According to the latest article by the World Heart Federation, every one in a hundred children born will have a malformation of the heart. Out of these, nearly half of them require medical care in their lifetime, and many within their first year of life. While the majority of congenital heart defects don’t require a child heart treatment, regular checkups and monitoring by a pediatric cardiologist are necessary. In cases of delayed diagnosis and lack of timely treatment espevially with regards to a congenital heart defect treatment, they get repeatedly hospitalized for heart failure, recurrent pneumonia, cardiovascular complications, and associated problems. A delay in diagnosis can compromise the surgical outcome, and may also make the child inoperable later. On the other hand, a plan of ‘pediatric cardiac care continuum’ is a requirement for the treated individuals. The “Hridyam” program implemented this, providing lifelong management (from the antenatal period to postnatal evaluation, cardiac surgery, and long-term follow-up) for the CHD-affected children, resulting in a decrease in infant all-cause mortality to 6/1000 live births by 2019. 

Following this unique pattern of planning, the first step in CHD treatment is prenatal care, which includes the following necessities:

  1. Family history of CHD and carrier screening: If there is a family history of a congenital heart defect then potential genetic factors should be identified. Genetic testing is required if the parents are carriers of specific mutations associated with CHD. However, due to a lack of resources in the health sector, it might now always be possible to have this assessment.
  2. Proper maternal healthcare: Prenatal care with timely visits and routine checkups, including ultrasound screenings, is necessary. It can help in the early diagnosis of the disease. Management of chronic conditions such as diabetes or hypertension should be done effectively to reduce the risk.
  3. Avoiding certain medications: Teratogenic drugs, such as lithium and isotretinoin used in acne, should be avoided in pregnancy. Healthcare providers must be consulted before taking any medication.
  4. Vaccinations: The pregnant female should be up-to-date and vaccinated to prevent infections such as rubella, which have a risk of congenital anomalies.

Fetal echocardiography has been playing an important role in diagnosing CHD During pregnancy. If the doctor suspects the foetus to have a CHD, then a fetal echocardiography is usually carried out at around 18–22 weeks to confirm the diagnosis. Sometimes, however certain anomalies are missed especially if they are not critical. If the baby shows other symptoms of a CHD then there are certain other tests undertaken to confirm the diagnosis, including:

  1. Pulse oximetry: a simple technique that measures the oxygen saturation levels in the body. This has been used widely in the developed countries to look for a heart anomaly before sending new born babies home where a low oxygen saturation level indicates an issue with the heart.
  2. Electrocardiogram: It helps in recording the electrical activity of the heart. It can detect how well the heart is beating or if there are any irregular heart rhythms.
  3. Echocardiogram: This is an ultrasound of the that maps the function of the heart valves.
  4. Chest X-ray: A simple chest X Ray also helps to detect a heart defect.  An enlarged heart or extra blood/fluids in the lungs are also indicative of a heart defect.  
  5. Cardiac catheterization is an invasive procedure where information about the blood flow and function of the heart is provided.
  6. MRI: it creates a 3D image of the heart to visualize the accurate measurements of heart chambers. It is used in adolescent and adult CHDs.

If there is suspicion for the child to have a CHD, then one should connect with a pediatrician or a pediatrc cardiologist to examine the child. Most congenital heart defects if diagnosed on time can be treated today.  

The medical intervention for the a congenital heart defect treatment depends on the type and severity of defect the individual has. While the majority of CHDs need only regular follow-ups and proper monitoring, severe heart defects need surgery and other interventions with lifelong management.

Some of the methods for treating a congenital heart defect are as follows:

Medication:  Blood pressure drugs, diuretics and antiarrhythmic drugs such as angiotensin-converting enzyme inhibitors and beta blockers, lower the blood pressure and provide symptomatic relief.

Cardiac catheterizations: This is a non-invasive technique where a catheter is inserted into the heart from the blood vessels usually from the leg or neck and guided to the heart for the necessary intervention. This can be used to perform procedures such as valvuloplasty, stent implantation, angioplasty and others.

Heart surgery: This can be an open heart surgery or a minimally invasive surgery and done usually in the case of a moderate-critical heart defect.

Heart transplants: These are done in the case of a critical heart defect.

For a successful child heart treatment, it is essential that even after an intervention the child remains in touch with the pediatric cardiologist to ensure that the child is progressing well. Regular follow-ups are essential unless advised otherwise. In addition, Nutritional support with special diets is sometimes required for optimal growth and recovery.  While this may sound daunting, most children born with a CHD can live upto near normal lives with just one intervention.

Timely diagnosis and provision of the optimum treatment have given many children across the world a near normal life.

 

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