by The Welthi Bureau | 29th Oct, 2019
Congenital Heart Disease (CHD) implies all structural abnormalities of the heart present since birth. A few of them may be silent in early life and manifest later in adolescence or adulthood. We are now seeing more cases of congenital heart diseases, owing mainly to a heightened awareness, an earlier clinical suspicion and improved diagnostic modalities., Dr.Nitin Rao, Leading Paediatric Cardiologist of Star Hospitals, Hyderabad will brief you about Congenital Heart Disease (CHD).
The incidence of CHD in various reported studies worldwide has ranged from 4 per 1000 to as high as 50 per 1000 live births. However, most data is from epidemiological studies done in the developed countries. The incidence of CHD in different studies varies depending upon the type of study (hospital or community based) and the population selected but roughly, an average worldwide incidence of CHD is about 6-8 cases per 1000 live births. The frequency of different forms of CHD also differs greatly from study to study. There have been numerous paediatric cardiac trials till date, to address this issue.
CONGENITAL HEART DISEASE (CHD) PREVALENCE - THE INDIAN SCENARIO
Most available data on CHD is from large studies carried out in developed countries and Indian statistics are relatively less - mainly due to improper reporting and also because home deliveries are under reported & hence statistics are incomplete. Besides, access to primary medical care is probably not available to all and a large number of children with serious heart defects probably do not reach a centre where an accurate diagnosis can be made and data reported.
The incidence and prevalence in India is likely to be very high considering the high birth rate in India. There have been studies with varying reported incidence of various lesions. One of the early and detailed studies has been an autopsy series by Kinnare et al which reported a very high incidence of complex CHDs including hypoplastic left heart syndrome and d-transposition of arteries. Other lesions like ventricular septal defects, patent Ductus arteriosus and small Atrial septal defect, etc. have been seen in older children and also in community based studies. There is an Indian study that reported a higher incidence of Congenital Heart Disease in girls than in boys.
The 2001 census estimated a crude birth rate of 27.2/1000 and estimated live births at 28 million per year. Assuming an incidence of 8 cases per 1000 live births, almost 1, 80,000 children with CHD are born annually. 25 to 30% (50,000 to 75,000) of these will require an intervention in the first year of life.
Nevertheless, there are certain definite differences in the incidence of some types of CHD in different populations. The best documented of these is the excessively high proportion of sub arterial VSDs in China and Japan (about 35% vs. 5% in Caucasians). There are also indications of an excessive incidence of tetralogy of Fallot and other forms of right ventricular outflow tract obstruction in countries like Malta, and Fixler et al. observed that Aortic Stenosis and Coarctation were more common in Caucasians than in the black or Hispanic population. Because of these inaccuracies, it is difficult to know whether the differences are real or merely methodological.
Women with a high folate intake and multi vitamin supplementation in pregnancy have a 30-40 % lower risk of cono-truncal malformations. Retinol intake from foods and supplements in the year before gestation of more than 10,000IU per day has been reported to dramatically increase the risk of d-transposition of great arteries but not other conotruncal defects with normally related vessels. There have been recent reports of a significant decline in the prevalence of severe congenital heartDisease (CHD) in Quebec since 1998, following folic acid fortification.
In the Baltimore-Washington Infant Study, infants with tetralogy of Fallot, AV septal defects, hypoplastic left heart syndrome, pulmonary stenosis, Coarctation of the aorta, VSD and ASD were significantly more likely than controls to have low birth weight for gestational age.
SYMPTOMS & SIGNS
Common symptoms include poor weight gain , Recurrent respiratory infections, Improper feeding & Recurrent hopsitalisations. Rarely , there may be a history of blueness on crying or activity ( these are “Blue Babies”). Rare symptoms include fainting episodes & neurological complication like seizure, neurological deficit etc. Rarely blue babies will develop brain infections – like a brain abscess- that may cause fever/ convulsions/vomiting/drowsiness or altered consciousness etc.
Any child who has an inadequate weigh gain or is frequently ill should be evaluated for congenital heart disease.
Treatment of Congenital Heart defects includes routine care – including nutrition , treatment of respiratory infections & drugs to keep the heart functioning properly. All defects do no need surgery – only large defects or defects causing some effect on the heart (eg abnormal enlargement, increased lung pressure or abnormal valve function) will need surgery at an appropriate age. If surgery is delayed beyond the recommended age for correction , it may lead to irreparable damage to the heart .
Common surgeries include closure of holes in the heart -VSD, ASD, PDA etc & complex repairs as in Tetralogy of Fallot(TOF), Coarctation of Aorta, Transposition of Great arteries etc. the usual hospital stay following cardiac surgery is about 7 -10 days following which the child is discharged & advised regular check up. Rarely,some children may require a second surgery if it is a complex heart disease or some defects need a staged surgeries over ea period of time, for More Details: +91 9573582082.
NON SURGICAL TREATMENT OF HEART DISEASE
This is a very exciting recent development in the treatment of congenital heart disease. This include closure of holes in the heart ( eg ASD, PDA ,VSD ) or dilating narrowed valve (Aortic & Pulmonary valves) or stenting blood vessels as in Coarctation of Aorta or pulmonary arteries.
The advantage of these techniques is that there is no surgical scar ( & therefore no long reminders of being treated for heart disease, quick recovery & quick discharge home – unlike a Surgery that will involve a Surgical Scar, prolonged hospitalization & slow recovery)
This treatment involves passing a tube through the leg (or sometimes neck vessels) into the heart & then passing a device through this tube (under X Ray guidance) to close a hole or passing a balloon to dilate a valve.
These modalities are now used for smaller babies ( including new born babies) with excellent , gratifying results. The smallest neonate that has been treated at our hospital was 2 kg in weight.
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