As a community, we are witnessing a change in the pattern of diseases affecting children. Malnutrition and infectious diseases such as diarrhoea used to be the concern in the 90s and early 2000s, and were the focus of all child health programmes around the world. This focus has led to a significant reduction in these issues, and newer non-communicable and congenital diseases are gaining prominence.
Congenital Heart diseases, i.e, structural heart diseases that are the result of improper development of the baby’s heart in utero, are now one of the main factors that cause infant morbidity. With changing times, the treatment for these heart defects has also changed, and many non-surgical options are available for the treatment of congenital heart diseases.
Congenital heart diseases can vary in severity from minor conditions that require no treatment to critical ones, when the babies need surgery soon after birth. The most common of these lesions is a ‘Hole in the heart’. The wall separating either the atria or the ventricles has holes, through which there is mixing of blood from one chamber to the other. This then leads to a rise in the pulmonary artery pressures and requires closure. A good number of these defects close as the baby grows. For those that don’t, they have to be closed with surgery or intervention.
Catheter-driven intervention or device closure is often possible for these Holes. The Septal Occluder devices are dumbbell-shaped and made of Nitinol meshes filled with a polyester or Dacron fabric. Once in place, they seal the hole and prevent movement of blood from one chamber to the other. The procedure employed for this is a minimally invasive alternative to open-heart surgery. This is performed through a small puncture made in the vessel in the groin area, and a catheter is introduced into the blood vessel. The course of the catheter is monitored with fluoroscopy, and once the catheter reaches the hole, the device is expanded, and the hole is closed. The procedure happens in the Cath lab and under local or general anaesthesia based on the age of the child.
Patent ductus arteriosus is a communication between the great vessels, the Aorta and the Pulmonary artery, which too can be closed with similar devices or plugs. Some heart conditions, such as Cyanotic conditions of the newborn (Blue Babies), may require a stent to be placed to keep the Ductus Arteriosus open till the corrective surgery can be performed in an older child. This significantly reduces the mortality and morbidity of surgeries in the newborns.
Coarctation of the aorta and narrow heart valves, such as aortic and pulmonary valves, also have the option of minimally invasive Interventional procedures wherein the narrow areas of the blood vessel and the valves can be dilated with a balloon to improve flow across these structures. Sometimes, narrowing of the pulmonary artery seen in a condition known as Tetralogy of Fallot may also be managed initially with stents placed in the pulmonary artery known as RVOT stents. And for the same condition in older adults, a percutaneous pulmonary valve placement is now possible.
Congenital heart diseases are therefore a growing concern and at the same time a problem with many possible solutions. Despite the increasing prevalence of Congenital Heart Diseases, newer and newer treatment options are also available to ensure that children with these ailments lead a normal life despite their critical heart problems.
The author is an Associate Consultant, Department of Pediatric Cardiology, KIMSHEALTH, Thiruvananthapuram.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
