Every year 8-12 children per 1000 live deliveries are born with heart defects. These are also called Congenital Heart Defect (CHD) which simply means that the heart developed problems since when it was being formed inside the womb. The commonest problems are holes in the heart. Although sound innocuous, this short phrase in my experience created a lot of apprehension and fear among the family and also health care providers. This article is our attempt to put the facts straight.
The Normal Heart:
The heart is a pumping organ and has got four chambers. The two upper chambers are called the Right Atrium and Left Atrium (RA and LA) and the two lower chambers are called the Right Ventricle and Left Ventricle (RV and LV). The upper chambers are separated by a wall called inter-atrial septum and the lower chambers are separated by another wall called inter-ventricular septum. From the RV, one artery or pipe takes impure /deoxygenated blood to lungs for oxygenation. This is called the Pulmonary Artery (PA) and from the LV another artery called Aorta carries pure/oxygen-rich blood to the whole body.
There is no simple and/or single answer to this. Your best guide is the pediatric cardiologist. As I have told that all of us are born with small ASD and PDA. Usually they close spontaneously by 1st week of life. Premature babies often have large PDAs and they often close after medical therapy with oral Ibuprofen or Indomethacin. Rarely some preemies need surgery. The baby’s neonatologist will start these.
Regarding ASD, small defects upto 3-5mm, often close spontaneously. However, larger defects like more than 5-8mm size do not close. They need closure by 3-4 years of age i.e. preschool age either by operation or non-operatively by a button called DEVICE. This is a nonsurgical technique, done under general anesthesia and takes about 40-45 minutes. The child is observed for 24 hours post procedure and then discharged. The advantage is this that there is no scar and unless someone does an Echo or Chest X-ray, it is impossible to identify that the child had an ASD. The usual hospital stay is 36 hours.
After 10 years of practicing pediatric cardiology, life still makes me humble. Way beyond all scientific predictions, sometimes miracles happen and we just bow our heads.
Baby S. is a 2 months old boy, born in Goa, a small state in India. Within a few days after birth, he was diagnosed to be a blue baby; TGA with VSD; Taussig- Bing anomaly. This is one of the most complicated diseases in pediatric cardiology. His parents were middle class people, but luckily they managed to obtain medicare help from Government of Goa. He came to us in a sick state with the train journey giving him one more problem; pneumonia. The first week in hospital stay was spent in treatment of pneumonia. After that he was evaluated and then taken up for a complex open heart surgery: Arterial Switch Operation. In this operation, the position of abnormal arteries from heart is interchanged and the hole is closed. It was a marathon surgery which took more than 6 hours and everything went well initially. But the baby was not able to maintain blood pressure after some time. All the most advanced medical and surgical support including ECMO was instituted, but somehow the response was not what we wanted.
We did an echo after the baby was out of operation theatre. His left side of heart was very weak. It was a desperate situation. As a last resort, the doctor’s team decided to do a bypass surgery to save the heart. Probably, this is one of the rarest cases where bypass surgery is performed in such a small child. But keeping in mind the parents only hope, it was done.
Even the surgeon was unsure what would happen next. Everyone was prepared for the worst. But slowly after a week, we found the baby’s heart is getting markedly better and went on improving. Gradually, all medicines were tapered and stopped. The child was taken out of life support including ventilator. Slowly, the baby recovered. When I did the pre-discharge echo, I could not believe my eyes. The left heart was pumping fantastically. Two days after, Baby S. was discharged from the hospital and went back to Goa.
Looking back, it seems that doing the bypass surgery at that time saved the baby. However, deep down inside, we know it was some other power which protected this life. You may call it God or some super-natural force. The bottom line is “ Never give up”. We don’t know His plans. May be one small step taken by you shall fulfill his bigger designs. That is the Power of Prayers.
PDA refers to an open vessel that allows blood to flow between the aorta and the pulmonary artery. The ductus arteriosus is open during fetal life to divert blood away from the unused lungs. Normally the ductus closes within the first day of life, but for unknown reasons it sometimes remains open. This occurrence is more common in premature infants. If the PDA is small, there may be no symptoms at all. Symptoms of a large PDA are rapid breathing, fatigue, and slow weight gain. After surgical correction, these symptoms will disappear. The surgery involves a left thoracotomy incision. The vessel is “ligated” and divided in half or clipped so that there will be no flow. This is a curative operation; no other surgery is required.
WHEN IS PDA LIGATED?
The video shows a VSD which is the most common type of hole in the heart. This location of VSD allowed us to do a nonsurgical closure of the hole by device. Though this is technically difficult, this allows the child to have complete one time cure of the hole without any scar
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