What to do if your child has a hole in the heart?
By Maitri
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.
Although VSDs are the commonest lesion, many of them close spontaneously especially if located in muscular part of the interventricular septum. However, the VSDs are also the trickiest lesion as some of them do not close, get bigger and cause poor growth, frequent chest infections and lung hypertension. It is only through an echocardiography that the correct stage is identified. Nowadays, VSDs are mainly closed by open heart surgery. It is a standard procedure and done in competent centers, the overall risk is <3%. We can expect a hospital stay for 7-10 days after surgery. Some VSDs can also be closed non surgically by DEVICE Closure.
PDAs are routinely closed non-surgically by PDA device closure. The procedure time and recovery is like that after ASD device closure.
The Financial Issues:
Many Indian families delay surgery fearing the cost factor. The costs of cardiac surgery in corporate setups vary between 70,000 – 250,000 Rs as a package. Fortunately many social health schemes like Yasawsini, Arogya Bhagya, Chief Minister Relief Fund, Prime Minister Relief Fund, Needy Heart Foundation etc are regularly helping poor patients below poverty line.
Take Home Message
1. Holes in Heart Are Quite Common
2. Be Aware of The Common Signs
3. Go to A Pediatric Cardiologist and Do Echocardiogram
4. Successful Treatment is Available For All Holes
5. Some Holes Can Be Closed Without Surgery
6. Financial Help Is Available If You Cannot Afford
Article by Dr Maitri Chaudhuri
MD (Pediatrics), Post Doctoral Fellow (Pediatric Cardiology)
Consultant Pediatric Cardiologist
Vikram Hospitals, Bangalore
Email: maitri_cee@yahoo.co.in
Contact No: 09731721968
