Advanced Centre For Paediatric Cardiac Surgery at Fortis Hospital Bangalore

Arguably considered to be one of the most common types of birth defects or abnormalities, congenital heart diseases happen to occur in nearly 0.8 percent of live births (8 out of every1,000 new-borns). They are described as defects that afflict the heart’s structure which manifest themselves right at birth. Moreover, these defects present themselves predominantly during the first year of birth more so during the first month itself. Some of these defects – which range from simple defects that display no symptoms to complicated defects showcasing severe, life-threatening symptoms – can affect the heart’s functioning in the following ways:

• Congenital abnormalities can have an impact on the heart’s interior walls

• Congenital abnormalities can affect the valves present inside the heart
• Congenital abnormalities can affect the arteries and veins that are responsible for carrying blood to the heart to other parts of the body
• Congenital heart defects can have an impact on the blood’s normal flow through the heart.

In most cases, babies are born with simple defects that can be usually fixed easily and doesn’t entail the need for any complex treatments. However, there are complicated congenital defects which require the need for special care immediately after birth. In such a %scenario, affected individuals require special attention and care throughout their lives.

What is Congenital Heart Disease?

A congenital heart defect can be described as a structural problem which affects the optimal functioning of the heart which is present right at birth. These defects could be inherited or caused by a variety of environmental factors.

More often than not, a baby’s heart develops early and starts beating as soon as 22 days after conception. Soon after, the heart starts bending and position itself towards the right side of the chest – usually between days 22 and 24. The heart starts taking the now familiar heart-shaped form by day 28 – a stage where the heart begins to develop the various valves, chambers, blood-vessels, and walls. This is the developmental stage at which congenital heart defects usually start revealing itself. These defects can interfere with the heart’s ability to accurately pump blood by disrupting the normal flow of blood through the heart. It may also exert additional pressure on the heart to work harder while slowing down or blocking the blood flow completely thus leading to an array of health complications including problems with breathing.

What Causes Congenital Heart Defects ?

While most cases are attributed to genetic disorders, the exact cause of why congenital heart defects develop is still relatively unknown. That being said, it has been noticed that genes do have a role to play in babies acquiring heart defects as it increases the likelihood of the child being born with such a condition. In other cases, children born with genetic conditions, such as Down syndrome, have an increased chance of being born with congenital heart defects.

Another factor which has shown to have an adverse effect is smoking, using illicit drugs or consuming alcohol during pregnancy which has shown to increase a child’s risk of having a heart defect while also being linked to multiple types of congenital heart defects, including septal defects.

Similarly, women suffering from a viral infection during the first trimester of pregnancyare at higher odds of giving birth to a child suffering from some sort of a heart defect. Last but not least, expectant mothers suffering from diabetes have also been linked to children being born with congenital heart defects.

Certain mutations can also have an adverse impact on the heart’s development which, in turn, can cause congenital heart defects including atrial septal defect – described as a hole that appears between the upper chambers of the heart.

Symptoms of Congenital Heart Defects

In most cases, it is difficult to detect congenital heart defects as they showcase few or no symptoms. Even a routine physical exam might fail to detect signs of heart defects. The best way to detect the existence of heart defects is through an ultrasound while the woman is pregnant. Upon hearing an abnormal heartbeat, the doctor might order certain tests including echocardiogram, a chest X-ray, or an MRI scan to further investigate the issue. Symptoms usually depend on the number, type, and severity of the defects. These symptoms may include:

• Breathlessness, Rapid breathing or trouble breathing
• Cyanosis – the presence of a bluish tint on the lips, skin, fingernails, and toes
• Abnormally low birth weight
• Poor weight gain in infants
• Fatigue
• Difficulties in feeding
• Poor blood circulation
• Delayed growth
• Abnormal heart rhythms

In some cases, heart murmurs can indicate the presence of an underlying issue with the heart which can be detected through a stethoscope. That said, not all murmurs are indicative of congenital heart defects and heart murmurs have been noticed in healthy children as well. In other cases, children usually don’t start exhibiting any symptoms until they get older. These children may get tired easily, have trouble breathing, or even faint during physical activity.

In addition, some congenital heart defects result in the heart having to work harder than normal which could even possibly lead to heart failure. These symptoms include:

• Tiredness and shortness of breath after physical exertions
• A build-up of blood and fluid in the lungs
• A build-up of fluid in the feet, ankles, and legs

Advanced Centre for Pediatric Cardiac Sciences

As one of the largest pediatric cardiac centre in India, we provide a range of comprehensive cardiac surgical services for our young patients in India, Dubai, Mauritius, and Sri Lanka.Our experts see children with all manners of acquired and congenital heart defects. Some of these conditions include

• Septal Defects – holes between the heart chambers. These include Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Patent Ductus Arteriosus (PDA), Atrio Ventricular Septal Defects (AVSD)
• Infections which cause damage to the heart.
• Abnormal heart rhythms
• Rheumatic Heart Disease
• Valvular Lesions
• Tetralogy of Fallot
• Disorders which impact the function of blood vessels
• Heart muscle diseases including cardiomyopathy and myocarditis
• Truncus Arteriosus
• Tricuspid Atresia
• TAPVC - Total Anomalous Pulmonary Venous Connection
• Hypo-plastic Left Heart Syndrome
• Pulmonary Atresia
• Stenosis – a condition characterized by the narrowing of blood vessels along with other tissues in and around the heart
• We are known to cater to both inpatients and outpatients with an emphasis on treatment of neonatal and complex congenital cardiac problems.

Treatment

At Fortis, our treatments are planned to keep in mind your child’s long-term health and future. If our diagnostic tests reveal the presence of a defect or if we feel a baby born with a congenital defect is in urgent need of intervention, we plan a heart surgery immediately to correct defects. With the aid of early intervention, we hope to repair or reconstruct the defect so that the baby’s heart develops with the child as he grows and he/she can benefit from a quicker recovery.

Depending on the type and severity of the child’s heart defect, we plan the treatment accordingly. Other factors that influence the treatment includes the child's age, size, and overall health. While certain congenital defects can be easily treated with the help of medications that can make the heart function more efficiently thus negating the need to perform surgery, there are cases where surgical intervention is required. Accordingly, here are some of the cardiological procedures we implement:

• Catheter Procedures – involves puncturing the skin with a needle through which the catheter (thin, flexible tube) is inserted into a vein or an artery.
• Open-Heart Surgery – recommended in cases where the heart defect can't be fixed using a catheter procedure.
• Heart Transplant – in cases where catheter procedures aren't suitable or are proving inadequate to repair a congenital heart defect
• Implantable Heart Devices – which includes pacemakers and implantable cardioverter-defibrillators (ICDs).

Early treatment for fixing congenital heart defects is of utmost importance as if left untreated, many of these conditions can quickly become life-threatening. While we always look to cure the condition, even if it’s left uncured, timely treatment will at least ensure that the child goes on to live an active and productive life ahead. Furthermore, it can also reduce the risk of any complications such as heart failure, heart infections, and stroke from occurring.

Fortis, A World-Class Center for Paediatric Cardiac Surgery

Today, studies and research have revealed nearly a fivefold increase in the incidence of congenital heart disease in children and siblings of patients with congenital heart disease. As a matter of fact, the genetic disorders that contribute to congenital heart disease is set to increase in all likelihood because advances in interventional techniques and surgery have resulted in more and more people affected with congenital heart disease starting to live beyond their childbearing age.

At Fortis, we adhere to the philosophy that the smallest patients are in need of special and compassionate care. Thereon, our world-renowned Paediatric Cardiac team comprising of pediatric cardiologists, cardiac surgeons physicians, intensivists, nurses, cardiovascular nurses, imaging technicians, and anesthesiologists are known to offer life-changing treatments that result in the very best clinical outcomes. We pride ourselves at being at the forefront of research and innovation. In that regard, we are constantly pushing our boundaries by developing several ground-breaking surgical innovations for correcting ever more complex abnormalities.

Combined with state-of-the-art diagnostics, our modern approaches to pediatric heart care has allowed us to cement our position as one of the leading centres and one of the most specialized pediatric heart hospitals in the world. Our multi-disciplinary team addresses any sort of heart defects – simple or complex – right from the onset thus giving our young patients the best chance to grow up healthy. From simple chest pain, palpitations, murmurs of the heart to complex congenital heart diseases, acquired heart problems, and pulmonary hypertension –our team covers it all with high levels of excellence.

We also understand these are sensitive surgeries and can also prove to be a highly stressful time for parents which is why we take all necessary precautions to prevent infections and minimize any risks associated with these surgeries. Further, our team goes above and beyond and ensures they keep the parents and family members regularly in the loop so that they remain up-to-date on the progress their child is making. Witnessing these children get back to their daily schedule and resuming normal activities as quickly as possible is our ultimate goal.