Covid 19: Taking care of new-borns with congenital heart defect

The COVID-19 pandemic across world has ignited fear and uncertainty globally, making self-care even more important. The situation is such that the parents are getting worried by the unknowns, which appear all of a sudden. They are faced with long periods of anxiety, and other stress factors, too, have emerged, such as stockpiling essential items, losing income sources and balancing domestic chores. Amidst this chaos, new-borns need their parents’ utmost attention. And it becomes utmost essential for parents to pay attention to the new-borns, defying all challenges.

Pay Attention to New-borns with Heart Defects

If you are a new parent, and you notice that your infant has blue blotches of skin at birth, abnormal heart murmurs and difficulty in taking breast feed, you need to be cautious. Without waiting for symptoms to further aggravate, take help of telemedicine and speak to a paediatric cardiologist about the child’s situation as this could be congenital heart defect. Using virtual modes to get healthcare aid is critical now more than ever as there is a fear of the patient and the specialist getting infected.

Considering a birth prevalence of congenital heart disease as nine out of 1,000, the estimated number of children born with the disease in India is more than two million per year. One-fifth of these are likely to have serious defect, requiring an intervention in the first year of life. With advancement in diagnosis and prognosis of cardiac care, majority of little hearts in urban areas reach adulthood. However, children born in rural areas remain deprived of latest healthcare technologies mostly due to lack of awareness.

What is Congenital Heart Defect?

Also called congenital heart anomaly or congenital heart disease, a congenital heart defect (CHD) is a defect in the structure of the heart or great vessels that is present at birth. 

In the womb when a baby’s heart or blood vessels develop in abnormal ways, it leads to several heart defects and conditions. There is no cure for congenital heart disease. However, it can be managed through certain medical intervention. There are 18 types of congenital heart defects. ASD, VSD and pulmonary valve stenosis are some of those.

Atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. This defect in the heart increases the amount of blood that flows through the lungs. This may cause problems over time such as high blood pressure and even heart failure. A hole can vary in size and may close on its own during infancy or early childhood or the child may need surgery.

Pulmonary Valve Stenosis is a condition caused by thickened or fused pulmonary valve that is not fully open. The valve is located between the right heart’s chambers and allows blood to flow into the pulmonary artery and then to the lungs. Pulmonary valve stenosis ranges from mild, without symptoms, to severe cases that require treatment.

Ventricular Septal Defect (VSD) is a hole in the wall (septum) between the two lower chambers of the heart. The wall keeps the oxygen-rich blood from mixing with the oxygen-poor blood. Many VSDs are small and close on their own. But infants with a large VSD may need surgery. In the cases where the hole does not close, it may increase pressure in the heart, reduced oxygen to the body or even heart failure.

Minimally invasive procedures are saving little hearts

Conventionally, for decades, heart defects were treated through open heart surgeries which involved more complications and risks of infection. Credit it to technology, we now have minimally invasive procedures to give infants a better quality of life. Congenital pulmonary stenosis balloon valvuloplasty is one such procedure that aims to fix the pulmonary valve stenosis problem. It is carried without the need for an open-heart surgery and aims to fix the pulmonary valve. A long, thin tube called a catheter is used in the procedure which has an inflatable balloon at its tip. The doctor puts this catheter through a blood vessel in the groin and threads it all the way to the pulmonary valve. The balloon is then inflated. The inflated balloon stretches the valve and helps open it up. This helps in flow out of the blood to the pulmonary artery without blockage.

For conditions like ASD and VSD, new age devices such as occluders are used to close the heart defect without surgically opening the chest and heart. During this procedure with the help of x-ray images, the doctor inserts a catheter into a leg vein and guides it to the heart. Once the cardiologist is satisfied with the positioning of the device, occlude is released to permanently close the defect and catheters are removed. With time tissue grows over the implant making the device a part of the heart.

Over the last three decades, India has made great strides for the management of children with congenital heart defect, but it remains grossly inadequate. Potential solutions to improve over-all access to cardiac care must consider being vigilant and spreading awareness.

About the author:

Dr. Ravi Ranjan Tripathi, Pediatric Cardiology, Child Heart Clinic, Indore.

(reference: Indian Pediatrics)

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