Congenital Cardiology

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Inborn Cardiac Studies, frequently referred to as Congenital Cardiology, constitutes a specialized domain nestled within Cardiology, focused on addressing cardiac anomalies in neonates and youngsters. This realm encompasses remediation for innate cardiac maladies and heart-related afflictions that transpire during juvenescence. Inherent cardiac disorders represent a prevalent congenital aberration, influencing approximately one in every centenary nativities. Technological strides and enhanced caregiving have rendered it feasible for a multitude of juveniles with cardiac irregularities to relish extended and salubrious existences. (1) (2)

Citing data from Mended Hearts, nearly a quarter of neonates born with an Inborn Cardiac Aberration (ICA) necessitate cardiac operations or supplementary intercessions to endure. In excess of 85% of infants with an ICA presently attain a minimum of 18 years of age. (3) (4)

"Clinical Presentation of Congenital Heart Disease: Cyanosis" by Michael Freed, MD

Definition and Overview

Congenital heart defects (CDHs) are known as problems with the structure of the heart. When a baby's heart does not develop normally during pregnancy, several abnormalities happen. The most typical kind of birth abnormality is congenital heart defects. 

The way the heart pumps blood can be altered by congenital heart defects. They may cause blood to flow too slowly, improperly, or entirely blocked. Congenital heart defects can occur in a variety of forms. They could be in one or many parts within the heart. (5)

While there are several types of congenital heart defects, they can be divided into three main categories: 

  • In heart valve defects, the valves that direct blood flow within the heart can close or leak. This interferes with the heart's ability to pump blood properly.
  • In heart wall defects, the natural walls between the left and right sides of the heart and its upper and lower chambers may not develop properly, causing blood to return to the heart or pool where it does not belong. The defect puts pressure on the heart to work harder, which can cause high blood pressure.
  • In blood vessel defects, the arteries and veins that carry blood back to the heart and body may not work properly. This can reduce or block blood flow, and lead to many health complications. (6)

Procedures

The kind of congenital heart abnormality the infant has and its severity will determine the type of treatment. These treatment types can be listed as medications, simple procedures and surgery.

  • Medications

Medications are often used if the baby has a certain congenital heart defect called patent ductus arteriosus. Usually, the patent ductus arteriosus goes away on its own, but sometimes, medication is required to close the patent ductus arteriosus in premature babies. 

  • Procedures

Cardiac catheterization is a common procedure occasionally utilized to repair simple heart defects such as atrial septal defect and patent ductus arteriosus if they do not heal on by themselves.  Additionally, it can be employed to open heart valves or blood vessels that are excessively small. A small, flexible tube known as a catheter is placed into a blood vessel in the neck or groin during this procedure.  The heart is then reached through the tube. 

  • Surgery

In congenital cardiac surgery, a surgeon opens the chest to operate directly on the heart. Surgery may be necessary, in order to close a hole in the heart caused by an atrial or ventricular septal defect, a patent ductus arteriosus, or a complex defect involving the position or formation of blood arteries near the heart. Additionally, it can be used to correct congenital heart defects or enlarge blood vessels that are already narrow.

Here are the most common surgeries;

  • Heart transplant

If a child has a complex congenital heart defect that cannot be surgically fixed or if the heart stops working after surgery, a heart transplant may be an option.

Children who require a ventilator to breathe or who have severe heart failure signs may also require a heart transplant. Additionally, some adults with congenital heart abnormalities can eventually require a heart transplant.

  • Palliative surgery

Some babies are too small or not strong enough to have heart surgery. Rather, they must undergo palliative surgery or temporary surgery to enhance their blood oxygen levels prior to heart surgery. During palliative surgery, the surgeon places a tube called a shunt, creating an additional pathway for blood to go to the lungs to receive oxygen. The surgeon takes out the shunt once the baby's heart defects have been fully repaired.

  • Ventricular assist device

This device acts as a mechanical pump to support heart function and blood flow in people with a weakened heart. However, in people with congenital heart defects, the abnormal structure of the heart may make it difficult to use these devices.

  • Total artificial heart 

A total artificial heart is a pump that is surgically implanted to reestablish circulation and swap out diseased or damaged heart ventricles. The heart's ventricles transport blood from the chambers to the lungs and other organs. Pumps that are implanted and enhance blood flow to and from the heart are controlled by machines outside the body. A total artificial heart may be necessary for people with complex congenital heart defects instead of a ventricular assist device. (7)

Candidates

Congenital heart defects can present with a variety of symptoms. For instance, symptoms in adults and babies may vary. Additionally, they are based on the number, type, and severity of the heart defects. People with with heart defects must show the following symptoms for treatment:

  • Bluish tone to a baby’s skin and lips
  • Fatigue, or feeling constantly tired
  • Heart murmurs, which are unusual sounds heard between heartbeats. Murmurs sometimes sound like a whooshing or swishing noise
  • Poor blood circulation
  • Rapid breathing
  • Shortness of breath during physical activity can happen in children or adults with a congenital heart defect (8)

Risks and Side Effects

Children and adults with congenital heart disease may be exposed to certain risks and side effects from treatment and operations. These include

  • respiratory tract infections
  • Endocarditis infection
  • pulmonary hypertension
  • heart rhythm problems
  • heart failure
  • blood clots (9)

Post-Procedure and Follow-up

Treatments for congenital heart defects may have different post-procedure and follow-up requirements. It depends on each patient's exact treatment and needs. It is crucial to adhere to the surgeon's general instructions and steps. In order to track the patient's development and guarantee that any implanted devices continue to work, follow-up doctor visits are required.

Recovery

Patients may need to adjust their lifestyles or take medicine in addition to medical monitoring to manage their conditions in the recovery process. They might need to avoid from engaging in particular physical activities, manage their weight, or take medicine to control their blood pressure or heart rate.

Results

Babies with CHD are living longer, healthier lives as medical care and treatment advances. Nowadays, many CHD children survive into adulthood. With little to no difficulty, a large number of patients with CHD lead independent lives. Others might eventually become disabled. Genetic issues or other medical disorders can raise the likelihood of impairment in some CHD patients. (10)

Many CHD patients do not improve even with improved therapy, even after their heart abnormalities are fixed. People with CHD may later experience different health problems depending on the exact heart faults, the number and the severity of the flaws.

  • (1) - https://www.mainehealth.org/services/cardiovascular/pediatric-cardiology 

    (2) - https://www.acc.org/clinical-topics/congenital-heart-disease-pediatric-cardiology

    (3) - https://mendedhearts.org/story/chd-facts-and-statistics/

    (4) - https://www.cdc.gov/ncbddd/heartdefects/data.html

    (5) - MedLinePlus. Congenital Heart Defects. (https://medlineplus.gov/congenitalheartdefects.html

    (6) - HealthLine. Congenital Heart Disease. (https://www.healthline.com/health/congenital-heart-disease#types

    (7) - National Heart, Lung and Blood Institute. How are congenital heart defects treated? (https://www.nhlbi.nih.gov/health/congenital-heart-defects/treatment

    (8) -  National Heart, Lung and Blood Institute. Congenital Heart Defects, Symptoms (https://www.nhlbi.nih.gov/health/congenital-heart-defects/symptoms

    (9) - NHS. Congenital Heart Disease Complications. (https://www.nhs.uk/conditions/congenital-heart-disease/complications/)

    (10) - Centers for Disease Control and Prevention. What are Congenital Heart Defects? (https://www.cdc.gov/ncbddd/heartdefects/facts.html

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