Congenital Heart Defects in Children

Overview

Congenital heart defects (CHDs) are structural problems with the heart that are present at birth. They are the most common type of birth defect and affect approximately 1% of all newborns. CHDs can range from simple issues, such as a small hole in the heart, to complex conditions that require multiple surgeries.

Types

There are many different types of congenital heart defects in children, some of the most common include:

• Atrial septal defect (ASD) - a hole between the upper chambers of the heart.
• Ventricular septal defect (VSD) - a hole between the lower chambers of the heart.
• Patent ductus arteriosus (PDA) - a persistent opening between two major blood vessels that carries blood away from the heart.
• Tetralogy of Fallot (TOF) - a combination of four heart defects that cause oxygen-poor blood to flow out of the heart and into the rest of the body. These include: Ventricular Septal Defect (VSD), Pulmonary Stenosis, Overriding Aorta and Right Ventricular Hypertrophy. 
• Transposition of the great arteries (TGA) - a condition where the two main blood vessels leaving the heart are reversed.
• Pulmonary stenosis - a narrowing of the pulmonary valve, which regulates blood flow from the right ventricle to the lungs.
• Coarctation of the aorta - a narrowing of the aorta, the main blood vessel that carries oxygen-rich blood from the heart to the rest of the body.
• Ebstein's anomaly - a rare defect in which the tricuspid valve, which separates the right atrium and right ventricle, does not function properly.
• Aortic stenosis - a narrowing of the aortic valve, which regulates blood flow from the left ventricle to the aorta.
• Double outlet right ventricle - a defect in which both the pulmonary artery and the aorta arise from the right ventricle instead of the left ventricle.
• Hypoplastic left heart syndrome - a rare and severe condition in which the left side of the heart is underdeveloped.
• Corrected transposition of the great arteries - a type of CHD that occurs when the two main blood vessels leaving the heart are reversed and a surgical procedure is performed to correct it.
• Mitral stenosis - a narrowing of the mitral valve, which regulates blood flow between the left atrium and left ventricle.
• Truncus arteriosus - a rare defect in which a single blood vessel arises from the heart instead of two separate blood vessels.
• Total anomalous pulmonary venous return - a rare condition in which the veins that carry oxygen-rich blood from the lungs to the heart do not connect normally.
• Endocardial cushion defect - a type of CHD that affects the formation of the heart's inner lining, called the endocardium.
• Pulmonary atresia - a rare condition in which the pulmonary valve does not form properly, obstructing blood flow to the lungs.
• Congenital mitral regurgitation - a condition in which the mitral valve does not close properly, causing blood to leak backward from the left ventricle into the left atrium.
• Congenital aortic regurgitation - a condition in which the aortic valve does not close properly, causing blood to leak backward from the aorta into the left ventricle.
• Cor triatriatum - a rare condition in which the left atrium is divided into two separate chambers by a fibrous band.

These are just a few examples of the many different types of CHDs. Each child's heart defect is unique and treatment will depend on the specific condition and the overall health of the child. Early diagnosis and appropriate care can greatly improve outcomes for children with CHDs.

Symptoms

The symptoms of congenital heart defects in children can vary depending on the type and severity of the condition. Some children with CHDs may not have any symptoms, while others may experience the following:

• Rapid breathing or shortness of breath
• Fatigue or weakness
• Poor feeding or poor weight gain
• Blue or gray skin color (cyanosis)
• Swelling in the legs, belly, or areas around the eyes
• Irregular or rapid heartbeat
• Heart murmur (an unusual sound heard during a heartbeat)

In some cases, CHDs may cause more severe symptoms, such as heart failure or cardiac arrest, which may require emergency medical attention.

Causes

Congenital heart defects are caused by a combination of genetic and environmental factors. Some of the factors that may increase the risk of developing a CHD include:

• Genetics - Some CHDs have a genetic component and may run in families.
• Maternal infections - Certain viral infections, such as rubella, during pregnancy can increase the risk of CHDs.
• Substance use - Alcohol, tobacco, and drug use during pregnancy can increase the risk of CHDs.
• Poor nutrition - A lack of essential nutrients during pregnancy, such as folic acid, can increase the risk of CHDs.
• Chronic medical conditions - Certain chronic medical conditions, such as diabetes and high blood pressure, can increase the risk of CHDs in a developing fetus.
• Certain medications - Taking certain medications, such as certain anticonvulsants, during pregnancy can increase the risk of CHDs.
• Environmental toxins - Exposure to certain chemicals, such as lead and mercury, during pregnancy can increase the risk of CHDs.

However, not all CHDs have a known cause and that many children are born with CHDs even though they don't have any of the known risk factors.

Complications

Congenital heart defects can bring about several complications that can impact a child's health and well-being. Some of these include:

• Cardiac arrest: An abnormal heart rhythm can trigger a cardiac arrest, which can be life-threatening.
• Respiratory problems: CHDs can lead to breathing difficulties, especially during physical activity, because of the limited flow of blood to the lungs.
• Blood clots: Children with CHDs are at an increased risk of developing blood clots that can result in strokes, deep vein thrombosis, or other serious health issues.
• Endocarditis: CHDs can increase the likelihood of endocarditis, a life-threatening infection of the heart's inner lining.
• Delayed development: Children with CHDs may have difficulties in language, motor skills, or behavior that can lead to developmental delays.
• Nutritional issues: CHDs can impact the child's ability to gain weight and grow, as the heart may not pump enough blood to the body to support growth.
• Psychological difficulties: Children with CHDs may face psychosocial challenges, such as low self-esteem or difficulty making friends.

Diagnosis

Diagnosis of congenital heart defects can involve a combination of medical tests and procedures, including:

1. Physical exam: The healthcare provider will examine the child's heart, lungs, and other parts of the body to look for signs of CHDs.
2. Echocardiogram (ECHO): This test uses ultrasound to produce images of the heart, which can help detect CHDs and evaluate the heart's structure and function.
3. Electrocardiogram (ECG): This test measures the electrical activity of the heart and can help detect heart rhythm problems and other CHDs.
4. Chest X-ray: This test can show the size and shape of the heart and lungs, and can help detect CHDs and other heart problems.
5. Cardiac catheterization: During this procedure, a thin tube is inserted into the heart to measure pressure and blood flow, and to perform other diagnostic tests.
6. MRI or CT scan: These imaging tests can produce detailed images of the heart and surrounding structures, which can help diagnose CHDs and assess the extent of the problem.

Treatment

Treatment for congenital heart defects can vary depending on the type and severity of the CHD. Some common treatments include:

1. Medications: Certain medications, such as diuretics or anti-arrhythmic drugs, can be prescribed to treat CHDs and manage symptoms.
2. Surgery: Depending on the type of CHD, surgery may be required to repair or replace damaged heart structures.
3. Interventional procedures: Minimally invasive procedures, such as balloon dilation or catheter-based procedures, may be used to treat certain CHDs.
4. Lifestyle changes: Children with CHDs may need to limit their physical activity or make changes to their diet, such as limiting salt or fluid intake.
5. Monitoring: Children with CHDs may require ongoing monitoring and follow-up appointments with a cardiologist to ensure that the CHD is being effectively managed.

Cost of Congenital heart defects in children's treatment in India

The cost of treating congenital heart defects (CHDs) in children in India can vary widely depending on several factors, including the type and severity of the CHD, the type of treatment required, and the healthcare provider.

Some CHDs may require only medication or lifestyle changes, which can be relatively low-cost. However, more complex CHDs may require surgery or other interventional procedures, which can be significantly more expensive. On average, the cost of surgical treatment for CHDs in India can range within a few thousand dollars, depending on the type and complexity of the procedure.