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Fortis Hospital, Sector 44, Gurgaon
Atrial Septal Defect (ASD) is a common heart defect which is present at birth. Atrial septal defect is a hole in the wall that separates the two upper chambers of the heart viz left and right atrium.
As the baby develops before birth the wall that separates the right and left atrium develops. When this wall does not develop completely a hole remains which is known as an ASD.
In presence of Atrial Septal defect the blood flows from the left to right side of heart resulting in enlargement of right side of the heart.
Children with Atrial Septal Defect are often asymptomatic except for a gracile built in some. Some of them may have symptoms of heart failure or shortness of breath and may need treatment early.
Depending on their location within the septum ASD may be Secundum, Primum or Sinus Venosus Defects.
Secundum Defects are the common ones and more often occur in isolation. Primum and Sinus Venosus defect may be associated with other abnormalities.
Small (less than 8 mm) are more likely to close on their own. Larger defects need to be closed usually beyond 2-3 years of age.
They may be closed by catheter procedures using a device or a surgical closure.
If left alone larger defects over the years may result in high lung pressures, atrial fibrillation, leakage of valve between right upper and lower chambers (Tricuspid Regurgitation).
These defects a carry an excellent long and short term outcomes after closure.
Congenital Heart defects are the most common birth defects. They denote a structural problem with the heart and are present at birth. They may involve the walls of the heart, valves of the heart or the connection and structure of the arteries and veins which connect to the heart. They can alter the flow of blood through the heart or slow down the blood flow towards the arteries or completely block the flow. At times the blood flow may be directed to the wrong direction or place.
Babies may present with fast breathing, bluish discoloration of lips, tongue and finger nails, failure to gain weight or repeated episodes of pneumonia. Older children may get tired or out of breath easily. At times a completely fine child may be diagnosed with congenital heart defects when doctor picks up a murmur during examination.
Doctors diagnose these defects by physical examinations and use of special tests like echocardiography, ECG and Chest X-ray.
Once diagnosed a specific treatment plan is made which is individualised depending on type of defect and its severity.Many children with congenital heart defects don't need treatment, but some others do. Treament may be medical management by medicines or specific precautions or in some cases may need surgical or catheter procedures.
If your child is suspected to have heart disease the Doctor may suggest one or all of the following tests either together or sequentially
A chest x-ray creates a shadow of structures inside the chest viz your heart, lungs, and blood vessels. It can reveal evidence of heart disease and its severity and its effect on the lungs.
An electrocardiogram, also called an ECG is a non invasive and painless test that records the electicalactivitiy of heart. It shows the status of the heart beat viz speed, regularity and it may also suggest structural heart disease. It may be part of a routine exam to screen for heart disease or to detect pattern for a fast or slow heartbeat.
For the test, the baby lies on a table and electrodes are attached to the skin on your chest, arms, and legs. Wires connect the electrodes to the ECG machine that records the electrical activity of the heart.
Echocardiography (echo) is a painless test that uses ultrasound waves to create moving pictures of the heart. This shows the size, shape and structure of the heart and is used by the doctor to diagnose structural problems of the heart. It is also used to assess the function of the heart.
For the test, gel is applied to the babies heart and bys using and moving the transducer on the chest a moving image of the heart is created on the screen and is assessed.
Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions. Doctor inserts a catheter which is thin fexible plastic tube into one of the blood vessels of the legs or neck and then through them into the heart. Doctor may use this catheter for angiography (imaging the heart chambers or blood vessels using a dye) or taking samples from various chambers and connecting arteries. At times this procedure may be used for treatment of structural heart problems using balloons (to open up blocked valves or arteries) or devices (to close the holes in the heart). Babies need to be under anaesthesia during the procedure.
These modalities are used to supplement the diagnosis of structural heart lesion and to plan the treatment modality in some of the heart problems.
Patent ductus arteriosus (PDA) is a condition in which the ductus arteriosus does not close. The word "patent" means open.
The ductus arteriosus is a blood vessel that allows blood to go around the baby's lungs before birth. Soon after the infant is born and the lungs fill with air, the ductus arteriosus is no longer needed. It most often closes in a couple of days after birth. If the vessel doesn't close, it is referred to as a PDA.
PDA leads to abnormal blood flow between the 2 major blood vessels that carry blood from the heart to the lungs and to the rest of the body.
PDA is more common in girls than boys. The condition is more common in premature infants and those with neonatal respiratory distress syndrome. Infants with genetic disorders, such as Down syndrome, or babies whose mothers had rubella during pregnancy are at higher risk for PDA. PDA is common in babies with congenital heart problems, such as hypoplastic left heart syndrome, transposition of the great vessels, and pulmonary stenosis.
A small PDA may not cause any symptoms. However, some infants may have symptoms such as:
Babies with PDA often have a heart murmur that can be heard with a stethoscope. However, in premature infants, a heart murmur may not be heard. The health care provider may suspect the condition if the infant has breathing or feeding problems soon after birth.
Changes may be seen on chest x-rays. The diagnosis is confirmed with an echocardiogram. Sometimes, a small PDA may not be diagnosed until later in childhood.
If there are no other heart defects present, often the goal of treatment is to close the PDA. If the baby has certain other heart problems or defects, keeping the ductus arteriosus open may be lifesaving. Medicine may be used to stop it from closing.
Sometimes, a PDA may close on its own. In premature babies, it often closes within the first 2 years of life. In full-term infants, a PDA that remains open after the first several weeks rarely closes on its own.
When treatment is needed, medicines such as indomethacin or ibuprofen are often the first choice. Medicines can work very well for some newborns, with few side effects. The earlier treatment is given, the more likely it is to succeed.
If these measures do not work or can't be used, the baby may need to have a medical procedure.
A transcatheter device closure is a procedure that uses a thin, hollow tube placed into a blood vessel. The doctor passes a small metal coil or other blocking device through the catheter to the site of the PDA. This blocks blood flow through the vessel. These coils can help the baby avoid surgery.
Surgery may be needed if the catheter procedure does not work or it cannot be used due to the baby's size or other reasons. Surgery involves making a small cut between the ribs to repair the PDA.
If a small PDA stays open, the baby may eventually develop heart symptoms. Babies with a larger PDA could develop heart problems such as heart failure, high blood pressure in the arteries of the lungs, or an infection of the inner lining of the heart if the PDA does not close.
Ventricular septal defect is a defect which is a hole in the wall that separates the two lower chambers of the heart (right and left ventricles). It is the commonest of heart defects and accounts for half of all congenital heart defects. It may occur in isolation or in association with other structural heart problems.
The cause of VSD is not known. Before the birth of the baby in early gestation when the heart is forming the right and left ventricles are one and then the wall develops which seperates these chambers. Incomplete formation of this wall results in a hole in the heart or VSD. VSDs can be single or multiple,
The baby may be totally asymptomatic or may have significant problems needing early treatment. Smaller holes may close on their own. The larger ones result in excessive blood being pumped into the lungs resulting in baby being symptomatic. These babies need their hole to be closed.
Children with VSDs may not have symptoms. Babies with large holes may have symptoms due to excessive blood being pumped into the lung.
The most common symptoms include:
Chest X ray, ECG and ECHO may be ordered by your childs doctor to diagnose VSDs and to plan the treatment.
If the defect is small, no treatment may be needed. But the baby should be closely monitored for growth issues and development of any symptoms.
Babies with a large VSD who have symptoms may be started on medications to control the symtpoms. Surgery or catheter closure of hole may be needed in some cases.
Children who do not need closure of VSDs need to be on prophylaxis for infective endocarditis and ensure appropriate dental hygiene.
Short and long term prognosis for children with VSD remains excellent.
Complications of VSD may include: