Congenital heart defects (CHD), also known as congenital heart defect or congenital heart disease, are the most common form of birth defects in children and occur in 1% of all live births worldwide, affecting more than 40 million people worldwide.
Congenital heart defects are defects, present at birth, that affect the structure of the heart – the inner walls, heart valves or blood vessels of a baby’s heart.
A baby’s heart begins to take shape and beat during the first six weeks of pregnancy and it is at this stage that certain coronary heart diseases begin to develop.
Prescription drugs for conditions such as epilepsy can also cause coronary heart disease in pregnant women. Mothers with a viral infection like rubella during the first trimester of pregnancy are more likely to give birth to a child with a heart defect.
Pregnant women should be warned by their doctor against the use of alcohol or illegal drugs during pregnancy, as these can increase the risk of heart defects in the child.
Women with diabetes or obesity have a high chance of giving birth to children with coronary artery disease. Gene or chromosome problems in a child, such as Down syndrome, can be another determining factor.
There are many different types of congenital heart defects, mainly falling into these categories:
- Holes in the heart. Holes can form in the walls between the heart chambers or between major blood vessels leaving the heart in certain situations. These holes allow oxygen-poor blood to mix with oxygen-rich blood, reducing oxygen transport to your child’s body. Depending on the size of the hole, this lack of oxygen can turn your child’s skin or nails blue or lead to heart failure.
- Obstructed blood circulation. When blood vessels or heart valves are narrowed due to a heart defect, the heart has to work harder to pump blood through them. Eventually, this leads to enlargement of the heart and thickening of the heart muscle.
- Abnormal blood vessels. Many congenital heart defects occur when blood vessels to and from the heart don’t form properly or aren’t positioned as they should.
- Heart valve abnormalities. If the heart valves cannot open and close properly, blood cannot flow properly.
- An underdeveloped heart. Sometimes a large part of the heart does not develop properly and cannot effectively pump enough blood to the body.
- A combination of flaws. Some infants are born with multiple heart defects.
Your child’s doctor may first suspect a problem because he or she hears a heart murmur during a routine exam.
A heart murmur is an abnormal sound that occurs when blood moves through the heart or blood vessels fast enough to make a sound that a doctor can hear with a stethoscope.
Children with coronary heart disease may also experience bluish discoloration of the lips, fingers, or tongue. Recurrent lung infections with rapid or labored breathing during activities, poor weight gain are other symptoms. Swelling of the legs, hand, abdomen, or areas around the eyes can also be a sign of a heart defect in children.
Thanks to the improvement and advancements in technology, doctors can now diagnose early enough whether a child will be born with coronary artery disease. Most serious coronary heart disease is detected during pregnancy using a fetal echocardiogram performed at 18-22 weeks of pregnancy.
Others can be identified immediately after birth. However, less severe lesions may go unnoticed until a child is older and begins to show signs and symptoms associated with coronary heart disease.
Some congenital heart defects may have no long-term effect on your child’s health and may not be treated safely. Some defects, such as small holes, can even be corrected as your child grows.
Some heart defects, however, are serious and require treatment soon after detection. Some children and adults now have their congenital heart defects repaired using catheterization techniques, which allow the repair to be performed without surgically opening up the chest and heart.
Catheter procedures can often be used to repair holes or areas of stricture. In procedures that can be done through catheterization, the doctor inserts a thin tube (catheter) into a vein in the leg and guides it to the heart using x-ray images.
Once the catheter is positioned at the site of the defect, tiny tools are threaded through the catheter to the heart to repair the defect. Depending on your child’s condition, he or she may need surgery to repair the defect. Many congenital heart defects are corrected by open-heart surgery.
In open-heart surgery, the chest must be open. In some cases, minimally invasive heart surgery may be an option. This type of surgery involves making small incisions between the ribs and inserting instruments into them to repair the defect.
Sometimes a combination of treatments is needed. Additionally, some catheter or surgical procedures must be performed in stages, over a period of years. Others may need to be repeated as the child grows.
It is important to be treated by professionals who are familiar with coronary artery disease, a team represented by a cardiothoracic surgeon, a pediatric cardiologist, a cardiac anesthesiologist, cardiac intensivists and cardiac nurses.
As one can imagine, these cardiac procedures and surgeries are expensive, costing around 1.2 million Kenyan shillings (Ksh) for open heart surgery. In Kenya, children with coronary artery disease have benefited greatly from the National Hospital Insurance Fund (NHIF) which funds almost Kshs 500,000 for such surgeries. financial donors.
Congenital heart defects have an impact on all aspects of quality of life and therefore the psychological support and education of patients and their parents, guardians, relatives or carers is a crucial factor in achieving better health outcomes. processing.
Our vision in Kenya should be directed towards the development of a pediatric cardiac care program and a center of excellence for coronary heart disease to try to reduce the high costs associated with the treatment and management of these defects.
Children suffering from heart defects need our attention, it is our duty to save these children and improve their quality of life as much as possible.
By Dr. Sean Del-Rossi, Consultant Pediatric Interventional Cardiologist at Aga Khan University Hospital, Nairobi