How are pediatric congenital heart defects treated?

Congenital heart defects (CHDs) are the most commonly seen defect that babies are born with. They exist at birth, having appeared during embryonic and/or fetal growth and development. There are many different types of recognized CHDs, ranging from simple to more complex defects.

Examples of simple defects include holes in the cardiac septum (eg, ventricular septal defects) or its vessels, while complex abnormalities manifest as combinations of structural and/or functional problems. For example, tetralogy of Fallot (ToF), which is a combination of four abnormalities, is a complex CHD.

One study reported that coronary heart disease accounts for approximately 4.2% of all newborn deaths. In the United States, about 1 in 4 children born with coronary artery disease will have a severe one.

About 30% of children born with very critical coronary artery disease may not survive beyond age 18; however, 95% of children with noncritical coronary artery disease suffer from it. Survival depends on the severity of coronary artery disease, the time that elapsed before diagnosis, the general health of the patient and the success of the treatment employed.

Often many children with coronary artery disease do not need any treatment, especially if it is simple, but there are some who do.

Treatment is vital in people with complex defects. Treatment options vary depending on the nature and severity of the defect.

Procedures that involve catheterization can be used in combination with surgery. However, such a combination is not always necessary, and these techniques can be performed independently depending on the nature of coronary artery disease.

In addition to these invasive procedures, non-invasive drug therapy may also be used in some cases. Some patients may need medication for many years.

Treat congenital heart disease from birth to adulthood

Catheterization

It involves the use of a thin, flexible tube that is inserted into a blood vessel such as the femoral vein and then threaded back into the heart.

It is a fairly simple procedure compared to surgery, and therefore is much better tolerated and allows for faster recovery.

Catheterization is usually the treatment of choice for simple coronary artery disease, such as pulmonary valve stenosis or atrial septal defect (ASD).

A small device that is used to close the defect is passed along the catheter. There may be two small discs to install, one on each side of the hole. Or it may have an extendable umbrella-like structure that will close the hole.

The device is pushed out of the catheter in the correct place to close the septal defect, and secured so that it remains in place when the catheter is withdrawn. Tissue grows on these discs over a period of months. Thus, as the child grows, there is no need to replace the device used to connect the ASD.

When there is stenosis of the pulmonary valve, a catheter is used to insert a balloon which will eventually be inflated in order to open the valve leaflets. It is then deflated and removed once the valve opening is enlarged enough.

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If the defects cannot be repaired using catheterization, surgery is required. Open-heart surgery involves opening the chest to access the heart directly.

Congenital heart disease in infants

Also, depending on the severity of the defect, multiple surgeries may be required over a period of time. Various procedures are adopted, including the placing of patches to close the defects, the repair or replacement of valves, or the transplantation of various parts of the heart and its great vessels.

Combinations of these are used in more complex CHDs. Children with coronary artery disease that has progressed or is already beyond the scope of surgical repair may need a heart transplant. These cases are fortunately very rare.

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