A few months ago we received a referral call for a 40 day old baby from a peripheral hospital with a very low body weight in critical condition. The child was diagnosed with Patent Ductus Arteriosus or PDA, a common condition found in premature babies. Doctors performed a minimally invasive treatment procedure using a wire mesh device to close the PDA and successfully treated the infant.
In India, eight in 1,000 newborns suffer from heart defects, which is about 1.5 lakh of infants born with congenital heart disease per year. About 10% of the infant mortality rate can be attributed to congenital heart disease alone. These faults range from the simple to the complex. Some problems can be examined by the doctor and treated with medication, others require surgery, sometimes as early as the first hours of the child’s birth.
Understanding Heart Defects in Newborns
Knowing how the heart works is essential to understanding congenital heart disease. The heart is divided into chambers – two upper chambers (atria) and two lower chambers (ventricles). The right side of the heart transfers blood to the lungs through blood vessels called pulmonary arteries. The oxygen-rich blood in the lungs then returns to the left side of the heart. The left side of the heart then pumps blood to the rest of the body through a blood vessel called the aorta. When a person has congenital heart disease, any structure of the heart can be affected, including the valves, chambers, arteries, and the wall of tissue that separates the upper and lower chambers called the septum.
Congenital heart defects can be classified into three categories, viz. one with the increased flow to the lungs which includes persistent ductus arteriosus (PDA), interatrial communication (ASD), interventricular communication (VSD) and atrioventricular duct (stroke or AV duct) Coarctation of the aorta (CoA) ), pulmonary stenosis and aortic stenosis (AS).
Congenital heart defects can be detected during pregnancy using ultrasound (fetal echocardiography or abnormalities scan). After birth, abnormalities are diagnosed by echocardiography if suspected during a physical examination in the form of abnormal pulses or abnormal heart sounds. Other clues that point to the presence of congenital heart disease are low oxygen levels, recurrent pneumonia, poor weight gain, persistent difficulty feeding and breathing, or a history of heart disease. .
APD occurs frequently in premature infants, especially in those with respiratory distress syndrome. In mature term newborns, the incidence of PDA is 1 in 2000 births, representing 5-10% of coronary heart disease, while in premature newborns, the incidence ranges from 20 to 60 %. APD occurs when a blood vessel called the ductus arteriosus, which connects the pulmonary artery directly to the aorta (which is supposed to close after birth), remains open. This leads to additional blood flow from the aorta to the lungs and is often seen in premature infants. Normally, the PDA is closed within 72 hours of birth. But if PDA persists, it can often lead to heart failure, kidney failure, brain hemorrhage, poor weight gain, or pulmonary congestion which can lead to death, prolonged hospital stay, or dependence on the ventilator or patient. CPAP. In such a scenario, it is important to shut down the PDA.
How can this condition be treated?
There are three types of treatment options available for this condition namely, medical management, surgical management, and non-surgical procedure. Paracetamol, Ibuprofen, and Indomethacin are three drugs widely used to shut down PDA. So, medical treatment is normally the first choice to treat this disease in newborns. If this fails and the baby’s condition worsens, there are two options: surgical and non-surgical. Surgical repair is performed under general anesthesia and involves closing the open PDA with a surgical incision through the side of the chest using clips or stitches to prevent excess blood from entering the lungs from the chest. ‘child. The third option advanced to treat this condition is transcatheter using the closure of a wire mesh occlusion device. This is a minimally invasive (non-surgical) procedure to close the ductus arteriosus.
Specialized cardiologists called pediatric cardiac interventionists use a minimally invasive procedure to shut off the PDA. Medical technology has given way to an advanced pea-sized device that can help treat even the smallest of babies from just 500 grams. This medically advanced wire mesh device is self-expanding and is inserted through a puncture in the leg vein and guided through the vessels to the heart, where it is placed to seal the opening in the heart. It is designed to allow the physician to insert it through the aortic or pulmonary artery, as well as to recover and redeploy the device for optimal placement, release.
Due to the minimally invasive nature of this procedure, many critically ill premature babies in the neonatal intensive care unit can be weaned from life support soon after the procedure with less risk compared to surgery.
For years, congenital heart defects have been repaired by open heart surgeries that carried risks such as blood transfusion, blood infections, and longer hospital stays. Thanks to advanced technologies, we now have minimally invasive procedures for certain heart conditions to treat infants with fewer complications and shorter hospital stays.
Although advancements in technology have saved a million lives with coronary artery disease, there are a few things that parents or pregnant parents should keep in mind. Young women should seek antenatal care early, even before they become pregnant. Stopping smoking, reducing stress, taking folic acid supplements, maintaining their blood sugar levels would be the key to maintaining health and well-being. It is advisable to discuss any medication you consume with the doctor. Healthy eating, regular physical activity, and working closely with the doctor to develop a personalized plan will help maintain a healthy body.
By Dr Sudeep Verma, Pediatric Cardiologist, KIMS Hospital, Secunderabad – Hyderabad
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