Children’s heart health is often a topic filled with questions and uncertainties for parents. With early detection and advancements in treatment, most heart conditions in children can now be managed effectively, allowing them to lead happy, healthy lives. Did you know that every year, over 2.5 lakh babies in India are born with congenital heart defects (CHDs)? As parents, understanding the signs, symptoms, and treatment options for pediatric heart conditions can make a world of difference in your child’s health and well-being.
To shed light on this vital subject, we had the privilege of speaking with Dr. Supratim Sen, a Senior Consultant Pediatric Cardiologist at Narayana Health SRCC Children’s Hospital, Mumbai.
With over 15 years of experience and international training, Dr. Sen is a leading expert in pediatric cardiology. He specialises in advanced cardiac care for children. After completing his MD Pediatrics, he did his FNB in Pediatric Cardiology from the prestigious RN Tagore International Institute of Cardiac Sciences, Kolkata. He subsequently trained further in Pediatric Cardiology at the Sydney Children’s Hospital Network, Australia. Dr. Sen’s expertise & leadership have been instrumental in developing Narayana Health SRCC Children’s Hospital as a Premier Pediatric Cardiac Center in Western India. His compassionate, patient-centred approach has been instrumental in offering the best cardiac care for children. Let’s see what Dr. Sen has to say about pediatric heart conditions, their detection, and treatment!
What are Common Pediatric Cardiology Conditions?
Pediatric Cardiology is a speciality that deals with heart diseases in children. The most common heart diseases in children are congenital heart defects (CHD), which the child is born with. CHDs are a large spectrum of defects, including holes in the heart, blocked or leaking valves, narrow vessels, and a combination of these.
Children can also present with acquired heart conditions such as Kawasaki disease, Rheumatic heart disease, and myocarditis.
What is a congenital heart defect? And how common is it in India?
As mentioned above, a congenital heart defect is a defect the child is born with. There are a wide variety of congenital heart defects, including holes in the heart, blocked or leaking valves, small vessels, small and incompletely formed cardiac chambers, and a combination of these.
The world over, the incidence of CHDs is estimated to be 8-10 per 1,000 live births. In India, based on the birth rates, it is estimated that every year, 2,50,000 babies are born with congenital heart defects. Of these, around 1/3 to 1/4 are born with critical defects that will need surgery or intervention within the first year of life.
What can parents do for Prevention and Early Detection of Pediatric Heart Conditions?
There are no definite precautions to prevent congenital heart defects, but some studies have indicated that folic acid supplementation for the mother during conception and the first trimester of pregnancy can reduce the incidence of CHD in the baby.
More important is the early suspicion and early detection of congenital heart defects because early detection leads to timely treatment and improves long-term outcomes in these children. Nowadays, many of the major critical congenital heart defects can be detected antenatally by a fetal echocardiogram as early as the 16th to 18th week of gestation.
After birth, heart diseases are detected as the child develops characteristic symptoms, and the pediatrician suspects a heart disease based on these symptoms and refers the patient to a pediatric cardiologist for further evaluation.
What are the signs and symptoms of heart problems in children?
Signs and symptoms vary with the child’s age. A baby might present with poor feeding, failure to gain weight, excessive sweating, fast breathing, and recurrent pneumonia. Some heart diseases also cause cyanosis or bluish discoloration, where the oxygen saturation of the baby is low.
Older children might complain of easy fatigability, breathlessness on exertion, sudden loss of consciousness, or palpitations. On examination of patients with heart defects, the doctor might hear a murmur and might detect low oxygen saturations, respiratory distress, and liver enlargement.
Please note here that chest pain, the common symptom of heart disease in adults, is quite an unusual symptom for most heart diseases in children
Signs of heart problems that parents may have missed?
Some holes in the heart, like ASD, may not cause dramatic symptoms in the child and may be diagnosed late. Any baby who has any of the symptoms mentioned above should ideally be examined by a pediatrician, and if there is any suspicion of heart disease, they should be evaluated by a pediatric cardiologist.
Unfortunately, we still occasionally see children who have been detected to have heart disease at a very late age, by which time permanent complications such as pulmonary vascular disease have set in, and the patient is inoperable. So even simple symptoms such as recurrent pneumonia and poor weight gain should not be ignored or passed off as insignificant without a proper medical examination.
How can heart defects be treated?
Heart defects are treated either with surgery or with a transcatheter intervention in the Cath lab. Nowadays, we can close a lot of holes in the heart with devices, open up blocked valves with balloon angioplasty, and enlarge small vessels with stents, all through minimally invasive techniques in the Cath lab via catheters placed through the blood vessels.
In the last 5-10 years, pediatric cardiologists have also started implanting valves in the heart through these minimally invasive techniques. However, around 60-70% of all CHDs will need to be treated with cardiac surgery.
Is cardiac surgery safe in children?
In the present era, cardiac surgery is very safe in children. At the pediatric cardiac centers in developed countries, and even the best tertiary cardiac centers in India such as ours, the overall surgical mortality for congenital heart defects is less than 2%.
There is no minimum age or weight for cardiac surgery. If there is a clinical indication, cardiac surgery can be performed even in a small baby weighing as little as 500g to 1 kg. Of course, if the baby is low birth weight or preterm, the surgical risks are more. But remember that not treating the heart defect will lead to many more complications and is much riskier for the patient than timely cardiac surgery.
Who should decide the optimal time for cardiac surgery or intervention?
The pediatric cardiologist and pediatric cardiac surgeon decide on the optimal timing of treatment based on the baby’s diagnosis and symptoms.
Can any holes in the heart close by themselves?
Small holes in the heart can sometimes close spontaneously within the first 1-2 years of life. However, the decision regarding whether it is safe to follow up with the patient or whether the defect needs early surgery or intervention must be taken by a trained pediatric cardiac specialist.
How is the long-term outcome in patients with CHD after treatment?
Most patients who have been treated for their CHDs with surgery or intervention have excellent long-term outcomes. They have a normal life expectancy and lead normal lives with no restrictions.
Around 20% of patients with CHD have complex diseases where one side of the heart has not properly formed. These patients can only be offered palliative surgery, not corrective surgery. Hence, these patients do have a poorer long-term prognosis and some restrictions on their activities.
Dr. Sen’s insights underline the importance of early detection, timely treatment, and advanced care in managing pediatric heart conditions. As parents, staying informed and vigilant about your child’s health can make all the difference. With advancements in minimally invasive procedures and safe surgical practices, most children with congenital heart defects can lead fulfilling lives.
For more details or to consult Dr. Supratim Sen, visit www.narayanahealth.org