Adding life to years

Most stories about congenital heart disease deals with a lot of despair, however, it may not be necessary. In the advanced age that we live in, most of the children with congenital heart defects can live a socially productive life almost mirroring the general life expectancy.

But, the caveat is related to the accuracy of diagnosis and the timing of the intervention, be it medical, transcatheter or surgical.

The birth defects can now be diagnosed with greater accuracy even as early as the first 3 months of pregnancy. In an ideal situation, the cardiac defect which makes up 50% of all birth defects should be diagnosed before delivery, following which the patient families can be appropriately advised and counseled towards the expected outcome.

Then the pregnancy could be continued with the delivery being performed in a setup where the care for this neonate can be adequately provided based on a previously determined plan. It is this improvement in care that has resulted in a significant impact on an overall positive outcome.

As far as the treatment and management of these children goes, it can either be medically managed or through some form of operation, be it surgical or non surgical methods. Not all “holes in the heart” require an operation, as nature cures many of those, but it is important to know which ones can close spontaneously and which ones require aggressive treatment.

Most complex cardiac defects can also be managed successfully through a combination of catheter and surgical methods. The advanced skills and care which is now available in our homeland can provide atleast a better quality of life if not a long one.

So, a child with a typical heart defect may undergo a series of steps before achieving the final stage of complete repair. First, a series of non-invasive evaluations including imaging with ultrasound and chest x-ray is performed. This is generally followed by a more invasive strategy like a cardiac angiogram which should accurately provide the diagnosis in most patients.

This generally is followed by a detailed discussion by the pediatric cardiac team to detail a customized treatment plan and time the intervention. Following this approach will not only assure a complete evaluation, but also virtually assure the best outcome for the precious children with birth defects of the heart.

(The writer is a paediatric cardiologist)