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august 2012

Little Hearts In A Mix Up

Dr Vikas Kohli
The outlook for a child with a hole in the heart is very good, irrespective of whether it is remedied by surgical intervention or non-surgical intervention. Explore the options for the child in your care

The commonest of the birth defects observed in infants and newborns are largely related to the heart. The incidence of congenital paediatric cardiac abnormality is almost one in every 100 pregnancies. The diagnosis maybe made during pregnancy or some time after the birth of the baby. The diagnosis of heart defects in a newborn or paediatric cardiac abnormality or paediatric cardiac ailment usually involves a paediatrician hearing a heart murmur. A heart murmur happens to be an abnormal heart sound. A cardiologist comes into the picture for confirmation – he will perform an echocardiogram to confirm whether the heart murmur is from an abnormality or whether it is just an innocent murmur. An abnormality noted thus is often a condition of the heart, which on occasions also warrants surgical intervention.

Cardiac defects in newborns and infants are mainly of two types -
case where the newborn or the baby turns blue and the case where the baby does not turn blue. Almost all conditions in which the baby turns blue require surgical intervention. The other may be treated by balloon angioplasty or device closure. Both these methods are nonsurgical. The more common defect is a ‘hole in the heart’.

Pure And Impure Run Ins
The case presenting as a ‘hole in the heart’ may be a ventricular defect or an atrial defect. The isolated hole is found between the chambers carrying red and blue blood (pure or oxygenated blood and impure or deoxygenated blood respectively). The condition arising from an isolated hole in the heart should not be confused with conditions where a hole is present in association with many other abnormalities of the heart. The outlook for a child with a hole in the heart is very good, irrespective of whether it is remedied by surgical intervention or non-surgical intervention; non-surgical remedy is generally done through stenting or angioplasty as in adults.

A hole in the heart results in extra blood flow to the lungs. The affected child is susceptible to chest infections and has difficulty in gaining weight; the child’s parents and guardians will encounter problems when feeding the child.

Baby Turns Blue
On the other hand, the child could be blue, when in addition to a hole in the heart there is a blockage of blood flow to the lungs (It is a condition called Tetralogy of the Fallot - ToF). This is the commonest condition in which the baby turns blue. It always requires surgical intervention.

Other defects that will have a child turning blue is when oxygen-rich blood from the lungs drains abnormally into the blue blood carrying vessels or when the blood vessels coming out of the heart carrying red and blue blood get switched. In the latter, the body ends up receiving blue or impure blood and the lungs with pure blood! These defects are usually remedied by one-time surgery and the child can have a normal life

. The congenital heart condition that is seen to affect the quality of life of an affected child is when the valves of the heart or the valves of the vessels that pump blood to and from the heart are not normal. The child generally requires more than one surgical intervention and it has a bearing on his/her quality of life and life span.


Dr Vikas Kohli is Senior Consultant Paediatric Cardiologist, Indraprastha Apollo Hospitals, New Delhi.