Understanding Congenital Heart Disease: Causes, Symptoms, and Treatments

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Congenital heart defects refer to defects in the heart that children are born with. These are one of the most common congenital defects globally. In India too, 200,000+ children are born with a congenital heart defect (CHD). These are the numbers of the cases that are recorded – there maybe many more which go undiagnosed and hence untreated. Only 25 per cent of the children diagnosed with a congenital heart defect are able to get the required treatment. A lack of awareness and access to resources are the biggest challenges in children getting timely treatment. Organisations like Genesis Foundation, a congenital heart foundation India has been taking steps to both build awareness and provide financial treatment to those who cannot afford the cost of treatment. The treatment for CHD is expensive and families that do not earn enough to meet their daily needs have to depend on funds they receive as a congenital heart disease donation to support the treatment. Symptoms of Congenital Heart
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Types of Heart Surgery

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Heart-related problems do not always require surgery. Sometimes they can be addressed with lifestyle changes, medications or nonsurgical procedures. But surgery is often needed to address problems such as heart failure, plaque buildup that partially or totally blocks blood flow in a coronary artery, faulty heart valves, dilated or diseased major blood vessels (such as the aorta) and abnormal heart anamolies that might require congenital heart disease treatment. There are many types of heart surgery.

1. Coronary artery bypass graft surgery (CABG) 

It is a procedure used to treat coronary artery disease in certain circumstances. Coronary Artery Disease (CAD) is the narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle), caused by a buildup of fatty material within the walls of the arteries.

This buildup causes the inside of the arteries to become rough and narrowed, limiting the supply of oxygen-rich blood to the heart muscle.

One way to treat the blocked or narrowed arteries is to bypass the blocked portion of the coronary artery with another piece of blood vessel. Blood vessels, or grafts, may be pieces of a vein that are then grafted above and below the blocked area of a coronary artery, allowing blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest may also be used to create a bypass graft.

One end of the graft is attached above the blockage and the other end is attached below the blockage. Thus, the blood is rerouted around, or bypasses, the blockage through the new graft to reach the heart muscle.

This bypass of the blocked coronary artery can be done by performing coronary artery bypass surgery.

Traditionally, to bypass the blocked coronary artery in this manner, the chest is opened in the operating room and the heart is stopped for a time so that the surgeon can perform the bypass. In order to open the chest, the breastbone (sternum) is cut in half and spread apart.

Once the heart is exposed, tubes are inserted into the heart so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine (heart-lung machine). The bypass machine is necessary to pump blood while the heart is stopped and kept still in order for the surgeon to perform the bypass operation.

While the traditional "open heart" procedure is still performed and often preferred in many situations, newer, less invasive techniques have been developed to bypass blocked coronary arteries.

"Off-pump" procedures, in which the heart does not have to be stopped, were developed in the 1990's. Other minimally invasive procedures, such as key-hole surgery (performed through very small incisions) and robotic procedures (performed with the aid of a moving mechanical device), are also in development.

2. Heart Valve Surgery

There are four heart valves that open and close to regulate blood flow through the heart. Heart valve surgery treats diseases and defects of these valves of the heart.

There are two main types of heart valve surgery:

Surgery to replace faulty heart valves.
Surgery to repair faulty heart valves.

There are four valves of the heart:
Mitral valve
Aortic valve
Tricuspid valve
Pulmonary valve

Heart disease can affect any of the four valves of the heart. Most commonly, it affects the mitral and aortic valves. Some types of heart valve disease are congenital and other types develop over time.

3. Aortic Valve Surgery:

 Aortic valves help pump blood out of the heart to the rest of the body. In a person with aortic valve disease, the aortic valve has a malfunction:

Regurgitation: The aortic valve does not close completely, causing blood to flow backward instead of forward through the valve.
Stenosis: The aortic valve opening does not form properly or becomes narrow, inhibiting the flow of blood out of the chambers of the heart. When this happens, the heart is forced to pump blood with increased force in order to move blood through the stiff (stenotic) valve.

Aortic valves can have regurgitation and stenosis at the same time.

When heart valves fail to open and close properly, the heart can become damaged. Heart valve problems are one cause of heart failure.

The damaged Aortic valve can be replaced with mechanical or Biological valve. The surgery can be done with standard sternotomy, minimally invasive approach and also recently through transcatheter approach.

4. Mitral valve surgery 

Mitral valve replacement: As described earlier with Aortic valve, the severely damaged mitral valve can be replaced with biological or Mechanical valve.

5. Aortic replacement  

Surgery to repair or replace aortic aneurysms and aortic dissections. When the ascending aorta (initial part of aorta) is dilated more than 5 cm in size, it should get replacement in order to prevent rupture. 

An aortic aneurysm (say "a-OR-tik AN-yuh-rih-zum") is a bulge in a section of the aorta, the body's main artery. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death.

Aneurysms can form in any section of the aorta.

They are most common in the belly area. This type is called an abdominal aortic aneurysm.
They can also happen in the upper body. This type is called a thoracic aortic aneurysm. These are much less common than abdominal aortic aneurysms.

A pseudoaneurysm happens when a bulge occurs but doesn't affect all three layers of tissue in the wall of the aorta. This type of aneurysm might be caused by an injury.

6. Congenital heart defects 

Congenital heart defects are structural heart problems or abnormalities that have been present since birth.

Congenital heart defects usually have no known cause. In some cases, they may be passed from a parent to a child (inherited). They also may occur in the developing baby (fetus) of a woman who has an infection or who is exposed to radiation or other toxic substances during her pregnancy but congenital heart disease treatment has really improved in the past few years.

Having a congenital heart defect increases the risk for complications, such as heart failure, endocarditis, atrial fibrillation, and heart valve problems 

-Contributed by R. Srivatsan

Location: Gurugram, Haryana, India

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