Surgical and Non-Surgical Treatments for Congenital Heart Disease in Infants

-Contributed by Navaneeth R

Congenital heart disease (CHD) refers to structural and functional abnormalities in the heart present at birth. It is one of the most frequently diagnosed congenital disorders, affecting nearly 1.3% of newborns worldwide. The children born with CHD face significant challenges as the conditions often pose substantial risk for their life. The advancements in the medical field have enabled us to effectively manage these children, ensure their survival and improve their quality of life as they grow up. 

Congenital heart defects in infants include numerous disorders ranging from minor defects to complex, challenging conditions. While some of these which are minor resolve spontaneously on their own, others require surgical or non-surgical interventions. Even for those who do not require any treatment, long term monitoring and routine cardiac evaluation is a must.

Non-Surgical Treatment for CHD

All patients with CHD do not require open heart surgeries. Some can be medically managed while others can be treated with minimally invasive procedures with less complications and duration of hospital stay. For example, in preterm babies with Patent ductus arteriosus (PDA), which is an abnormal connection between aorta and pulmonary artery that persists after birth, closure can be achieved by giving drugs such as Indomethacin, Ibuprofen and sometimes even with Acetaminophen/Paracetamol. There are other medications which helps in managing the symptoms and prevent the complications like Diuretics which prevents fluid build-up in body and lungs due to heart failure, Beta Blockers which reduce the heart rate and thereby strain on the heart, ACE inhibitors, Prostaglandin analogues and Ionotropic agents.  

Minimally Invasive procedures: These include catheter-based interventions where a thin, flexible tube (catheter) is introduced into the heart through a blood vessel, offering less invasive correction of certain defects. These procedures revolutionized the treatment of CHD by offering effective alternative to tedious open-heart surgeries. Some of these procedures are:

• Device closure of ASD: Here, Atrial septal defect (ASD) which is a hole in the heart is closed with the help of a small device which is placed in the defect through a catheter. 

• Coil closure of PDA: It is done in term infants with PDA where a coil is used to close it.

• Ballon atrial septostomy: It is done in case of Transposition of great arteries (TGA) where the great arteries (aorta and pulmonary artery) arise from the wrong chambers. This is a palliative procedure that ensures the survival of the child till a definitive repair can be done.

• Balloon Valvotomy: It is done in children with valve stenosis or narrowing of the valve. Here a balloon is inflated to widen the valve and improve the blood flow through it.

Surgical Treatment for CHD

Surgeries are often necessary with complex congenital heart defects in infants as there is substantial disruption of normal anatomy and physiology of heart. There are definitive surgeries which aims to restore the normal structure and function and there are palliative surgeries which are done to keep the child alive and relieve the symptoms until a definitive surgery can be performed. Surgeries are most often open-heart surgeries where a cardiopulmonary bypass (CPB) is used to support circulation until they are completed. Some of the commonly performed surgeries include:

• Repair of Septal defects: While in selected patients, atrial and ventricular septal defects can be closed by catheter-based procedures, others require surgical closure. Usually, repair is done with the help of a patch which is used to close the defect.

• Arterial switch operation: It is done for patients with Transposition of great arteries (TGA). Here the main arteries are switched back to their normal positions and although complex, it has excellent long-term prognosis.

• Blalock-Taussig shunt: It is a palliative surgery done for children with tetralogy of Fallot (TOF)

• Norwood procedure, Glen shunt and Fontan operation: It is done for babies born with Hypoplastic left heart syndrome (HLHS) where the left side of the heart is too small and underdeveloped to pump blood.

The children treated for CHD require long term follow up and monitoring. They should be evaluated by a pediatric cardiologist routinely. Proper nutritional support should be given as they often struggle with weight gain and growth. Heart disorder treatment is no longer a distant dream for families struggling financially and emotionally, thanks to organisations like Genesis foundation who provides financial assistance for life-saving procedures to underprivileged children suffering from CHD. With the advanced technology and sophisticated treatments available today, these little hearts can beat stronger with the hope for a healthier future!

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References:

1.Kliegman RM, St. Geme JW. Nelson Textbook of Pediatrics. 22nd ed. Chapter 483: General principles of treatment of congenital heart disease

2. Varela-Chinchilla CD, Sánchez-Mejía DE, Trinidad-Calderón PA. Congenital Heart Disease: The State-of-the-Art on Its Pharmacological Therapeutics. J Cardiovasc Dev Dis. 2022 Jun 26;9(7):201. doi: 10.3390/jcdd9070201. PMID: 35877563; PMCID: PMC9316572.