AC surgery – what is new and progressive? – Dr. Joseph Xavier, Consultant Pediatric Cardiac Surgeon, Fortis Hospitals
On this day when hearts are handed to the loved ones as symbol of love, let us take a moment to reflect on the heart disease of children.
Many of them are born with the problem and many develop the disease due to various infections that affect the heart like rheumatic fever affecting the valves of the heart. In India about 1.5 lakh children are born each year with defects of the heart and only about 10 thousand get surgical or other interventional treatment. The rest wait endlessly some dying of heart failure, some becoming inoperable with time. The problems which plague this spectrum of disease include disease being more common among the poor with less access to diagnostic facilities and treatment which is expensive. In India insurance does not cover children with congenital (born with) problems. Apathy on the part of parents who think that it’s easier to have another child than care for a disabled child. And on the part of care providers many do not want get involved with care for heart problems of the child because one needs to hire and train special skill sets besides the fact that many of the complex problems drain resources. Children with rheumatic heart disease also form a large group who need constant monitoring and surgery for the valves of the heart. Valve repair is preferred inn this group because of the intricacies of anticoagulation associated with valve replacement in a group that is dynamic and injury prone.
World over, the advances in paediatric cardiac surgery is focused on the area of intra uterine (foetal) surgery, which is in its infancy and still mostly in laboratory models. A step ahead would be the attempt to make an antenatal diagnosis by expert ultra-sonogram, called anomaly scan and if any congenital heart defect is found out, and then preparations are made to have the delivery in a tertiary care hospital with paediatric cardiac intervention capabilities. This seemingly simple protocol has taken a long time to catch on; then consider a country like ours where primary health care has not reached all the corners of the nation, and 90% cannot afford cardiac surgery, government infrastructure for critical medical care is restricted to very few government institutions and medical insurance for the common man unheard of.
Advances in surgical techniques in paediatric cardiac surgery are limited, as treatment protocols for most of the conditions have been clearly outlined and only small variations happen from case to case. However advances in technology are going on all the time to make management of complex problems and tiny neonates easier for the physician. Artificial perfusion during cardio-pulmonary bypass, ventilation of small babies with very small breaths and airways, administration of microscopic doses of drugs accurately, are a few of the recent developments where advances in technology have improved outcome. Continuous research is on, to better understand the body functioning and develop treatment modalities accordingly, including drugs and devices like artificial heart and lung, and methods to preserve and use biological tissue, like a heart valve with its tube in continuity called homograft. All these advances have improved the survival, and conditions once thought to be non correctable are today treated successfully.
The other fallout of all these developments is that more centers across the country are able to carry out these complex procedures and a larger population now has access to such amenities. Yet for paediatric cardiac surgery in India there are miles to go before we sleep.
Our pediatric Heart Surgeon Talsk About Congenital defects
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About Congenital Heart Disease
February 14 is celebrated as Congenital Heart Defect Awareness Day. A day of heart gives us a chance to take on a human cause for promoting the awareness of congenital heart defects. On this special day a concerned global effort come together to heighten awareness of this deadly group of diseases. Some non profit organization, families, support groups and professionals has taken some great efforts and joined hands together to increase the public awareness of heart disease in children. Congenital Heart Disease is said to be the most common birth defect and has become a leading cause for birth defects related deaths worldwide. It is said to be lethal constellation of birth defect that is affecting millions and millions of new born babies and it has been claiming thousands of lives every year.
Congenital Heart Disease affects more than 1.8 million families around the world and on the contrary a very small amount of funding is available for parent & patient educational services and support. It is one of the sincere hopes that more efforts are put together to educate the public this will result in early diagnosis and improving the situation of the same. With additional funding & support for educational services, scientific research and access to quality of care for children and adults.
There are several things people should know about CHD; firstly that it is a birth defect and it affects 1% of newborn babies over 40,000 babies born every year. Awareness must be raised for the need of funding for CHD research and also for the need of organ and blood donation. Lastly people should know that there is a support for families dealing with CHD and with more and more hands joining that support organization the support will be extended.
Pediatric Heart Problems in India
It is estimated that between 130000 to 270000 children are born with Congenital Heart Disease (CHD) each year in India, of which approximately 80000 newborns would require intervention during the infancy each year. Between 3 – 10% of the present infant mortality may be accounted for by CHD. It is estimated that only 2 – 3% of the affected infants with serious heart disease in India receive timely attention. In all probability, the remaining 97 – 98% do not survive.
Fortis Advantage
1. Multi-disciplinary Team based specialized approach
2. Team of professionals specially trained in the special needs of children
3. Comprehensive cardiac surgery programs to address all aspects of congenital heart diseases
4. Best and latest technological support to deliver the superlative care
5. Most sophisticated Neonatal Intensive Care Unit (NICU)
Children and Teens
Ongoing Medical Care
Ongoing medical care is important for your child’s health. This includes:
- Checkups with your child’s heart specialist as directed
- Routine exams with your child’s pediatrician or family doctor
- Taking medicines as prescribed
Children who have severe heart defects may be at slightly increased risk for infective endocarditis (IE). IE is a serious infection of the inner lining of your heart chambers and valves.
In a few situations, your child’s doctor or dentist may give your child antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria into the bloodstream. Your child’s doctor will tell you whether your child needs to take antibiotics before such procedures.
To reduce the risk of IE, gently brush your young child’s teeth every day as soon as they begin to come in. As your child gets older, make sure he or she brushes every day and sees a dentist regularly. Talk with your child’s doctor and dentist about how to keep your baby or child’s mouth and teeth healthy.
As children who have heart defects grow up and become teens, it’s important that they understand what kind of defect they have, how it was treated, and what kind of care is still needed.
This understanding will help these teens take responsibility for their health. It also will help ensure a smooth transition when they start getting care from a cardiologist instead of a pediatric cardiologist. A cardiologist treats adults who have heart problems.
Young adults who have complex congenital heart defects require ongoing care by doctors who specialize in adult congenital heart disease.
You may want to work with your health care providers to put together a packet of medical records and information that covers all aspects of your child’s heart defect, including:
- Diagnosis
- Procedures or surgeries
- Prescribed medicines
- Recommendations about medical followup and how to prevent complications
- Health insurance
