Paediatric Cardiology treatments

Foetal Echocardiogram
Knowing your baby is growing normally and safely in your womb is one of the happiest phases for a mother-to-be. Routine tests for you and your baby can ensure all is going well. If your gynaecologist detects an abnormal heart beat or any other conditions in the foetus, she may recommend a foetal echocardiogram. 
A foetal echocardiography, similar to an ultrasound, is done on the mother’s abdomen to reveal the structure of your baby’s heart and its functions. It is typically done in the second trimester, between 18 and 24 weeks. The test uses sound waves that echo off the structures of the foetus’s heart while a machine analyzes these sound waves and creates a picture, or echocardiogram, of the little heart’s interiors. This image enables your doctor to see the blood flow through the foetal heart and show up any abnormalities. 
You may also need this test if: 
You have a family history of heart disease
Your previous baby was born with a heart condition
You have other medical conditions, like rubella, type 1 diabetes, lupus, or phenylketonuria
Your unborn baby is at risk for a heart abnormality or other disorder
You’ve taken certain medications or been exposed to medications that can cause heart defects, such as those for epilepsy or prescription acne drugs
You’ve smoked, had drugs or alcohol during your pregnancy

Balloon Dilatation of Stenotic Valve in Neonates, Newborns, and Children
In medical parlance, an abnormal narrowing within a structure of the body is called stenosis. The aorta is a major blood vessel that carries blood to different parts of the body. Aortic valve stenosis is the narrowing of the heart’s aortic valve - a one-way valve located between the left ventricle and the aorta. When a child has aortic valve stenosis, the leaflets or tiny flaps of tissue that make up the aortic valve get stuck and can’t separate fully. This blockage loads the left ventricle to pump more, and lessens the amount of blood that goes out of the ventricle to the body through the aortic valve. This overloads and weakens the heart as time passes. However, initially your child may not require immediate treatment except monitoring by your paediatrician. 

Solutions 
Children with severe to critical stenosis will require treatment and your paediatrician may recommend the minimally invasive interventional catheterization, valve repair or replacement procedure.
At Manipal Hospitals, Interventional catheterization is the first line of treatment adopted by our expert paediatric cardiac surgeons with Balloon valvuloplasty the most common interventional catheterization procedure used to treat aortic valve stenosis. In this procedure, the child is sedated and a small, flexible catheter with a miniscule high precision camera and miniature tools is inserted through a blood vessel in the groin.  The surgeon guides the catheter up into the inside of the child’s heart and across the aortic valve. A deflated balloon at the tip of the catheter is inflated once the tube is in place, and this balloon stretches the aortic valve open.

Haemodynamic evaluation of Complex Congenital Heart Diseases
Comprehensive haemodynamic evaluation is one of the efficient diagnostic tools employed by our highly skilled doctors at Manipal Hospitals to evaluate your cardiovascular health. This method studies your blood pressure and the way your body transports oxygen in your blood to your tissues. This thorough yet complex evaluation method gives your doctors an in depth analysis of all the components that impact your blood pressure and overall cardiovascular health. 
Hemodynamic evaluation plays an important role in the diagnosis of Congestive heart failure, Congenital cardiomyopathies, Shortness of breath, Valvular heart disease, Pulmonary hypertension, and Systemic hypertension

This comprehensive method studies and analyses:
Systemic vascular resistance or vasoreactivity – reveals certain conditions that affect the diameter of your blood vessels and blood vessel constriction resulting in decreased blood flow and hypertension.

Blood volume — reveals if the volume of blood you pump is normal, you have increased volume or fluid overload caused by fluid retention, or you have decreased volume caused by fluid loss.
 
Inotropes — reveals how these hormone-like substances circulate through the blood and stimulate the heart muscles to increase or decrease your heart rate.
 

Counselling following a diagnosis of congenital heart defects in Neonates, Infants, Children, and Adults

At Manipal Hospitals, we take everything to heart. Congenital heart disease comes with a baggage-full of uncertainty. Because it is a significant cause of morbidity and mortality in a newborn, its diagnosis can trigger overwhelming emotions in the baby’s family especially the parents. Realising that the baby is in a delicate state and may not be able to live a full life can be catastrophic. The onus is on the paediatric cardiologist to break the news gently.
At Manipal Hospitals, just as we take pleasure in bringing new and precious lives into the world, we also take pride in our team of compassionate paediatric cardiologists and trained counsellors, who take on the huge responsibility of revealing the details of the delicate condition to the neonate’s parents.
Counselling is an essential and significant part of our ethos. Through gentle and skilled counselling, the cardiologist in addition to her/his diagnostic calibre will require to influence the parents to accept the reality and focus on the baby’s singular care and development. 
Congenital heart disease can manifest itself in various ways in each individual. This is the reason it is pertinent for the treating paediatric cardiologists and physicians to be part of Manipal Hospital’s all-time counselling culture, from diagnosing the anomalies before birth and monitoring and caring for the patients from birth till adulthood.

Device closure of abnormal communication such as Patent Ductus Arteriosus (PDA)
Every baby is born with a ductus arteriosus which is a normal foetal artery connecting the aorta (main body artery) and the main lung artery (pulmonary artery). The ductus or opening allows blood to leave the lungs before birth. After birth, the opening narrows and closes within the first few days.
In some babies, the ductus may fail to close. This is common in premature infants but rare in full-term babies.
In children, the cause of PDA is unknown. In a normal heart, its left side pumps blood only to the body, and the right side only to the lungs. In a child with PDA, extra blood gets pumped from the aorta into the lung arteries. If the PDA is large, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested. This makes the child breathe faster and with more difficulty. Infants may have trouble feeding and growing at a normal pace and the symptoms may not show up until several weeks after birth. With high pressure in the blood vessels in the lungs, it may cause permanent damage to the lung blood vessels over time.

Solutions
At Manipal Hospitals, your paediatrician will close the troublesome PDA by inserting catheters into the blood vessels in the child’s leg to reach the heart and the PDA, and using a coil or other device to plug the PDA. In the surgical process, an incision is made in the left side of the chest, between the ribs. The ductus is closed by tying it with suture or by permanently placing a small metal clip around the ductus to squeeze it closed. These methods can give the child a new lease of life. 

Device closure of Septal Defects such as Ventricular Septal Defects (VSD) and Atrial Septal Defects (ASD)
Atrial and ventricular septal defects are among the most common congenital heart defects and are holes in the walls or septa that separate the heart into the left and right sides. A heart murmur is one of the first audible signs that can be confirmed by an echocardiogram. 
Ventricular septal defects (VSD): are located between the lower chambers or ventricles of the heart which pump blood to the body. Ventricular septal defects can be located in several different sections of the wall between the lower chambers of the heart. Some have a good chance of closing on their own (for example, those that are called muscular ventricular septal defects) whereas others do not close spontaneously. VSD vary from small holes, which may cause a heart murmur but no symptoms, to larger ones that cause symptoms early in life. These usually develop when an infant is between 6 and 8 weeks of age and include rapid breathing, difficulty feeding, sweating while eating, and slow weight gain. These symptoms are an indication of the child developing heart failure. If untreated, the child may have recurrent lung infections and increased pressure in the lung blood vessels that will eventually become permanent, leading to serious complications and shortened life span.

Atrial septal defects (ASD): are stretched out normal hole (foramen ovale) between the upper chambers that is present before birth. Most of these defects (patent foramen ovale) close on their own within the first 3 years of life, although sometimes they persist into adulthood. A true hole between the atria (true atrial septal defect) usually does not close. Infants and children with atrial septal defects usually have no symptoms. Once in a while, a child with an atrial septal defect will grow slowly. However, in early adulthood or middle age, atrial septal defects that are untreated, particularly those that are large, can lead to a stroke or high blood pressure in the lungs. Smaller atrial septal defects can also become more complicated over time as the left side of the heart naturally stiffens, pushing more blood through the hole and back through the lungs.

Diagnosis: Echocardiography (ECG)
For both atrial and ventricular septal defects, echocardiography or ultrasonography of the heart is conducted to verify the diagnosis and determine the size and location of the defect and any associated enlargement of heart chambers. ECG will also reveal if other heart defects is present and is typically done even in infants. ECG may show signs that one or more heart chambers are enlarged. 

Solutions
The mode of treatment depends on the type and size of the defect and whether it is causing symptoms. Sometimes drugs, a plug or other specialized device is inserted through a catheter to block hole.

Atrial septal defects
Because atrial septal defects usually cause no symptoms, affected children do not usually need any drugs. If the hole persists beyond age 2 to 3 years, unless the hole is tiny, doctors usually recommend closure to prevent complications. During this procedure, a catheter or tube is inserted into the large vein at the top of the child's leg and then carefully pushed up through the blood vessel until it reaches the heart. Once the catheter is in the proper location, the closure device is threaded through the catheter and out of the tip of the catheter, allowing the device to expand and seal the hole.

Ventricular septal defects
Children with small ventricular septal defects usually require no treatment. However, some smaller VSDs located near the aortic valve can cause the valve to leak (aortic regurgitation). If children have aortic regurgitation, doctors usually perform surgery to close the VSD and sometimes repair or replace the aortic valve.


 

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