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Birth defects of the heart and its vessels

Herbal Cure for Heart - Complete Pack
Total Heart Support
Arjuna
Arjun Tea
Arjun Saar
Kumari Saar
Total Price
Divine Remedies Total Heart Support is herbal treatment for High Cholesterol, High Blood Pressure natural remedy, herbal solution for congestive heart failure, blocked coronary arteries, irregular heart beat, blocked circulation in extremeties, Natural Rejuvenation for Your Heart, Natural cleansing for circulatory system Arjun Tea is herbal, natural way to control cholesterol, blood pressure,coronary artery diseases

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Eight to ten babies in a thousand are born with defects of the heart and/or its great vessels. Varying from comparatively simpler holes in the heart to narrow or absent valves, abnor­mal communications to mismatched connections, and even more complex afflictions-they are over a dozen kinds, of diverse nature and severity; some present at birth itself, others in infancy, and some going into adulthood before they manifest themselves. A vigilant mother or a granny and the family physician can at times sense their presence. Diagnosis has now become much easier and surer largely as a result of newer imaging techniques of 2-D echocardiography and colour doppler, joining hands with time-tested means of cardiac catheterization and angiocardiography. Modern-day cardiac surgery and interventional cardiology has done much to im­prove the salvage rate and today most such defects are read­ily corrected. Prevention is possible to some extent, through care exercised both before and during the time the baby is taking shape in the mother's womb.

How common are birth defects of the heart?
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Why? Can't these defects be corrected? Or is there a dearth of facilities?

How and why do heart defects at birth occur?

What are the various kinds of congenital heart defects?

What are the warning signs and symptoms which suggest the possibility of such defects in the child?

What are the investigative techniques which help establish the diagnosis?

What are the available modes of treatment? Is total cure possible?

What is the ideal age for surgery? Can an infant bear it safely?

What surgery is required in the more common con­genital cardiovascular defects?

How safe are the corrective surgical techniques? What is the current mortality rate?

What are the possible complications if surgery is not done?

Can congenital heart disease be prevented? What measures can help?

 

How common are birth defects of the heart?   Top  

About 1 per cent of all live births are complicated by birth defects of the heart and/or its major blood vessels. By itself, this figure may not seem striking, but the magnitude of the problem can be gauged, by multiplying this figure with the number of total births occurring around the world every year. In India alone, this amounts to over a hundred and twenty thousand babies being born with such defects in one calendar year. This is merely the incidence figure, or the number of new cases. The total number at any given time would be qmch larger. Although many are snatched by death and some be­ come normal after surgical correction of the defect(s), a much larger number continue to lead a troubled, handicapped life. Lack of proper management shortens their life expectancy.

Why? Can't these defects be corrected? Or is there a dearth of facilities?   Top  

The reasons are many. Most stem from the social condi­tions in our country. Lack of awareness, myths and misconcep­tions, and limited economic resources are the prime causes. Modern-day cardiac surgery can, otherwise, readily correct most such defects.

Mythological associations are often evoked by our elders when they see a blue baby: The child is treated as a reincarnation of some mythological god, when what is needed is an urgent surgical remedy of the cardiac defect. Many such Shivas and Krishnas, deprived of medical and surgical treat­ment, live a short agonized life and meet an untimely death. The dusky or blue hue of these babies is only an indication of
insufficient oxygen in the blood, caused by an anomaly of the heart.

Many parents close their minds to reality and cannot bear to think of their little babies being subjected to the torture of surgery. Often they believe that surgery is a last-ditch measure and hence, delay it too far when the surgical risks actually outweigh the benefits. Little do they realize that timely surgery has no equal in restoring their child to health.

Some parents and elders are also misguided by the belief that time may be the spontaneous healer. This faith may originate from the observation that some 25% of small ven­tricular holes (VSDs) in the heart at birth may undergo spon­taneous closure in childhood. But, on the other hand, this is also equally true that a similar number, if not operated by the age of two years, worsen so much that they can no longer be helped by surgery. Essentially, the decision of surgery and its timing should be left to the clinical' judgement of the cardiolo­gist and the cardiac surgeon. Wishful thinking in this respect can be very harmful. 

Finally, there is the question of expense. By Indian living standards, surgery for heart defects at birth is quite expensive, although no more than adult cardiac surgery. This expense has certainly to be borne with, and if an individual cannot afford to pay, it becomes the responsibility of the state and privately­ funded philanthropic societies.
Facilities need to be more readily available too. But such as those exist are excellent and compare favourably with the best in the world.

How and why do heart defects at birth occur?   Top  

Birth defects of the heart and larger blood vessels occur in one of the three ways-as a result of some aberration during the formation of heart inside the mother's womb. It could result in either its faulty development or a failure of a part to progress beyond an early stage of embryonic growth. Or alter­natively, the baby's heart after its birth retains one of the passages which helped bypass the inactive lungs during the time it was in the mother's womb. (Normally, these passages close down on their own at or soon after birth.)

The critical time for the heart's development in an embryo are the fifth to eighth weeks following conception. Interfer­ence with development at this time is notorious for producing anomalies at birth.

A rubella (German measles) infection of the mother during this time can be disastrous for the unborn baby and produce multiple organ defects. Indeed, so virulent is the infection, that it is now a ground for legal termination of pregnancy in many countries, including India.

Chronic alcohol intake by the mother can also cause inter­ference with the normal development of the baby's heart, and cause many other defects, besides cardiac septal defects. But such cases are fortunately rare in India till now, because. few Indian mothers are alcoholic.

Deficiency or excess of several vitamins, and many kinds of medication can also upset normal cardiogenesis. It is best therefore not to take any drugs, even homoeopathic or ayurve­dic, during the early months of pregnancy.

X-rays are potentially risky too. As such, a woman carrying a baby should never be X-rayed unless absolutely necessary. She should step out of the X-ray room if any close friend or relative is being X-rayed.

The heredity factor possibly plays a significant part in car­diac and all other birth malformations, but it is not possible to clearly determine this. Though fresh gene mutations can oc­cur, one factor which can be blamed is the custom of consanguineous marriages between first cousins widely prevalent in some parts of the country. Children born to parents from such marriages show a much higher incidence of cardiovascular, and all other, birth anomalies.

Likewise, family studies indicate a two-to- fivefold increase in congenital heart disease in the siblings of affected patients. None the less, the risk is so small-2-5%-that it should not discourage the parents of one affected child from having addi­tional children unless the genetic counsellor's advice is to the contrary.

What are the various kinds of congenital heart defects?   Top  

For a basic understanding of various defects, a simplistic explanation of normal circulation is necessary. The human heart is a two-tier structure made up of four chambers-the two-upper chambers are called atria and they serve to receive the blood, and the two lower, named ventricles, pump out the blood.

Functionally, it is a two-compartment model-the right and the left. The right atrium and right ventricle function as one. compartment, while the left atrium and left ventricle act as the other, or left compartment.

With all things normal, the right upper compartment (atrium) receives the impure deoxygenated blood from all parts of the body through conduits called the vanae cavea. Being devoid of oxygen this blood is darker in colour. The right lower compartment (ventricle) pumps out this blood into the pulmonary artery, which carries the blood to both the lungs.

The lungs purify the blood, making it rich in oxygen, and remove carbon dioxide, the waste product of body metabolism.

This bright red, oxygenated blood is carried to the left upper compartment (atrium) through pulmonary veins. The lower left compartment (ventricle) then pumps the blood out into the aorta-the largest artery of the body which divides into many branches to supply the oxygen-rich blood to all parts of the body.

Structurally, the two compartments are walled off and sepa­rated from each other by curtain-like structures, called the septa. The right and the left atria are separated by an inter­atrial septum. The ventricles have an inter-ventricular septum interposed between themselves. If somehow, any of the two septa are deficient in a part, blood from the two compartments can intermingle, resulting in abnormal circulation. When such a defect occurs in the interatrial septum, it is called the atrial septal defect (ASD). A similar defect between the ventricles is called ventricular septal defect (VSD). Both these defects are amongst the commonest of congenital heart defects, and are commonly referred to as a hole in the heart.

Very commonly, as ASD may simply be a persistent remnant of fetal circulation. In a foetus, by necessity, the lungs are cut off from the circulation as they are wholly inactive (the job of providing oxygen-rich blood lies with the maternal cir­culation). To short-circuit the lungs, the unborn baby is pro­vided with two temporary shunts. One such shunt is the foramen ovale, or a flap valve, opening between the two atria. After birth, when the baby's lungs begin to expand, this flap valve normally seals off and the shunt is obliterated. But abnormally, it may stay open and thus be a cause of ASD.

The other fetal shunt lies between the pulmonary artery and the aorta. This is through a conduit, called ductus arteriosus. Normally, soon after birth, as the lungs become active and the resistance to the blood flow into the lungs falls dramatically, this shunt is thrown out of action and it gets sealed off. But in some children, the shunt fails to close and continues to provide an abnormal passage to the blood from the aorta to the pulmo­nary artery. This abnormality is called persistent ductus arteri­osus (PDA).

Sometimes, the aorta gets narrowed in its part during its development, usually in the region where the ductus arteriosus attaches itself to it. This condition is called coarctation of the aorta.

Occasionally, wrong or mismatched connections occur. The aorta, instead of arising from the left ventricle, originates from the right, and the pulmonary artery reverses its origin to the left ventricle, a condition called transposition of great arteries (TGA). It is incompatible with life unless an ASD or a VSD occurs simultaneously.

In the heart itself, various other defects may arise. In each compartment, between the atrium and the ventricle, and at the exit point of the ventricles just where the great arteries take root, there are certain valvular structures which serve to keep the blood flowing only in a forward direction and seal off its return. These check-valve-like structures, simply called valves, may suffer from congenital defects too. Any of them may be absent, or narrow (stenosed), or leaky (regurgitant).

More complex kinds of anomalies also occur. Thus, in tetralogy of Fallot (TOF), the commonest cause of blue babies, four anomalies occur together. There is pulmonary valve nar­rowing, a high ventricular septal defect, a malplaced aorta, and enlargement of the right ventricle.

It is convenient and conventional to classify these and the other less common defects into two broad categories-cya­notic, where the baby is blue from want of oxygen-rich blood, and acyanotic, where the baby continues to get oxygenated
blood in spite of the anomaly.

What are the warning signs and symptoms which suggest the possibility of such defects in the child?   Top  

The cyanotic group of congenital cardiovascular anomalies is obviously easier to suspect. These babies have a blue or dusky hue and are popularly called blue babies. This is clearly neither a sign of divinity nor that of nobility. It clearly reflects the lack of oxygen in the arterial blood. Blue lips and blue nails are the two most noticeable features in them. The mother may notice that the dusky appearance gets heightened when the baby cries while bathing or straining for stool. Often, the infant goes limp after such an episode. Some children experience sudden spells of increased cyanosis, or bluish, discoloration. They may even have convulsions or fits during such spells. Many learn to squat to relieve themselves of added cyanosis and breathlessness.

The signs and symptoms of acyanotic congenital heart dis­ease are however more subtle. Some may even .be totally silent until adulthood. In VSD, the commonest defect, the child has repeated chest infections as a result of the lungs being dammed with extra loads of blood, continually shunted across the left ventricle into right ventricle and from thereon into the lungs. Signs of heart failure may appear. The mother may find that the infant has become more irritable, is not gaining weight, has frequent interruptions or breaks during a milk­feed, and has unusual sweating on the forehead while feeding or crawling. The child may frequently become breathless. A little older child may complain of fatiguing easily, and may develop a swelling of feet. These signs of heart failure may appear in other kinds of heart defects too.

Some intelligent parents may notice a tumultuous heart impulse or a purring impulse over the left chest of the child. Often it is the attending obstetrician or paediatrician who detects the anomaly at the time of birth, or later, in baby clinics by hearing the heart sounds of the baby. In some cases, the defect gets noticed much later in childhood, in course of a medical examination. Each defect brings peculiar changes in the heart sounds which are audible to the trained ear.

What are the investigative techniques which help es­tablish the diagnosis?   Top  

A thorough medical examination, the-ray of the chest and an electrocardiogram (ECG) are the first line of diagnosis. They help by providing many valuable indicators.

After these simple investigations, more refined techniques are brought into action.
A two-dimensional echocardiography (see Chapter 16) harnesses sound waves inaudible to the human ear. The cham­bers, valves and septae of the heart, and the great arteries can be accurately imaged by it, and irregularities diagnosed with precision. The application of the doppler, which picks up the direction and velocity of blood flow at a specified location within heart chambers, has added much to the efficacy of echocardiography. It provides information on the functional consequences of the defect. The colour doppler is a further refinement on it.

These techniques are non-invasive, causing no pain or discomfort, and are harmless to the patient. They can even be performed on a foetus lying in the mother's womb.But at times when echocardiography is unable to satisfy the investigating cardiologist, cardiac catheterization and angio­cardiography may become necessary.

What are the available modes of treatment? Is total cure possible?   Top  

Beyond doubt, surgical correction is the most definitive treatment for congenital cardiovascular anomalies. Complete cure and normal life expectancy is possible with timely sur­gery before any permanent complications arise.

Of late interventional cardiology is making inroads into the domain of traditional surgery. Smaller ASDs, VSDs, and PDAs have been successfully closed by placing umbrella-like de­vices sent through a special kind of catheters. Children with coarctation of aorta and narrow valves have been helped by balloon dilatation. But these techniques are still in infancy arid not quite as reliable as surgery.

In rare, more complex, cases, even surgery cannot offer cor­rection. In them, the way out is a cardiac transplant (substitu­tion of the defect-ridden heart by a donor heart). However, these facilities do not exist at present in India.

What is the ideal age for surgery? Can an infant bear it safely?   Top  

This depends upon the nature of the defect, its natural history and course, the kind of surgical expertise available and the surgical risk involved. In general, however, once the diag­nosis is established and surgery recommended, the sooner it is done, the better. It is no good delaying surgery in the wanton belief that the child may improve on his own or surgery can anyway be done at a more opportune time. The delay can make the case hopeless.

Infancy is no bar to surgery.

In fact, whenever surgical intervention is contemplated, it is best undertaken before the school going age, thus limiting the psycho-social trauma it may bring to the child.

But in cases of ASD and PDA, even if the defect is diagnosed at a later date, surgery can be done quite safely. Some patients have undergone successful surgical correction even after rais­ing a family.

What surgery is required in the more common con­genital cardiovascular defects?   Top  

All corrective surgery for congenital heart anomalies done today is usually as an open-heart operation. The heart and the lungs are temporarily put out of circulation by hook­ing the patient to an artificial heart-lung machine which serves to oxygenate the blood and pump it into the arterial system. This allows the cardiac surgeon ,to operate with safety with direct vision on the open and motionless heart.

In the intracardiac shunts-ASD and VSD-the defect is closed with a patch of artificial material, such as Dacron mesh.

In PDA, a simple ligation or division of the ductus arteriosus is carried out.

In coarctation of aorta, the narrowed segment of the aorta is excised and the healthy portions of the aorta are stitched together, by end-to-end anastomosis. If the affected segment is large, a patch of crimped Teflon or Dacron is used to bridge the gap, after removing the defective portion of the aorta.

In congenitally narrowed valves, usually direct surgical relief of the obstruction is achieved.

Surgery for tetralogy of Fallot is comparatively a more dif­ficult procedure. Two kinds of surgical approaches are in vogue. One is a palliative technique. It is designed to improve the patient's condition by increasing the blood-flow to the lungs. For this a shunt is created which carries blood from the aorta to the pulmonary artery. But this can at best be only a temporary measure. A more complicated total correction of the defect needs to be carried out sooner or later. This involves the removal of obstruction to the right ventricle's outflow and a Dacron patch closure of the VSD.

In the transposition of great arteries, a jest of nature, causes reversal at the origin of the two great arteries-pulmonary artery and aorta. This defect is incompatible with life, unless a shunt exists between the two heart compartments. To save the life of the baby at birth, cardiologists push in a balloon catheter into the foramen ovale and tug at it to enlarge it, thus improv­ing the chances of survival. A surgical correction is done soon, in infancy itself, by either shifting the great arteries to their . normal position or switching the great veins, thus making the natural right compartment as the left and vice versa.

How safe are the corrective surgical techniques? What is the current mortality rate?   Top  

Surgery in good hands, and at centres suitably geared for pre-, intra-, and post-operative care of the patient, is quite safe today. Mortality rates vary with the natur of defect and the type of surgery. With the simplest of defects such as ASD and PDA, the mortality is close to zero, but with more complex defects such as TOF it approaches ten per cent.

What are the possible complications if surgery is not done?   Top  

Many kinds of complications can arise. In shunts and obstructions, the abnormal and turbulent flow of blood fa­vours bacterial infections of the tissues of the heart. This condition, called bacterial endocarditis, is fraught with grave risk to the patient's life.

In patients with cyanotic congenital heart disease, venous blood bypasses the normal filtering action of the lungs, and blood clots arising in the veins may pass to block the arteries of the brain. Brain abscess may develop leading to severe brain damage.
All forms of defects lead, ultimately, to increased load on the heart. The heart goes into failure, even in the first few months or years of life.

In shunts, the lungs are flooded with extra loads of blood which lead to repeated chest infections and damage to the lungs. With the passage of time, the circulation in the lungs becomes hypertensive, which eventually causes reversal of the shunt and deoxygenated blood begins to flow into arterial circulation, causing cyanosis of the patient and its attendant complications.

By and large, whatever be the defect (except the smallest of ASDs), the patient faces the prospect of an untimely death, in one form or the other.

Can congenital heart disease be prevented? What measures can help?   Top  

Yes, to some extent. All girls should be vaccinated against rubella in their childhood. Pregnant women should avoid all kinds of medication, unless medically advised, in the
first three months of pregnancy. This restriction should also apply to homoeopathic and ayurvedic medications. No X-rays should be done as far as possible during pregnancy, and certainly not in the first three months. The practice of consanguinous marriages (first cousin marriages) should be voluntarily stopped by the communities where this is the custom. If the family history of congenital cardiac anomalies is strong, genetic counselling is advisable before planning parenthood.

These measures can help restrict the number of babies born with congenital malformations of the cardiovascular system. The risk would still exist, though curtailed.

Herbal Cure for Heart - Complete Pack
Total Heart Support
Arjuna
Arjun Tea
Arjun Saar
Kumari Saar
Total Price
Divine Remedies Total Heart Support is herbal treatment for High Cholesterol, High Blood Pressure natural remedy, herbal solution for congestive heart failure, blocked coronary arteries, irregular heart beat, blocked circulation in extremeties, Natural Rejuvenation for Your Heart, Natural cleansing for circulatory system Arjun Tea is herbal, natural way to control cholesterol, blood pressure,coronary artery diseases

Free Shipping and Handling
Worldwide!
No Side Effects!
2 Bottles
1 Bottle
1 Pack
4 Bottles
4 Bottles
$47.90
$ 31.00
$ 14.95
$ 75.80
$ 75.80
$ 274.55
Price after Discount 20%
$ 220.00
Buy This Pack for Just $ 220.00
Free Shipping and Handling Worldwide! No Side Effects!

Click here to buy Individual herbal products for heart care, heart herbal cure, herbs for heart

 


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