While congenital heart disease is a serious problem, advances in technology have led to vast improvements in the survival of children afflicted by the condition. Priya Kulasagaran summarises the types of treatments available.
Since congenital heart disease covers a wide range of defects, ranging in complexity, the required treatment options depend on the type and severity of the condition.
Some children with heart defects, such as small holes in the heart, may even safely go untreated as these defects correct themselves as the child ages.
Other defects meanwhile, may require some amount of invasive treatment, or even surgery.
The seriousness of the defect could also determine when treatment is needed; while some children can afford to hold off invasive treatment until they are older, others may require treatment soon after the defect is detected, or even soon after they are born.
Before going into treatment options, medical professionals first have to perform a number of scans and tests to determine the exact nature of the defect.
An example of a common type of scan is echocardiography, which uses sound waves to build an image of the heart.
Also called a heart ultrasound, the test does not involve radiation and is safe enough to be performed repeatedly even on infants.
For a more in-depth look at the heart, doctors may also administer a cardia magnetic resonance scan (CMR).
Using a large magnetic machine, this scan takes pictures of the heart while it is beating, to study the structure of the heart as well as how the blood is flowing through it.
Cardiac catheterisation is a procedure used to diagnose and sometimes even treat heart conditions.
A catheter is a thin, flexible, hollow tube that can be inserted into the blood vessels.
Usually, the catheter is inserted into the groin or leg, and gently guided up into the patient’s heart and major arteries and veins with the help of X-ray images.
When used for diagnosing purposes, the procedure allows doctors to learn more about the type of heart defect the patient has, and how serious it is.
The procedure is used to treat simple heart defects, such as repairing narrow heart valves or arteries, or closing some holes in the heart.
Once the catheter is positioned at the site of the defect, tiny tools are threaded through the catheter to the heart to repair the defect.
For example, to correct a hole in the heart, the catheter may be equipped with an umbrella-like device that is opened and left in place.
This plugs the hole, and over time, normal tissue grows over the device.
In cases where there is a narrowing of the veins, the catheter is equipped with a small balloon that’s inflated in the narrowed area to allow blood to flow through.
In some rare cases, cardiac catheterisation is also used as a temporary measure until the child is older or more stable for a more invasive surgical treatment.
Newborns and young infants in particular benefit from cardiac catheterisation, as it only requires a small cut to the skin rather than outright surgery.
A child’s recovery time from this procedure is shorter than with surgery, shortening the stay at the hospital.
While it can be frightening for parents to have their newborn or young child undergo surgery, the consensus among medical professionals is that surgical corrections early in life are the best long-term solution.
This is to minimise any adverse effects of the heart defect on the child’s overall health and development.
As the need for surgery depends highly on the type of defect, it is hard to generalise the kind of symptoms that indicate the need for an invasive procedure.
Broadly speaking, some of these symptoms may include a blue-ish tinge to the skin and lips which indicate a lack of oxygen in the blood.
If a child has difficulty breathing because the lungs are congested or filled with fluid, it could be a sign of a serious heart condition.
Such symptoms combined with irregular heart rates and poor sleep or feeding may also indicate a need for surgical treatment.
The two common types of surgery when it comes to repairing congenital heart defects are either open or closed-heart surgery.
A closed-heart surgery, or a thoracotomy, is where an incision is made on the side of the chest in between the ribs.
This form of surgery is sometimes done with a camera to help surgeons guide the instruments in the body.
Meanwhile, in open-heart surgery, the surgeon makes an incision through the sternum (breastbone) while the patient is under general anesthesia.
Tubes are used re-route the blood through a special pump called a heart-lung bypass machine, which keeps the blood circulating through the body while the surgeon is repairing the heart.
After the repair is done, the heart is started again, the machine is removed, and the chest is closed up.
Some children with congenital heart defects require multiple procedures and surgeries throughout their lives.
In certain cases, a combination of treatments is necessary, and some procedures have to be done in steps over a period of years, while other procedures may need to be repeated as a child grows.
Some mild congenital heart defects, especially those found later in childhood or adulthood, can be treated with medications that help the heart work more efficiently.
Even those who have undergone surgery may require medication if the defect cannot be completely repaired.
These types of medications are used to help ease stress on the heart by lowering blood pressure, heart rate and the amount of fluid in the chest.
Certain medications can also be prescribed to help irregular heartbeats (arrhythmias).
Even after corrective surgery, many people will have to be monitored even as adults to make sure their condition does not contribute to other health problems.
While many children can go to participate in physical activity, some many need to limit the amount or type of exercise they do depending on their condition.
Sometimes, a congenital heart defect can increase the risk of infections — either in the lining of the heart or heart valves (infective endocarditis).
Children whose defect was repaired with a prosthetic material or device, such as an artificial heart valve, also tend to have a higher risk of infection.
This risk means that some children may need to take antibiotics to prevent infection, especially before additional surgeries or dental procedures.
With the advances in science, the chances of living a productive life with congenital heart disease has dramatically improved.
At the National Heart Institute (IJN) for instance, an increasing number of complex heart procedures for children are being carried out locally, compared to the past where patients had to be flown to other countries to undergo corrective surgery.
The latest breakthrough for IJN in pediatric heart surgery has been using bioabsorbable heart conduit implants for children as part of a clinical trial.
Having used the new implants on five young patients so far, IJN’s consultant cardiothoracic surgeon Dr Sivakumar Sivalingam said he has great hopes for the procedure to be rolled out on a wider scale in the near future.
“The current implants for correcting heart valves that we use are usually wholly synthetic materials or those of animal origin.
“These valves do not ‘grow’ along with the patient, the child has to return for repeated surgeries to replace the valve as he or she grows.
“However these bioabsorbable ones, which are made from a special sort of polymer, encourage the growth of natural tissue; what happens is that once the natural tissue has formed, the polymer scaffold will dissolve, and you have now have a valve made of new healthy tissue.
“It’s still at the early stage, but the results have been promising so far – if all goes well, it could really change the lives of a lot of children,” he said.
Another issue faced by parents here is one of cost; while subsidised public healthcare is available, some parents cannot afford the long waiting lists involved when their child is in a critical condition.
This is where private health providers have started playing their part for the community, such as Gleneagles Kuala Lumpur’s “A Heart for A Heart” programme.
Since its inception in 1996, the programme has helped some 500 children with congenital heart disease from low-income families receive treatment for their condition.
The hospital’s corporate social responsibility senior manager Samiha Abd Aziz said the programme was a collective effort
“We started it with the News Straits Times Group, where they would publish stories of children who need corrective surgery for their heart defects.
“All the donations received are channeled solely to pay for their surgeries at the Gleneagles Cardiac centre.
“Since then, we now have other media partners, as well as corporate sponsors and non-governmental organisations pitching in to make more surgeries possible.
“I think the message we want to give parents of children with the condition is that there’s help available for them, and not to give up,” she said.
Samiha said that the department was also open to more partners for the programme, adding that it would benefit a greater number of patients in the future.