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Congenital Heart Disease in India

Dr Neville Solomon

 
While conducting an outpatient clinic with my pediatric cardiologist Dr Muthukumaran last year in Tamil Nadu, in a matter of a half hour we saw three children ranging in age from 3 -5 years with a very simple congenital heart defect called ventricular septal defect.

Timely surgery would have given these children a new lease of life. However, in the case of these three lovely kids, fate had dealt them a cruel blow.

All three hailed from poor families who could not afford cardiac surgery, and had developed Eisenmenger’s syndrome. This made them inoperable and doomed to a life with limited quality and expectancy. Death is usually slow and painful as they enter their thirties and forties.

Congenital Heart Defect (CHD) is a defect in the structure of the heart and great vessels of a newborn. One in every 125 babies born has congenital heart defects, which incidentally, is also the most common birth defect. The eight most common defects account for 80 percent of all congenital heart diseases, while the remaining 20 percent consist of many independently infrequent conditions, or combinations of several defects. Ventricular Septal Defect (VSD) is generally considered to be the most common type, accounting for about one-third of all congenital heart defects. It is estimated that 125,000 children are born every year with congenital heart disease. Many of these children will have curable conditions and with good long-term prognosis.

How blue is the baby?
Congenital heart disease can be broadly classified into acyanotic and cyanotic.

Acyanotic heart disease is when the child is not blue. Common conditions include atrial septal defect, ventricular septal defect, patent ductus arteriosus, and common atrioventricular canal defect. These are conditions associated with “holes” in the heart and increased blood flow to the lungs. The infants present with symptoms and signs of congestive cardiac failure such as breathlessness, failure to thrive, poor feeding, excessive sweating and multiple admissions for lung infections. Coarctation of aorta is a condition wherein there is a tight narrowing in the aorta (the main blood vessel supplying oxygenated blood) restricting blood flow to the lower part of the body. Newborns (neonates) may present with this condition and require emergency surgery.

Most of the above-mentioned conditions are straightforward surgical and interventional procedures. The tragedy in India is that due to various reasons, children are brought late for surgery. Some succumb to complications like heart failure or pneumonia. Others present too late as the lung pressure would have increased, pre-empting successful closure of the heart defects. There are various reasons for this: late diagnosis and referral, lack of funding, fear of surgery, ignorance etc.
 
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