How to treat congenital heart disease in children

The incidence of congenital heart disease (CHD) in Indonesia is estimated at 43,200 cases out of 4.8 million live births (9: 1000 live births) each year, based on data from the Indonesia Heart Association. When a baby is diagnosed with congenital heart disease at birth, doctors usually suggest various ways to treat the condition. So, what are the treatments that are usually recommended and what are the preparations for when a child needs to undergo congenital heart surgery? Come on. see the following review.

Why do children with CHD need to be treated?

Congenital heart disease (CHD) indicates abnormalities in the structure and function of the heart and surrounding blood vessels. This includes a variety of conditions, including leaking of the heart's chambers (atrial septal defect and ventricular septal defect), or not closing the two main arteries of the heart (patent ductus arteriosus).

This abnormality in the structure of the heart can cause blood flow from the heart to all body tissues to not run smoothly. This can cause annoying symptoms, such as shortness of breath, turning blue, and swelling. In fact, it causes fatal complications, ranging from arrhythmias to congestive heart failure.

Therefore, if the doctor will immediately evaluate the health of the child and decide how to treat the right child's congenital heart as soon as possible.

Congenital heart disease (CHD) usually appears since the baby is still in the womb. That is why, pregnant women are advised to detect congenital heart disease early in order to determine the possibility of this condition in babies.

"So when you are born, you can immediately treat congenital heart disease. This also allows the baby's growth and development to be healthier in the future, "said dr. Winda Azwani, Sp.A (K) when met by the Hello Sehat team.

How to treat congenital heart disease in children

There are various ways to treat heart defects in children. However, the treatment will be adjusted to the type of congenital heart disease the child has as well as its severity. That is why, dr. Winda and several pediatric cardiologists at RSAB Harapan Kita stated that not all cases of congenital heart defects will be treated with surgery.

For more details, let's discuss one by one the ways to treat congenital diseases that are usually recommended by doctors below.

1. Take medicine

Reporting from the National Heart, Lung, and Blood Institute websites, atrial septal defect is one type of simple congenital heart defect. This condition often does not require repair surgery because the hole that forms in the upper chamber will close by itself over time.

Likewise with the condition of the patent ductus arteriosus, which is a condition where the arteries of the heart don't close after the baby is born. The small opening can also close on its own so it is a simple heart defect that may not require surgery.

In these and other simple heart defects, the doctor may only recommend medication treatment.

Children with a patent ductus arterious may be prescribed medications such as paracetamol, indomethacin, or ibuprofen. This medication can help close the openings in the arteries more quickly.

In addition to the drugs above, the patient may also be prescribed drugs for other congenital heart diseases, such as:

Angiotensin-converting enzyme (ACE) inhibitors, which are drugs to relax blood vessels.
Angiotensin II receptor blockers (ARBs), which are drugs to treat high blood pressure and prevent heart failure.
Diuretic drugs to prevent body swelling, relieve stress on the heart, and normalize the heart rate.
Beta-blockers, which are drugs to help lower blood pressure.
Some medicines to treat arrhythmias.

Drug administration will be adjusted according to the child's age, considering that some drugs have the risk of causing side effects if given not according to the specified age.

2. Cardiac catheterization

Cardiac catheterization is known not only as a heart health test, but also as a way to treat simple congenital heart disease. For example, atrial septal defects and patent ductus arteriosus that do not improve on their own and heart valve abnormalities.

Before cardiac catheterization, the patient will be asked to perform diagnostic tests, including blood tests, heart imaging tests, and cardiac stress tests. The doctor will then inject anesthesia into the blood vessels to make the patient more relaxed and less painful during the medical procedure.

Generally, this cardiac catheterization can only be done in infants weighing at least 5.5 kilograms. This medical procedure is a non-surgical way of treating congenital heart disease. This means that the doctor does not need to make an incision wound in the chest.

This medical procedure is performed with the help of a catheter, which is a long, thin, flexible tube (resembling an IV) that is inserted into a blood vessel around the arm, upper thigh, groin, or neck.

The doctor will look at a special monitor that shows the location of the catheter as well as determine other treatments that need to be done to treat congenital heart defects.

After the treatment is done, the doctor may require the patient to spend the night in the hospital. The goal is to monitor blood pressure, as well as prevent possible complications, such as bleeding and blood clots that are at high risk of causing stroke.

3. Heart surgery

If the baby or child has a dangerous risk, heart surgery will be chosen as a way to treat congenital heart defects. This procedure can actually be done when the baby turns 2 weeks of age.

In heart surgery, a surgeon will make an incision wound in the chest with the following objectives:

Repairing holes in the upper and lower chambers of the heart.
Treating openings in the main arteries of the heart.
Repair complex defects, such as inappropriate location of the heart blood vessels.
Repair or replace heart valves.
Widen the arteries of the heart that are abnormally narrowed.

Types of surgery for congenital heart disease

There are several types of surgery to treat congenital heart defects. The doctor will help consider which type of surgery is suitable for the patient's condition. The types of surgery include:

Palliative surgery

In babies who have only one ventricle that is weak or too small, it is necessary to undergo palliative surgery. The goal is to increase oxygen levels in the blood.

Preparation for surgery for congenital heart disease in children is no different from other heart surgeries, which requires anesthetic injection. Then, the surgeon makes an incision and inserts a shunt, which is a tube that creates an additional pathway for blood to get to the lungs and get oxygen.

The heart shunt will be retrieved by the surgeon when the congenital heart defect has been completely repaired.

Operation with ventricular assist devices

The next way to treat congenital heart disease is surgery with a ventricular assist device (VAD). This tool works to help normal heart function and is used until a heart transplant procedure is performed.

Preparation for surgery for congenital heart disease in this child begins with anesthetic injection. Afterward, the surgeon will make an incision in the chest, connecting the heart arteries and veins to a heart-lung bypass machine.

Then, a pump will be placed over the abdominal wall and connected to the heart with a tube. The other tube will be connected to a tube connected to the main artery of the heart and the VAD device will also be connected to an external control unit.

Furthermore, the bypass machine will be turned off and the VAD can work to take over the function of the heart in pumping blood. The complications that may occur from this procedure are bleeding and blood clots.

Heart transplant

Babies and children who have to undergo this treatment have complex congenital heart defects. This medical procedure is also intended for those who are dependent on a ventilator or show symptoms of severe heart failure.

Likewise, adults who have undergone simple heart defect treatment are likely to undergo this procedure at a later date.

The way to treat congenital heart disease is to replace the damaged heart with a new heart from a donor. However, before heart transplant surgery is performed, doctors will observe the compatibility of the donor's heart with the patient.

Preparation for surgery for congenital heart disease in this child, begins with the injection of a local anesthetic in a blood killer. A breathing tube will also be attached and connected to a ventilator to help the patient breathe.

Next, the surgeon will make an incision wound in the chest, connecting the heart arteries and veins to the heart bypass machine. These arteries and veins with a bypass machine will be reconnected to the donor's healthy heart.

The transplant operation is complete, the surgical wound will be sutured back and the patient will need to be hospitalized for 3 weeks for recovery and undergoing a cardiac rehabilitation program.

The success rate of treating congenital heart disease is about 85% in the first year after surgery. In the following years, the survival rate will decrease by about 4-5% per year.

However, heart transplant surgery also has risks, namely graft heart dysfunction that can cause death in the first month after surgery.

Follow-up treatment for congenital heart disease

"After undergoing treatment for congenital heart disease, the child's health condition will of course be much better than before. Especially babies and children who get CHD treatment at the right time or as early as possible, "said dr. Winda.

He also added that treating congenital heart disease in children as quickly as possible will help him develop properly and normally during childhood. Even so, children still need long-term care until they are adults.

Children who have received treatment for congenital heart disease, both operative and non-operative CHD, must get adequate nutrition for wound recovery. This can be done by adopting a special diet for congenital heart defects.

"Don't forget, the nutritional intake that children get must be good, because there are scars on the surgery on their bodies. Well, in the wound healing process, adequate protein intake from his daily diet is needed, "said dr. Winda.

"In the process of wound healing, children need adequate intake from their daily food," he said. "So, try to make children get a good nutritional status. Milk intake every day should not be missed, especially if the treatment for congenital heart disease was carried out as a baby. "

Even though the child's treatment has been completed, dr. Winda suggested that the treatment of children with congenital heart disease should be regularly monitored to the doctor to stay healthy. Especially in the months after surgery, see a doctor at least once a month.

"If it has entered 6 months after surgery, child health control can be done every 6 months. Well, the schedule for children's health checks can also be done several times a year as a long-term treatment, ”concluded dr. Winda.