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There are two types of heart disease in children - Congenital and Acquired. Congenital heart disease (als known as a Congenital Heart Defect) is present at birth. Some of the defects in this category are patent ductus arteriosus, (PDA) Atrial Septal defects, (ASD) and Ventricular Septal Defects (VSD). These defects  (ASD and PDA) have been found to be more common amongst females. Earlier these defects needed  complicated surgical procedures, but not anymore. Advancements in medical technology have ensured a smoother, non-surgical, minimally invasive procedure of closing these heart defects through a very small  incision in the groin, performed under x-ray guidance in the cardiac catheterization laboratory instead of the operation theatre. This non-surgical method has success rates (almost 95 per cent) comparable to surgery, albeit without the trauma and risks associated with open-heart surgery.

Benefits to patient include:

1) Less time spent in the hospital,

2) Quicker recovery time,

3) Reduced post-procedure pain and

4) Avoiding a scar on the chest.

 Research for these methods had started in the ’70s and was attempted sporadically in the ’80s but it’s only in the last five years that they have almost been perfected.

Let’s take a look at what these heart defects in children are and how they are rectified. ATRIAL SEPTAL DEFECT (ASD)

Atrial septal defect (ASD) is when there is a communication or hole between the left and right atrium (the right and left side of the upper chambers of the heart), which causes an increase in blood flow in the right side of the heart and to the lungs. Because it is receiving so much extra blood, the right side of the heart does more than its normal share of work. The heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries, supplying blood to lung, can increase (pulmonary hypertension) due to the increase in blood flow. If the defect closes on its own or with the aid of surgery, these consequences can be avoided.

Thus, the patient may feel tired, have difficulty breathing, and fail to grow normally, or be sick more often with respiratory infections such as colds or pneumonia. Larger ASDs can lead to heart failure and death. The unusual part about ASDs is that the symptoms rarely appear in newborns and infants and they are typically discovered at preschool routine examination when the doctor hears a "murmur" and investigates it. Sometimes ASDs go undetected and manifest themselves only when the patient is in his 20s or even 30s. To close this hole, the interventional cardiologist will insert a tube that carries the closing device through a blood vessel in the groin. The closing device could be an umbrella or a patch.

Once the tube passes through the hole and gets to the other side, the closing device is lodged on the hole and once it’s certain that the hole has been covered correctly, the tube is withdrawn. A Transesophageal Echocardiography (TEE) monitors the entire procedure. The colour visuals allow the cardiologist to be sure that the entire procedure has been done correctly, before letting the umbrella stay put on the hole. With most of the presently used umbrella devices, half of the device is connected to one side of the atrial septum, and the second half of the device attached to the other portion, forming a sort of "sandwich" of the defect. The device is held in place by the natural pressures generated within the atria.

Defects amenable to such device therapy tend to be smaller (less than 20 to 25 mm [3/4 to 1 inch] diameter). Importantly, these lesions must be centrally located within the atrial septum. Defects at the very upper or lower edges of the atrial septum (called ostium primum or sinus venosus) are not good candidates for this procedure, because these defects usually involve other abnormalities of the heart valves, or venous drainage from the lungs. The patient’s primary cardiologist can make this determination. 

 VENTRICULAR SPETAL DEFECTS (VSD)

The other defect is the Ventricular Septal Defect (VSD). In a case of VSD, there is a defect (hole) in the wall (septum) between the two lower chambers (ventricles) of the heart. VSDs are the most common type of heart defect. As in the case of the ASD, the heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries can increase (pulmonary hypertension) due to an increase in blood flow. Like ASDs, the size and therefore, the clinical course of these defects is quite variable. Some remain large, while others become smaller over time. It is not unusual for small-to-medium sized VSDs to eventually close spontaneously. Many, but not all that remain will require closure by the surgeon.

The VSD can cause symptoms such as growth failure, fatigue, difficult or rapid breathing or chronic respiratory infections. These kinds of defects are more difficult to close than the ASDs, especially if the holes are closer to the valves. If they are away from the valves, the same method by which the ASDs are treated can be applied. Our body’s regenerative system is so strong that within six weeks or so of the operation, tissue will grow over the device that covers the hole and that device functions in harmony with the body.

PATENT DUCTUS ARTERIOSUS (PDA)

 Patent Ductus Arteriosus (PDA) is a heart defect that occurs when a blood vessel called the ductus arteriosus, which is normal while the baby is in the womb, fails to close after the baby is born. The ductus arteriosus should close permanently in most cases within 24 hours. This condition can cause symptoms such as fatigue, difficult or rapid breathing, or chronic respiratory infections. A patient with a PDA can also be asymptomatic (without symptoms). Large openings can lead to heart failure and death. Cardiologists close these defects with devices that look like springs or coils or even plugs. The larger holes can only be covered with the plugs, which are more expensive albeit more reliable. For all these procedures to be successful, the sizing of the hole has to be accurate. Generally, an inflated rubber balloon is passed through the hole and then pulled through. This allows the cardiologist to note the ‘stretched diameter’ of the hole