children s health issues
Overview of Heart Defects
Treatment of Heart Defects
Open-heart surgery Cardiac catheterization procedures Medications Extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs) Rarely a heart transplant Heart failure or cyanosis that occurs in the first week of life is a medical emergency. Doctors often insert a thin tube (a catheter) in the newborn's vein within the umbilical cord to make giving medications easier and faster. Medications, are given by vein to reduce the workload of the heart and to improve the amount of oxygen that can be delivered to the body. In newborns, prostaglandins can be life saving in certain critical heart defects that require the ductus arteriosus to stay open. Newborns may also need a ventilator to help them breathe. When certain defects are present, newborns are sometimes also given oxygen. Many serious heart defects can be effectively repaired with open-heart surgery. The timing of the operation depends on the specific defect, its symptoms, and the severity. However, infants with severe symptoms resulting from a heart defect should have surgery during the first days or weeks of life. The repair of some complicated heart defects may be too difficult in the first few weeks and a non-open-heart procedure may need to be done to stabilize the infant's condition and delay the need for a more corrective operation. An example of this type of operation would be creation of a shunt between the aorta and the pulmonary artery. Cardiac catheterization is a procedure in which a thin tube (catheter) is inserted into a vein or artery in the groin and advanced to the heart for diagnosis or treatment. Other approaches to the heart are sometimes used, including the umbilical (belly button) vein or artery in the newborn. Narrowed structures can sometimes be widened by passing a catheter into the narrowed area of the heart. A balloon attached to the catheter is inflated and widens the narrowing, usually in a valve (a procedure called balloon valvuloplasty) or blood vessel (balloon angioplasty). These balloon procedures may be done instead of open-heart surgery or may delay the need for open-heart surgery. In some newborns, such as those with Transposition of the Great Arteries , a procedure called balloon atrial septostomy can be done during a cardiac catheterization. In this situation, a balloon is used to enlarge the foramen ovale (hole between the upper chambers of the heart) to help improve oxygen flow to the body. This procedure is usually done to stabilize the baby before open-heart surgery. Cardiac catheterization can also be used to close a Patent Ductus Arteriosus or certain holes in the heart (many In a newborn, when blood flow to the body or to the lungs is severely blocked, a type of medication called a prostaglandin can be given to keep the ductus arteriosus open, which can be life-saving. Other medications that are commonly used in children with a heart defect include A diuretic, such asfurosemide, which helps to remove excess fluid from the body and lungs Angiotensin-converting enzyme (ACE) inhibitors, such ascaptopril,enalapril, orlisinopril(which relax blood vessels and help the heart to pump more easily) Digoxin, which helps the heart to pump a bit more forcefully Milrinone, a powerful drug given by vein (intravenously) to stimulate the heart to beat more strongly and relax tight blood vessels Mechanical devices may be used to support the heart in children who have severe heart failure and do not respond to medication. These devices have a pump that helps to send enough blood to the lungs and to the body when the heart is unable to pump effectively. They can be used for days, weeks, or even months to allow a child's heart to recover from a viral infection or major open-heart surgery or to help stabilize the child until a heart transplant can be done. In extracorporeal membrane oxygenation (ECMO), blood from the child is circulated through a machine that adds oxygen and removes carbon dioxide and then pumps that blood to the child's body. Some devices, called ventricular assist devices (VADs) can be inserted into the body. A VAD pumps blood from the heart to the body. This device allows for longer support of the circulation than ECMO. In rare cases, when no other treatment helps, Heart Transplantation is done. However, the lack of donor hearts limits the availability of this procedure. Children with a weak heart muscle or residual valve problems after surgery require long-term treatment with medications and changes to their diet (such as salt restriction and use of a high-calorie formula in a relatively small amount of liquid). These treatments decrease the workload of the heart. Some children who have significant heart defects or have had surgeries to repair their heart defects need to take antibiotics before visits to the dentist and before certain surgeries (such as on the respiratory tract). These antibiotics are used to prevent a serious heart infection called Infective Endocarditis . However, most children with heart defects, whether or not they had surgery, do not require these antibiotics. However, all children with heart defects, should take good care of their teeth and gums to decrease the risk of infection spreading to their heart. 