Pediatric Second Opinion: Knowing your child's disease better

Pediatric Second Opinion: Knowing your child's disease better: "Many times parents are unaware of the health condition of these child. Especially in country like India, a proper communication between pare..."

A hole in the heart.

Many times parents are unaware of the health condition of these child. Especially in country like India, a proper communication between parents and treating physician is lacking. This may be due to lack of time or lack of a proper rapport with the doctor. Too much of information or use of lots of technical terms can sometimes leaves parents confused. Parents need to get the right information, not only because its there right,  but because it helps them to get an idea about the severity, progress and the likely outcome of the disease.

In this blog, We are trying to deliver the right information in simple words,so that parents from all educational backgrounds can understand their child's condition.

Stating this  blog with a common heart condition diagnosed in children.

A hole in the heart: congenital heart disease.

Yesterday I saw my colleague nurse saddened and worried about her nephew. Apparently her nephew was diagnosed to have "a hole in the heart". She broke into tears while mentioning about the parents getting worried and quite concerned about their kid. What amazed me was, the parents knew nothing except that there was "a hole in the heart" of their child.

The heart, while developing inside a fetus, is made up of tiny tubes. These tubes are made up of muscle fibres, and after a series of events, finally develop into 4 chambers, 2 atria [pleural for atrium]and 2 ventricles. There is a hole in the heart in all of our hearts at some point of development. These holes are present in the partition between the two chambers of the heart[between two atria or ventricles]. Some of these holes disappear early in fetal life while others get closed soon after birth. If the hole continues to be there after birth, its called as a septal defect.

These defects allow shunting of blood between the chambers up to a variable extent, depending upon the size and pressures. A smaller defect doesn't allow much of a shunting but creates loud noise, which is heard on the chest as a "murmur". A large defect causes a lot of shunting and mixing of blood, thus can lead to increased pressure in the lungs.

Many of these defects are innocent, get detected on general check-ups and need no treatment except for wait-and-watch for spontaneous closure, which usually happens by 3-4 years of age.

If it fails to get closed or the size is moderate, child can be operated electively with almost 100% success rate.

In case the defect is large, child may suffer from repeated chest infections and fails to grow properly. These children need medical therapy to prevent the heart from failing. The medical management is usually a time-buyer, till the definitive surgery is planned. Most of the large defects are correctable after surgery, and these children can lead a normal healthy life after surgery.

There are few forms of septal defects associated with bluishness of lips and nails. These are complex heart diseases, called as cyanotic congenital heart diseases. In such diseases, the septal defects are actually helpful for the survival of the child as they allow mixing and keep some oxygen rich blood flowing to the vital organs like brain.

If you are the parent with a child diagnosed with a "hole in heart", don't get unduly alarmed or depressed. Find an opportunity to discuss with doctor the nature and the size of the defect. Discuss the treatment options medical and surgical. Its a good idea to discuss the tentative timing and expenses of the surgery so that you can plan your things accordingly. Doctor may not be able to give you exact percentage but always discuss the quality of life the child will have after a corrective surgery, especially if he/she has other ailments along with heart disease, for example a stroke or neurological impairment. Its very important to protect such children from common infections by observing hygienic measures. Ensuring adequate diet, iron supplements in the prescribed doses and additional vaccines to prevent infections are the minimum that you should do for your child.

Never lose hope if your child is detected to have a "hole in the heart", as most of them are curable.