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Recent Advances in the Diagnosis and Management of Congenital Heart Defects

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Genesis Foundation
Recent Advances in the Diagnosis and Management of Congenital Heart Defects

Ever since the first Blalock-Taussig (BT) Shunt surgery was performed in 1944 at John Hopkin’s Hospital, the field of Pediatric Cardiology has evolved and made rapid progress. Technology is playing an important role in both in the detection of Heart Disorders in Children and in Congenital Heart Defect Treatment. 


Many children with Congenital Heart Defects now live well past into their adulthood because of innovations in Child Heart Treatment. 


Advances in medical technology are proving to be a big boon for doctors in providing the best treatment for Heart Disorders in Children.

 

The recent advances in Diagnosis and Management of Congenital Heart Defects can be classified in three broad categories:

 

Diagnostic Modalities, Surgical Interventions and Catheter Based Interventions:

 

Diagnostic modalities:

 

A) 3 D printing of heart models: 3 D printers are being used to reconstruct the anatomy of complex congenital heart defects to decide between biventricular and univentricular pathway. 3 D printed heart models are being also used in certain Heart disorders in children like Double Outlet Right Ventricle (DORV) with inlet Ventricular Septal Defect (VSD) to assess routability. This is also being used in disorders like Transposition if the Great Arteries (TGA) with VSD and Pulmonary Valve Stenosis to assess whether to use the Nikaidoh procedure or Root translocation assessment


B) 3 D echo: 3 D echo is actively being used in Congenital heart defect treatment of valves, especially the Aortic Valve.  


C) Magnetic Resonance Imaging (MRI): The Role of MRI is becoming increasingly important in Children Heart Treatment. Some of the areas where Cardiac MRI is being used is 


- To assess Right ventricular function: cc TGA, post op TOF repair


- To assess myocardial ischemia/edema/ fibrosis as cause of myocardial dysfunction


- To assess spatial orientation of intracardiac shunts and their functional assessment/shunt fraction. It enables dynamic along with static assessment of shunt physiology.


- To assess circulation in failing Fontan patients.


D) Cardiac CT :


- To evaluate major vascular anatomical variation: arch anomalies, systemic venous drainage anomalies, TAPVC anatomy


- To assess coronary anomalies: CT plays crucial role in identifying anomalous origin/course of coronary arteries. Example Anomalous origin of Right coronary artery from LM or vice versa, Intramural course of coronary arteries.

Surgical Interventions (link to How is technology helping heart surgery in newborn babies? – Blog (genesis-foundation.net)

 

Evolution of technology has also been playing an important role in the improvement of surgical techniques for Congenital heart defect treatment and Children Heart Treatment.

 

Some of the recent advances are as follows:

 

a)  Late presenters of TGA with intact septum are being offered primary arterial switch operation instead of Senning or rapid two stage arterial switch. Initially arterial switch was offered safely in first 2 weeks of life. At present multiple studies have shown that primary arterial switch can safely be offered with help of ECMO support even upto 8 weeks and beyond.

b)  For children with Aortic Stenosis or Pulmonary Stenosis, the Aortic or Pulmonary Valves are being reconstructed with the child’s tissues by a procedure called the Ozaki Procedure. Due to thus method the overall cost of surgery is reduced and the recovery rate of the child is faster.

 

Cath Lab Interventions

 

Similarly, some of the advances in Cath Lab Based interventions are as follows:

 

a)  Ductal Stenting: PDA is being stented to keep it open in high patients with high risk in place of the conventional BT Shunt Surgery

b)  Hybrid Cath Lab procedures: This method is followed in children having multiple holes like multiple VSD (Apical and Muscular. For some of the VSD’s devices are put and simultaneously PA Band is also done.

 

Genesis Foundation (www.genesis-foundation.net) is a not-for-profit organization based out of India supports Congenital heart defect treatment. Currently partnering with 34 hospitals Pan India who offer best in class diagnosis for Heart disorders children along with Children Heart Treatment

 

References :

 

Kappanayil M, Koneti NR, Kannan RR, Kottayil BP, Kumar K. Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment. Ann Pediatr Cardiol. 2017 May-Aug;10(2):117-125

 

Bisoi AK, Ahmed T, Malankar DP, Chauhan S, Das S, Sharma P, Saxena A, Boopathy NS. Midterm outcome of primary arterial switch operation beyond six weeks of life in children with transposition of great arteries and intact ventricular septum. World J Pediatr Congenital Heart Surg. 2014

 

Yang HS. Three-dimensional echocardiography in adult congenital heart disease. Korean J Intern Med. 2017


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