Congenital Heart Disease
Congenital Heart Disease
Congenital heart disease (CHD) can be benign and not require any treatment or life threatening requiring immediate life shaving action.
The worrisome group of heart diseases are the ‘duct’ (PDA) dependent CHD lesions most often presenting in the neonatal period. These conditions are often asymptomatic in the early stages but may be detected by routine post-natal oxygen concentration assessment at birth or Day 1. The other assessment includes presence of a soft murmur (abnormal sound from the heart), poor pulses (especially lower limbs), fast breathing (tachypnoea), fast heart rate (tachycardia) or a very active chest wall movement.
Duct dependent lesions are divided into Right heart lesions such as Transposition of the Great Arteries, Tetralogy of Fallot, Pulmonary Atresia/Stenosis and Left heart lesions such as Hypoplastic Left Heart Syndrome, Coarctation of the Aorta, Critical Aortic Stenosis/Interrupted Aortic Arch.
Right heart lesions present with cyanosis (blue discolouration of body / lips) and left heart lesions with heart failure.
Investigations
- Chest Xray (to rule out respiratory disease or specific heart disease)
- ECG
- Cardiac echo is diagnostic.
Management
- Admission to NICU
- Vital signs and pre and post ductal SaO2.
- Supplemental O2, CPAP or ventilation as needed
- Central lines depending on severity.
- IV fluid / TPN administration
- Antibiotics as needed
- Prostaglandin E1 (PG) infusion to maintain ductal in open position
- Surgical / medical management as per cardiologist