CONGENITAL HEART DISEASES

The Desk of Chairperson
Dr P S Sreemathi
Panel of Pediatric Cardiologists and Cardiac Surgeons
Peadiatric Segment
E-mail: Sreemathi@careultimate.com
Why should we know about the heart? It becomes important only when we come across someone, who we know or is close to us, is a victim of heart disease. There is a pang in the heart which is more when it happens to be a child. Now we are beginning a series of articles written by the panel members of the Paediatric segment of careultimate.com. about heart disease and what you would like to know.

They will be in the form of questions you may already have. The answers are there for you to read. If you still have questions to ask, you may do so. You will be answered.

Dr. R. Suresh Kumar MD, DM, FSCAI

Senior Consultant and Head, Department of Pediatric Cardiology,

Institute of Cardio-Vascular Diseases, Madras Medical Mission

What if such children are affected by heart disease?
Poignancy leaves an indelible mark.

Shall we try to find about this scourge known as heart disease?

Even a baby can feel sorry for a girl who suffers from heart disease. What more the grownups !

What is the incidence and cause of Congenital Heart Disease in children?
CHD occurs at the rate of 8/1000 live births. The exact cause is not known in most of the cases. In a minority of cases the CHD is part of a chromosomal abnormality like Down’s syndrome or is part of a Mendelian disorder like Marfan’s syndrome. Advances in molecular genetics are unraveling new mutations underlying several inherited disorders including some congenital heart diseases as occurring in Neonan’s syndrome.

Can a diagnosis be made before birth?
Most of the major congenital heart diseases can be diagnosed by fetal echocardiography. This is best done at 16 – 20 weeks of pregnancy. By this time, the cardiac anatomy is clearly demonstrable and the gestation is early enough to consider termination, if required. Disorders like ASD & PDA are not diagnosed in the fetus as the relevant communications are part of the normal fetal circulatory pathway. Fetal echo is indicated when an obstetric anomaly scan is suspicious of heart disease or there is a high statistical probability of CHD as in mother with previous child having CHD.

How does the diagnosis of CHD affect pregnancy?
Fetal congenital heart disease raises questions regarding viability of gestation. Some complex anomalies like hypoplastic left heart syndrome and complex heterotaxies have high risk of fetal death and low chance of survival after birth. The parents might opt to terminate the pregnancy after an informed discussion with care providers. At the other extreme recognizing a minor abnormality like a small VSD or mild aortic stenosis is compatible with normal continuation of pregnancy. Between these two extremes falls the common category of correctable major CHDs like large VSD, TOF, coarctation of aorta, etc. In these cases, the parents are counseled to seek appropriate medical attention shortly after delivery.

Some conditions like complete transposition of great vessels require immediate attention after the delivery of the baby. In such cases delivery should be conducted in a hospital with tertiary pediatric cardiac care or at least close to such facility.

Who treats CHD?
Treatment of congenital heart disease involves teamwork. The main members of the team are pediatric cardiologist – who provides diagnosis, medical treatment and catheter intervention, when required, pediatric cardiac surgeon – who performs surgical treatment when required, pediatric cardiac anaesthesiologist – who puts the child to sleep for surgery or intervention and pediatric intensivist – who takes charge of the child in the pediatric ICU. Nurses, counsellors and physiotherapists are some of the other members of the team.

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Offering Istanbul as the venue for the upcoming talks with the G5+1,griffeys by the Iranian officials, might give this wrong impression to the West that Iran is in a weak position and Istanbul is Iran's only option, said Rezaei on Monday.

Hence, Baghdad,griffeys 2012 Damascus and Beirut are more suitable than Istanbul for holding talks (with the world powers), said Rezaei who is currently the secretary of Iran's Expediency Discernment Council which has mainly an advisory role to the Supreme Leader of the Islamic republic Ayatollah Ali Khamenei.

Last Thursday,griffeys sneakers Khamenei informed visiting Turkish Prime Minister Erdogan that he wanted Iran's nuclear negotiations to take place in Istanbul.

Last week,king griffeys Iran's Foreign Minister Ali-Akbar Salehi also said Tehran considers Istanbul as the best option to host the upcoming nuclear talks between Iran and the G5+1.

On Monday, media quoted Russian Deputy Foreign Minister Sergei Ryabkov as saying that time and venue for Iran-G5+1 has not been finalized despite earlier remarks of U.S.cheap ken griffey shoes secretary of state who said that the talks would take place on April 13 and 14 in Istanbul.

The reports said that time and place for the talks has been proposed by the G5+1 and Iran is yet to decide.griffey shoes 2012

The last round of nuclear talks between Iran and the G5+1 was held in Istanbul in January 2011 but ended up in vain.ken griffey shoes 2012 The round before that, in late 2010, was in Geneva.

Some European countries want the new round of talks in Geneva rather than Istanbul again.griffeys for sale But Iran and Turkey insist on the nuclear talks in Istanbul.

The Economic Community of West African States (ECOWAS) said on Monday that the bloc is applying diplomatic and financial sanctions previously announced on Mali's junta,nike heels effectively immediately, to press for the restoration of constitutional order in the west African nation.

Ivory Coast's President Alassane Ouattara said after a summit held in Dakar, capital of Senegal,nike high heels on Monday that the ECOWAS decided to impose sanctions on Mali's junta, including closing borders and freezing the country's access to the regional central bank.

All of the diplomatic, economic,jordan heels financial and other applicable measures would be in place starting Sunday and would remain in place until the constitutional order is restored, Ouattara said.

The ECOWAS said last week to impose severe sanctions on the junta,nike heels for women which overthrew President Amadou Toumani Toure in a coup, unless it surrendered power within 72 hours. The decision will come into effect despite the junta on Sunday announced to restore the country's constitution of Feb. 25 of 1992 to pave the way for a transition leading to the presidential election.

Leaders of the ECOWAS member countries also decided to deploy military force in northern Mali to stop rebellion raging there, according to Ouattara.nike dunk heels

They would meet for this purpose in Abidjan this week to define how to activate the force,nike dunk sb heels he said.

We are committed to the territorial integrity of Mali. This is why we decided the immediate establishment of the force of ECOWAS to standby,air jordan heels he said, adding the organization would deploy all necessary means to stop this rebellion.

The Malian government was toppled on March 22 by disgruntled soldiers who accused the government of failing to provide means for the military to curb Tuareg rebels in the north who so far,jordan high heels taking the advantage of the chaos, seized three key strategic towns of Kidal, Gao and Timbuktu, respectively on Friday, Saturday and Sunday.

The junta said late Monday that it has noticed the sanctions and reiterated its commitment on a suitable transition of power.air jordan high heels

The head of the junta Amadou Sanogo said in a communique that he thanked ECOWAS for its interest in the difficult situation facing the country,jordan heels for women adding the priority for the country is the urgency of recovery of the country's territorial integrity to the crisis in the north.

Sanogo reaffirmed its commitment to move quickly and in the coming hours to the establishment of a nike jordan high heels national agreement with all the forces of the country to spearhead the establishment of structures of a suitable transition to all parties.

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