Congenital heart disease (CHD) represents a pervasive health challenge that transcends borders, affecting approximately eight out of every 1,000 babies born globally. In the Indian context, these statistics translate into a staggering reality: every year, between 2.5 to 3 lakh children are born with a heart defect. The stakes are incredibly high, as it is estimated that nearly half of these infants will not survive past their first birthday if they fail to receive timely medical intervention. Consequently, CHD stands as a leading cause of infant mortality, a tragedy that medical professionals argue is largely addressable through modern healthcare infrastructures.
The landscape of treating these young hearts has undergone a radical transformation over the last three decades. Historically, paediatric cardiac surgeons spent much of their time correcting simpler defects. However, the field has evolved into a highly collaborative, team-oriented discipline, likened to a cricket team where surgeons and cardiologists play distinct yet complementary roles—one cannot function effectively without the other .
A significant development has been the rise of paediatric interventional cardiologists. Today, many "simple" conditions—such as atrial septal defects (ASD), patent ductus arteriosus (PDA), and some ventricular septal defects (VSD)—are treated without a single surgical incision. Instead, these defects are often closed using devices inserted through the groin, a procedure that has effectively removed these cases from the surgeon's operating table.
This shift has redefined the role of the paediatric cardiac surgeon, who now focuses almost exclusively on highly complex and critical conditions. Surgeons are routinely operating on neonates—babies just days old—who suffer from life-threatening anomalies like the transposition of great arteries or total anomalous pulmonary venous connection. The patients are smaller and more fragile than ever before, with successful surgeries performed on infants weighing as little as 1.2 to 1.6 kilograms.
Despite these advancements, misconceptions among parents and even some general practitioners continue to hinder effective treatment. One of the most persistent and dangerous myths is the belief that surgery should be delayed until a child reaches a certain weight, typically 10 kilograms, or a specific age. Dr Solomon clarifies that this is a "hangover" from an era over 30 years ago when surgical mortality for infants was significantly higher.
In the modern era, waiting is often not an option. Delaying surgery for a large VSD, for instance, can lead to the child developing pulmonary hypertension or succumbing to a sudden respiratory infection. The current standard of care dictates that if a child is symptomatic—struggling to breathe or feed—surgery must be performed regardless of weight, often as early as two to three months of age.
Other common myths include the hope that all heart holes will close on their own. While this is true for some defects, approximately 20-30% of VSDs will not close spontaneously and require surgical intervention to save the child's life. Furthermore, the assumption that an active, playing child is automatically "heart-healthy" can be misleading. Children may appear fine externally while a silent defect slowly damages their heart valves or lungs, leading to irreversible complications later in life.
The medical community is pushing for detection mechanisms that begin well before birth. Fetal echocardiograms at 20 weeks of gestation can now identify cardiac ailments, allowing parents to be counselled about the road ahead. In some cases, this early warning system allows for immediate intervention; babies can be delivered and rushed to surgery within hours of birth to correct complex defects.
For newborns, the signs can be subtle but telling. Neonatologists and paediatricians are trained to watch for rapid breathing, failure to gain weight, and low oxygen saturation levels. Parents are advised to be vigilant for symptoms such as excessive sweating, a "start-stop" pattern during breastfeeding due to breathlessness, or the baby turning blue. Listening for heart murmurs with a stethoscope remains a primary method of initial detection in clinics across both cities and smaller towns.
While congenital defects are present at birth, acquired heart diseases pose a different set of challenges. Historically, Rheumatic Heart Disease—caused by untreated streptococcal sore throats damaging heart valves—was prevalent. While incidence rates have dropped due to better primary care and antibiotic usage, it remains a concern.
A newer, rising concern is lifestyle-related cardiac stress in children. The shift towards sedentary habits, increased screen time, and consumption of unhealthy foods is leading to a rise in childhood obesity. This trend carries the risk of early-onset hypertension and diabetes, which can compound heart health issues down the line.
To handle the increasing complexity of cases, surgeons are embracing cutting-edge technology. For children requiring re-operations—where scar tissue makes the anatomy difficult to navigate—surgeons now use CT scans and 3D reconstructions to "see" inside the heart before making an incision. This virtual reality approach allows the surgical team to plan their approach meticulously, avoiding vital structures and significantly reducing mortality risks during second or third surgeries.
Minimally invasive techniques are also being adapted for children. Where appropriate, surgeons use side incisions or smaller cuts to perform repairs, prioritizing cosmetic outcomes without compromising safety.
Perhaps the most encouraging aspect of modern paediatric cardiac surgery is the long-term prognosis. The goal of surgery is not just survival, but a normal quality of life. Children who undergo successful repairs for conditions like VSDs or arterial switches can grow up to be anything they aspire to be—from astronauts to professional athletes.
While the majority of children are cured for life after a single procedure, a subset with very complex anatomies may require lifelong monitoring or subsequent interventions. To support these patients as they age, hospitals are establishing Adult Congenital Heart Clinics, ensuring that the care continuum remains unbroken as these "heart children" become adults.
Behind every successful surgery is a massive, often unseen, ecosystem. Paediatric cardiac surgery is described as a "priesthood," requiring immense dedication, long hours, and a willingness to sacrifice personal time. It is not a field driven by profit; in fact, many corporate hospitals hesitate to run such programs due to their low financial returns.
Successful units rely on a dedicated team of specialized nurses, intensivists, and technicians who manage the patient's delicate physiology post-surgery. The financial burden is also significant, with surgeries costing between three to ten lakhs. However, a combination of government schemes, corporate social responsibility, and aggressive crowdfunding efforts ensures that financial constraints rarely stand in the way of saving a child's life.
Ultimately, the field is defined by a blend of high-tech precision and deep human compassion, ensuring that thousands of children born with defective hearts are given the opportunity to live full, healthy lives.
Dr. Neville Solomon
Paediatric Cardiac Surgeon
Apollo Hospitals, Chennai