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Fetal Heart Diseases

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Introduction

Congenital Heart Defects (CHDs) or Fetal Heart Diseases are the most common type of birth defects. A  fetal congenital heart disease essentially involves a heart abnormality, which could be a structural defect, an issue with the fetal heartbeat, or a functional defect with the heart’s squeeze or filling. A baby’s heart starts to form and develop at conception, and it takes a complete form by 8 weeks. CHDs can develop during this critical first 8 weeks of development.

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What are Fetal Heart Diseases?

There are many types of congenital heart defects with different degrees of severity based on size, location, and other associated defects. In the more severe forms of CHDs, blood vessels or heart chambers may not be present, poorly formed, or located in the wrong place. Some of the most common occurring CHDs include:

  • ● Aortic stenosis
  • ● Atrial septal defect (ASD)
  • ● Atrioventricular septal defect
  • ● Pulmonary stenosis
  • ● Ventricular septal defect

 

Critical CHDs cases include:

  • ● Coarctation of the aorta (COA)
  • ● Dextro-transposition of the great arteries (d-TGA)
  • ● Pulmonary atresia (PA)
  • ● Tetralogy of fallot (TOF)

What are the Causes of Fetal Heart Diseases?

Higher occurrence of Fetal Heart Diseases is seen in closely related parents. The exact sequence of factors underlying fetal heart diseases development is poorly understood.

Some of the suspected causes of fetal heart diseases include:

  • Adverse drug reactions in medicating pregnant mothers: Some of the examples of medicines that may increase a baby’s risk of having a CHD include:
  1. ACE inhibitors
  2. Isotretinoin
  3. Statins
  • The mother’s diet and health conditions: The latter may include,
  1. Obesity
  2. Maternal phenylketonuria
  3. Preexisting diabetes
  4. Rubella and other infections
  • Combination of genes and other factors
  • Lifestyle and environment: These factors include diet, alcohol consumption, smoking, etc.
  • Maternal age: Babies of older women are more likely to have a birth defect.
  • Other birth defects: A baby affected by certain birth defects, such as Down syndrome, is more likely to have a malfunction of the heart.

What are the Symptoms of Fetal Heart Diseases?

Symptoms of a Fetal Heart Diseases in infants and children include:

  • ● Shortness of breath
  • ● Lung infection
  • ● A bluish tint to the skin, fingernails, and lips
  • ● Cyanosis, which is a condition caused by a lack of oxygenated blood supply
  • ● Poor weight gain
  • ● Difficulty in feeding, which may occur because of trouble in breathing

How is Fetal Heart Diseases Diagnosed?

Diagnosis of a Fetal Heart Diseases involves a physical examination followed by confirmatory tests and procedures, including:

  • Electrocardiogram: A type of ultrasound that takes pictures of the heart.
  • Cardiac catheterization: A very thin, flexible tube called a catheter is inserted through a blood vessel in the arm to reach the heart. The catheter contains a dye to visualise the heart under x-ray.
  • Chest x-ray: This can reveal signs of heart failure in infants and children.
  • MRI: Magnetic Resonance Imaging can help to visualise the heart’s structure.

How is Fetal Heart Diseases Treated?

The treatment option for CHDs is decided based on the type and severity of the defect. In some cases, the affected infants and older children might have to undergo one or multiple surgeries. These are done to repair the heart or blood vessels. Some children can be treated with a procedure termed as cardiac catheterisation. Medical management of CHDs involves using muscle relaxants, antiarrhythmics, antiplatelets, beta-blockers, diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and anticoagulants.

Non-surgical treatment

  • ● Antiarrhythmic medications can control the electrical activity of the heart, helping it to beat regularly in people with arrhythmias or irregular heartbeats. Examples of such medicines include amiodarone and flecainide.
  • ● Statins are used to treat high cholesterol. Examples include atorvastatin and fluvastatin.
  • ● Anticoagulants are medications that prevent blood from clotting, reducing the chance of a stroke or a blood clot in the lung arteries.
  • ● Beta-blockers are a type of medicine used to treat high blood pressure. They include atenolol and bisoprolol.
  • ● Aspirin is a blood-thinner drug often recommended for CHD patients to prevent obstruction of the coronary arteries.
  • ● Ranolazine is a medicine that may help patients with chest pain or angina. It may be prescribed in combination with beta-blockers for temporarily dilating coronary arteries and for reducing the heart’s demand for blood.
  • ● Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blocker (ARBs) are drugs that similarly decrease blood pressure. They may also help prevent the progression of coronary artery diseases.

Invasive and surgical treatment

Depending on the severity and location of the defect, various invasive surgical procedures are done for treating premature babies with congenital heart diseases. Certain health parameters, such as the baby’s weight, health, size, are considered before proceeding with surgical operations. The surgical procedure may often involve putting the baby in ECMO (extracorporeal membrane oxygenation), a device that takes over the function of the heart and lungs outside the body. Types of surgical procedures include palliative surgery, cardiac catheterisation, balloon angioplasty, arterial switch procedure, blalock-Taussig (BT) shunt, and Norwood procedure.

  • Palliative surgery: Procedure where complete heart repair is not possible, and blood is shunted. An implanted tube carries out the heart’s function.
  • Balloon angioplasty: Thin tubes called catheters are inserted into the narrow blood vessel; once the balloon catheter reaches the right place, it is blown up to open up the narrowed area.

What are the Results and Risks Associated with Fetal Heart Disease treatments?

Result

A Fetal Heart Disease, in most cases, remains a chronic illness and requires lifestyle changes, medications, and regular monitoring of cardiac activities. Advancement in stem cell therapy, surgical robotics, personalise gene therapy, and other advancements in modern medical and treatment methods promise successful treatment of cardiovascular diseases in the near future.

Risks Associated with Fetal Heart

The surgeries carry certain risks, including:

  • Ischemic heart damage: Damage to heart tissue caused by a lack of blood flow to the heart.
  • Bleeding: May occur at the incision site or from the area of the heart where surgery is performed.
  • Death: The risk of death is increased in surgeries where the heart is stopped for the procedure.
  • Emergency surgery: If a problem is discovered during the initial surgery, an emergency surgery may be necessary to repair the affected area(s).

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FAQ's

What are the Causes of Fetal Heart Diseases During Fetal Development?

Blockage or improper blood supply to the heart and underdevelopment of heart and arteries during the development of the fetus are the major reasons for Fetal Heart Diseases in infants.

What are the Symptoms of Fetal Heart Disease in Infants?

Difficulty in breathing, poor weight gain, and difficulty in feeding the infants are some symptoms of these diseases in infants.

Mention Some Common Heart Defects.

Ventricular septal defect, transposition of the great vessels, hypoplastic left heart syndrome, and tetralogy of fallot are some of the common defects presenting in the heart.

How is a Fetal heart Disease Diagnosed?

Fetal Heart Diseases are diagnosed by using x-ray, MRI, electrocardiogram, chest x-ray, and pulse oximeter.

What is the Life Expectancy of a Child with a Fetal Heart Disease?

About 75% of babies born with a critical CHD are expected to survive to one year of age. About 69% of babies born with a severe CHD are expected to survive to 18 years.

What are Some of the Medications Used to Treat Fetal Heart Diseases?

Sotalol, flecainide, and propafenone can be considered if heart rhythm-control is needed. Beta-blockers are frequently used for treating several cardiovascular conditions during pregnancy.

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