The heart plays a vital role in delivering oxygen-rich blood throughout the body, supporting growth, development and everyday activities. However, some children are born with structural abnormalities of the heart or develop heart conditions that may require specialised treatment, including surgery.
Paediatric cardiac surgery is a specialised field that focuses on the surgical treatment of heart conditions in newborns, infants, children and adolescents. These conditions range from relatively common defects, such as a hole in the heart, to complex birth defects and diseases that affect the heart's chambers, valves or major blood vessels.
Not every child with a heart defect requires surgery. Some resolve on their own with medical care and with age. However, some complex conditions may require surgery, which can involve the valves, heart chambers, blood vessels, and more.
Treatment particularly depends on the type of condition, its severity, the child's symptoms and its effect on heart function.
In this blog, let us understand the common paediatric heart conditions, their warning signs, diagnosis and the need for surgery.
What Is Heart Surgery in Children?
Paediatric heart surgery involves surgical procedures used to treat structural abnormalities and other heart conditions in children. Many of these conditions are congenital, meaning they are present at birth, although some heart problems can develop later.
Depending on the diagnosis, treatment may involve repairing a defect, reconstructing a heart valve, widening a narrowed blood vessel or correcting the connections between the heart and major arteries.
Some heart defects can be treated through catheter-based procedures, which use thin tubes inserted through blood vessels rather than conventional open-heart surgery. Others require open-heart surgery or more complex surgical techniques.
A paediatric cardiologist evaluates the child's heart condition and coordinates care with a paediatric cardiac surgeon when surgery may be necessary.
Causes of Heart Defects in Children
Many congenital heart defects develop during the first eight weeks of pregnancy, when the baby's heart is forming. It can be detected with high-end fetal scans. However, sometimes these defects may occur due to an unidentifiable cause.
The exact cause of a heart defect is often unknown, but several factors may increase the risk. These include:
- Genetic factors
- Family history
- Maternal health conditions
- Infections during pregnancy
- Medications and harmful substances
- Environmental factors
- Chromosomal abnormalities
Symptoms of Heart Diseases in Children
Symptoms of heart diseases in children may vary depending on the age of the child and the type and severity of the heart condition. Some congenital heart defects may not cause noticeable symptoms in the early stages. However, if you notice any signs, seek medical attention from an experienced child heart specialist near you.
These symptoms do not necessarily indicate a heart defect, but they might warrant appropriate assessment. Sudden severe breathing difficulty, blue or grey lips, collapse or loss of consciousness requires emergency medical attention.
Some of the common symptoms may include:
- Difficulty breathing or rapid breathing
- Bluish discolouration of the lips, tongue or nails
- Excessive sweating, especially during feeding
- Poor feeding or tiring easily while feeding
- Poor weight gain or delayed growth
- Frequent respiratory infections
- Persistent fatigue or weakness
- Rapid or irregular heartbeat
- Chest pain or discomfort
- Dizziness or fainting
- Swelling in the legs, abdomen or around the eyes
Understanding the Structure of a Child’s Heart
A child’s heart is a muscular organ that works like a pump, which continuously pumps blood throughout the body, supplying oxygen and nutrients that help the child grow, play and stay healthy.
The heart has four chambers:
- Right atrium: Receives blood that is low in oxygen from the body.
- Right ventricle: Pumps this blood to the lungs, where it picks up oxygen.
- Left atrium: Receives oxygen-rich blood from the lungs.
- Left ventricle: Pumps oxygen-rich blood to the rest of the body.
The heart also has four valves that work like small doors. They open and close to ensure that blood flows in the right direction without flowing backwards.
Septum: A wall that separates the right and left sides of the heart, preventing oxygen-poor blood from mixing with oxygen-rich blood.
7 Common Heart Conditions That May Require Surgery in Children
1. Atrial Septal Defect (ASD)
An atrial septal defect is a congenital heart defect in which an opening (hole) is present in the wall separating the heart's two upper chambers, known as the atria.
This opening allows oxygen-rich and oxygen-poor blood to flow between the chambers and mix. Small ASDs may cause no symptoms and can sometimes close naturally during childhood. Larger defects may cause excessive blood flow to the lungs and place additional strain on the right side of the heart.
Some children have no noticeable symptoms, and the defect may be discovered during a routine examination.
Treatment depends on the size of the opening, the amount of blood flowing through it and its effect on the heart. Small defects may only require monitoring. Suitable ASDs can often be closed using a catheter-based device, while some defects require surgical repair.
2. Ventricular Septal Defect (VSD)
A ventricular septal defect is an opening (hole) in the wall separating the heart's two lower chambers, called the ventricles. It is one of the most common congenital heart defects.
The size and location of a VSD determine how it affects the heart. Small defects may close naturally or remain harmless without requiring intervention. Larger defects can allow excessive blood flow to the lungs, making the heart work harder.
A heart murmur may also be detected during a clinical examination.
Paediatric cardiologists may recommend regular monitoring for small VSDs. Larger defects that cause heart failure symptoms, poor growth, excessive pulmonary blood flow or other complications may require surgical closure. Some suitable defects can be treated using catheter-based techniques.
3. Patent Ductus Arteriosus (PDA)
The ductus arteriosus is a blood vessel that connects the pulmonary artery (a blood vessel that carries oxygen-poor blood from the right side of the heart to the lungs ) and the aorta (the largest blood vessel that carries oxygen-rich blood from the left side of the heart to the rest of the body)before birth. It normally closes shortly after birth. When it remains open, the condition is called patent ductus arteriosus.
A small PDA may not cause significant problems. However, a larger opening can allow excess blood to flow towards the lungs, potentially placing additional strain on the heart.
PDA is particularly common in premature infants.
Symptoms of a significant PDA may include rapid breathing, difficulty feeding, poor weight gain and fatigue. Some children have no obvious symptoms, and the condition is detected during a heart examination.
Treatment depends on the child's age, the size of the PDA and its effect on circulation. Options may include observation, medication in selected premature infants, catheter-based closure or surgical closure. Surgery may be recommended when other approaches are unsuitable or unsuccessful.
4. Tetralogy of Fallot (TOF)
Tetralogy of Fallot is a complex congenital heart defect involving four structural abnormalities: a ventricular septal defect, narrowing of the pathway leading from the right ventricle to the lungs, an overriding aorta and thickening of the right ventricular muscle.
These abnormalities affect the normal flow of blood through the heart and can reduce the amount of oxygen reaching the body.
The severity of symptoms varies from child to child. Some babies are diagnosed before birth or soon after delivery, while others are identified during infancy.
Tetralogy of Fallot generally requires surgical treatment. Depending on the child's condition, surgery may be performed during infancy or earlier if urgent intervention is needed. The procedure aims to improve blood flow to the lungs and correct the structural abnormalities.
5. Transposition of the Great Arteries (TGA)
Transposition of the great arteries is a serious congenital heart defect in which the two main arteries leaving the heart are connected to the wrong pumping chambers.
Normally:
- The pulmonary artery carries oxygen-poor blood from the heart to the lungs to collect oxygen.
- The aorta carries oxygen-rich blood from the heart to the rest of the body.
In TGA, these blood vessels are connected to the wrong pumping chambers. As a result, oxygen-poor blood circulates back to the body, while oxygen-rich blood returns to the lungs instead of reaching the body normally.
Survival depends on the presence of pathways that allow oxygenated and deoxygenated blood to mix.
Babies with TGA may develop cyanosis shortly after birth, along with rapid breathing or other signs of inadequate oxygen delivery.
This condition requires urgent specialist assessment and treatment. Initial care may include medication and procedures to improve blood mixing, depending on the baby's condition.
Many infants with TGA undergo an operation called the arterial switch procedure, which reconnects the major arteries to the appropriate heart chambers. The timing of surgery depends on the clinical situation and is generally early in life.
Prompt diagnosis and specialised care are essential for managing this potentially life-threatening condition.
6. Coarctation of the Aorta
Coarctation of the aorta is a congenital condition in which a section of the aorta, the main artery carrying blood from the heart to the body, is abnormally narrowed.
This narrowing makes it harder for blood to flow through the affected area and may increase blood pressure in the upper part of the body while reducing blood flow to the lower body.
Symptoms vary depending on the severity of the narrowing. In newborns with severe coarctation, signs may include poor feeding, rapid breathing, weak pulses in the legs and reduced circulation. Older children may have headaches, leg fatigue during exercise or high blood pressure.
Treatment depends on the location and severity of the narrowing. Some children can be treated with catheter-based balloon angioplasty or stenting, depending on their age and anatomy. Others require surgery to widen or reconstruct the narrowed section of the aorta.
Early diagnosis is important because severe coarctation can affect circulation and heart function.
7. Heart Valve Abnormalities
Heart valves control the direction of blood flow through the heart. Congenital abnormalities or other valve problems can cause a valve to become too narrow, known as stenosis, or allow blood to flow backwards, known as regurgitation.
Symptoms depend on the affected valve and the severity of the problem. They may include breathlessness, fatigue, poor growth, chest discomfort or reduced exercise tolerance. Some children have no symptoms, and the abnormality is identified during a routine examination or echocardiogram.
Mild valve abnormalities may only require regular monitoring. Depending on the condition, treatment may involve medication, a catheter-based procedure, valve repair or valve replacement.
The decision to operate depends on how severely the valve affects blood flow, whether the heart is under strain and whether symptoms or other complications are present.
How Are Heart Conditions Diagnosed in Children?
The diagnosis of a suspected heart condition by a paediatric cardiologist begins with a clinical examination and a review of the child's symptoms, medical history and family history.
Depending on the findings, investigations may include:
- Echocardiography: An ultrasound examination that evaluates the heart's structure, valves, blood flow and pumping function.
- Electrocardiogram (ECG): Records the electrical activity of the heart.
- Pulse oximetry: Measures oxygen saturation in the blood.
- Chest X-ray: May help assess the heart's size and the condition of the lungs.
- Cardiac catheterisation or advanced imaging: Used in selected cases to obtain additional information about the heart and blood vessels.
- PET Scan: may be used in selected cases for detailed evaluation of heart structure and function.
When Does a Child Need Paediatric Cardiac Surgery?
A child may need heart surgery when a structural defect significantly affects circulation, causes symptoms, places excessive strain on the heart or creates a risk of serious complications.
However, a diagnosis of congenital heart disease does not automatically mean that surgery is required. Small ASDs, VSDs and PDAs may close naturally or only require monitoring. Other defects may be managed with catheter-based procedures, while complex conditions such as Tetralogy of Fallot and transposition of the great arteries generally require surgery.
The treatment plan is determined by a paediatric cardiology and cardiac surgery team after evaluating the child's diagnosis, age, symptoms, imaging results and overall health.
Parents should discuss the expected benefits, potential risks, timing of treatment and long-term follow-up requirements with the treating team.
Comprehensive Care for Little Hearts
Several congenital heart conditions may require paediatric cardiac surgery, ranging from septal defects such as ASD and VSD to more complex conditions such as Tetralogy of Fallot and transposition of the great arteries. The need for surgery depends on the severity of the defect, its effect on heart function and the child's overall clinical condition.
Sarvodaya Hospital, Sec 8, Faridabad houses one of the city’s most comprehensive paediatric cardiac units with highly skilled paediatric cardiologists, paediatric cardiac surgeons, paediatric cardiac anaesthetists and a dedicated paediatric nursing and care team.
From newborns to adolescents, the team has performed several successful complex surgeries in children across all ages.
Sarvodaya’s CSR initiative, Nanhi Dhadkan, also offers free heart surgeries to underprivileged children, giving little ones a new chance at life.
Congenital heart defects should be evaluated and treated on time to avoid complications. If you notice any sign or symptom related to a heart condition in a child, consult with an experienced child heart specialist and get the timely appropriate solution.
