Congenital heart disease – A complex cardiac anomaly: A case report

ABSTRACT

Congenital heart disorders (CHDs) are a major cause of juvenile morbidity and mortality in many poor nations, owing to late detection and a lack of talent and facilities for decisive treatments. A case of a newborn baby with atrial septal defect (ASD) with patent ductus arteriosus (PDA), tricuspid atresia (TA), and pulmonary valve stenosis is admitted to the pediatric ward. It is a complex cardiac anomaly that leads to mortality and morbidity. We rarely get to see a baby dealing with four major complex heart conditions except in the condition of tetralogy of Fallot. The child was a known case of congenital heart disease. Symptomatic treatment was given and treated with antibiotics.

Introduction

Congenital heart disorders (CHDs) are a major cause of juvenile morbidity and mortality in many poor nations, owing to late detection and a lack of talent and facilities for decisive treatments.[1]

There was no possible correlation between intermarriage and tetralogy of Fallot, tricuspid atresia (TA), aortic stenosis, co-arctation of aorta, or patent ductus arteriosus (PDA). Thus, consanguinity may worsen underlying genetic risk factors in a population with a high degree of inbreeding, particularly in the offspring of first cousins. Some heart abnormalities might be caused by a recessive component.[2] When the heart or blood arteries do not develop properly in the womb, those problems arise.[3] This case is rare because as such there is no previous study available with such a complex congenital heart anomaly. The prognosis in such cases is very poor.

Patient and Observation

A newborn female (B), a twin baby child, presented to our outpatient department (OPD) with complaints of breathing difficulty and inability to maintain oxygen saturation. The baby was born in a private hospital at Amravati and was referred by a physician to the hospital for further management. A structural congenital anomaly was noted at the time of ultrasonography in the antenatal period and informed to parents that there is a complex cardiac anomaly single inflow in the fetus (B) [Figure 1]. Since a couple of days, the baby girl started noticing similar symptoms like fever, cough, and cold.

Figure 1.

Ultrasonography showing a congenital defect

Her parents informed that the child had a fever, which scored 102°F on a digital thermometer. This fever was not associated with chills. Clinical examination revealed that the oxygen saturation was 86% without oxygen and the patient is having respiratory distress. Oxygen therapy was administered to the baby using nasal prongs. The weight of the baby girl was 2.100 g which decreased by 400 g from birth.

Complete blood count panels were checked and the results were as follows: Hemoglobin (Hb) was 19.7 g/dl which increased due to polycythemia, mean corpuscular hemoglobin concentration (MCHC) value was 33.7, mean corpuscular volume (MCV) value was 106.8, mean corpuscular hemoglobin (MCH) = 36, total white blood cell (WBC) was 5700, and platelets were 2.48, while C-reactive protein value was 1.96. Kidney function test and liver function test were also done, and the findings were normal. Two-dimensional echocardiography (2D echo) was also done for the confirmation of disease.

Therapeutic interventions given to the patient are inj. Cefotaxime 100 mg intravenously twice a day, inj. Amikacin 30 mg intravenously once a day, and syrup Deocal 2.5 ml twice a day. Provide a comfortable semi-Fowler’s position. Oxygen administration should be given.

Discussion

The incidence of CHD ranges from roughly 4/1,000 to 50/1,000 live births in different studies, researchers looked into the causes. The proportional frequency of different major kinds of CHD varies a lot from one study to the next. Bicuspid aortic valves, isolated anomalous lobar pulmonary veins, or a silent PDA affect additional 20/1,000 live babies, with special emphasis on the expanding use of echo in neonatal intensive care units. During the early second trimester or at midgestation, most congenital heart defects (CHDs) are detected using targeted prenatal transvaginal (TVS) or transabdominal (TAS) ultrasonography. Despite comprehensive echocardiographic evaluation, delayed diagnosis of some cardiac abnormalities persists. The purpose of this study was to examine the progression of fetal cardiac abnormalities and their development in utero.[4]

Most patients have been able to reach adulthood due to advancements in cardiovascular care and surgery. Unfortunately, longer longevity comes at a cost, since many patients develop late problems, the most common of which are heart failure and arrhythmias. As a result, these individuals must be monitored regularly by doctors who specialize in congenital cardiac disease. However, because the number of individuals living with congenital cardiac disease is difficult to estimate, planning treatment for this population is problematic.[5]

Echo can easily diagnose a primum atrial septal defect (ASD), with cardiac catheterization reserved for patients with associated left-sided obstruction. If the patient is in good health, the whole repair can be completed by the age of two to three years old with a low risk of death.[6]

As a bigger shunt becomes symptomatic earlier in infancy, PDA in adults is frequently an isolated lesion with a mild to moderate degree of shunt. In about 98% of patients, the percutaneous technique is both safe and successful. Except for 6 months after a percutaneous or surgical closure, subacute bacterial endocarditis prevention is not recommended.[7]

A study by Brittany Frock et al.[8] says that TA is a unique congenital cardiac abnormality in which the tricuspid valve, the right atrioventricular junction, is missing. As a result, there is no direct passage between the right atrium and right ventricle. Surgical therapy, such as the Fontan operation, is recommended but only palliative, leaving patients with a variety of long-term problems.

A study by Fedderly et al[9] says that for the treatment of isolated valvular pulmonary stenosis in newborns, children, and teenagers, balloon valvuloplasty for pulmonary valve stenosis by static dilation is the therapy of choice. In neonates, the surgery is also successful; however, the technique’s complications are much higher, and the effectiveness is lower.

In the present study, a baby is a neonate; hence, a symptomatic treatment for difficulty in breathing is given by administering oxygen to the baby. Where in this condition and by considering her age, it is impossible to plan for surgical management, hence on improvement with the condition, the child is been discharged with follow-up after 3 weeks.

Conclusion

In the present case of a complex congenital anomaly, the child with severe breathing difficulty was given oxygen therapy and symptomatic management. She was treated with intravenous antibiotics. The prognosis was good and the baby started maintaining oxygen saturation at room air. Hence discharged with oral antibiotics. As such, there is no more literature on such complex congenital conditions available. More studies on complex cardiac conditions are required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.