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For parents, being informed that their child will need to undergo a heart transplant can be extremely overwhelming and nerve-wracking. Processing the news itself can seem like a major blow while watching their child s health deteriorating due to a congenital heart disease.
Despite the long waiting lists in hospitals for a heart transplant, not many people are aware about the process or why children need to undergo this major surgery. Dr Swati Garekar, Consultant Paediatric Cardiologist, Fortis Hospital, Mumbai, tells us all that you need to know about pediatric heart transplants.
Globally, around 1200 heart transplants are done every year. The most common reason some children need a heart transplant is heart failure. Most of the time heart failure can be treated by treating the underlying reason: a hole in the heart or other problems in the heart s structure by birth, says Dr Garekar.
Rarely, the heart failure is due to unknown reasons or untreatable reasons. The heart failure progresses and the heart dilate. This condition is called dilated cardiomyopathy, adds Dr Garekar.
Due to this condition, even a 2-year-old child s heart becomes adult sized. The child starts to tire out with routine day to day activities. He gets admitted to the hospital frequently due to symptoms such as swollen feet, face and a protruding belly or simply, tiredness. These are the 7 symptoms of congenital heart disease.
The oral medicines they are on fail to keep their symptoms in check. There are two intravenous medicines available that may be delivered by a pump from home that may help for some time. At this point, there is a very high chance that they will die from progressive heart failure, says Dr Garekar.
In such cases, a heart transplant is a viable option for such children. The patient first undergoes some preliminary blood and other tests to determine whether they are a suitable candidate for heart transplantation. They should not have significant co-existing diseases (especially of the lungs).
Once they have cleared the tests, the patient s name is then added to the list of zonal transplant committee list as a potential heart transplant recipient. Then the long and nerve-wracking wait begins for a suitable weight matched and blood group matched brain dead donor. If there are more than two children suitable for an available heart, the sicker one gets the heart, explains Dr Garekar.
Challenges faced by children after a heart transplant
Once the family of a brain dead patient gives consent to donate the organs, the child who is most desperately in need of a heart transplant is called immediately to the hospital. By a carefully orchestrated sequence, the donor's heart reaches the child in the operation theatre when the old heart s vascular connections are ready to be cut from his/her body.
Then, the new heart s vessels are sutured to the child s vessels. A powerful medicine (immune-suppressant) is given to the child so that his body does not reject the new heart. Lower doses of similar immune-suppressants are required to be continued lifelong.
The challenges in the initial post-operative period are a rejection of the heart by the body, high lung pressure and infection. The child can be given a discharge by the tenth post-operative day if things go smoothly. There is a list of do's and don t's given to the child s family at home. The basic principle is that the child should avoid exposure to infection, take all prescribed medicines without fail and come for a follow-up check frequently, says Dr Garekar.
The first three months are crucial after which the follow-up visits also become spaced out. The first one year is the period where things are most likely to go wrong. If the first year passes by smoothly, the child s family and the transplant physicians can afford to relax, adds Dr Garekar.
Success rate of pediatric heart transplants
Many studies have been conducted on how children do after getting a heart transplant and they do better than adults who receive a heart transplant. Data suggests that out of 100 children who get a heart transplant, 85 will be alive and well after one year. After 20 years, 45 will still be alive. In fact, studies have found that successful heart transplant patients live 20 years longer. Pre-transplant, the child had a compromised quality of life with the spectre of death looming. Post-transplant, there is a very high chance that he or she will be a happy and productive citizen for years to come.
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