What Steps Should be Taken for Detection of Occult / Hidden Cases of Congenital Heart Disease CHD? Since there are still a large number of occult/hidden/ asymptomatic cases of CHD, especially of the late cyanotic or acyanotic (in which cyanosis does not occur) group, urgent steps are required to be taken for their early detection. Such cases can be detected in various camps, especially in schools/ colonies, etc. However, in many of the late diagnosed cases, as described earlier, treatment/surgery may not be possible.
It will be appropriate if at the time of birth, a pediatrician examines all the babies for any congenital lesion of the heart, and if suspected, an echocardiography should be carried out so that the disease can be diagnosed right at birth, and necessary steps of treatment can be planned well in time.
It is not difficult diagnosing/ suspecting/ detecting various congenital lesions in the heart, say, in the general population. The physician, besides a detailed clinical examination, is mainly required to auscultate the heart of each child or adult, as the case may be, for heart sounds and murmurs. It gives a fair clue of various congenital lesions of the heart, although all the murmurs of the heart may not be pathological. There are also so-called innocent murmurs. However, once the disease is suspected, the diagnosis can be confirmed by various tests, especially echocardiography.
Even a rare/uncommon heart disease can be diagnosed with fair accuracy on clinical examination of the heart. Hence in various camps that may be proposed to be organized by various voluntary organizations, not much expenditure is likely to be incurred. Routine tests, like ECG and X-rays etc., are required when' there is at least some clue on auscultation/ Clinical examination about the presence of CHD.
The case of a Chinese woman suffering from a congenital heart disease, rupture of sinus of valsalva, which is not very common, was reported in the British Medical Journal in its issue of 16th March, 1968. The same year, a similar case of an Indian patient was suspected clinically by the author. Advanced tests like echocardiography etc. were not available at that time. The patient was operated at Mumbai by Dr. K.N. Dastur, Honorary Cardiac Surgeon and Honorary Professor of Surgery, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital. Dr. Dastur, confirming the author's diagnosis, wrote, "The rupture of sinus of valsalva was into the right ventricle as postulated by you.
Hence, a clinical examination/ auscultation of heart will go a long way in detecting the subclinical cases of congenital lesions of the heart. And, therefore, a general realization of this fact is all that is required so that people themselves corne forward for such routine check-ups of their children by their physician, or report in the various camps that may be held from time to time. Unless this is achieved, the desired goal can not be reached. And the people, especially the late cases who are not fit for operation, may go on suffering from the morbidity of the disease, which is chronic in many of the cases.
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Article Added on Thursday, April 24, 2008
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