A common worry of cardiologists as well as their patients undergoing major catheter interventional procedures is regarding the urgent need for surgical intervention. Usually interventional procedures like balloon angioplasty (fixing up blocks in blood vessels with small catheters or tubes introduced into the blood vessels) are done in the cardiac catheterisation laboratory. If the procedure is not successful or when there is a complication requiring urgent surgical correction, the person has to be shifted to the cardiac surgery theater quickly. Very often there can be logistic issues in shifting a critically ill person, though with advanced interventional technologies which are available now, this is quite a rare occurrence. It is to counter this problem that hybrid operating rooms are being designed. This enables quick switching over from an interventional cardiology approach to a surgical approach without moving the subject from the operating table (or the cath lab table to be precise). Usually cath lab tables are not suited for surgeries and operating tables are not suitable for cath lab procedures as they are not meant for x-ray fluroscopy. Design of a hybrid suite is in such a way that both cardiac catheterisation and angiography with fluroscopy as well as surgical intervention is easily performed. Moreover an increasing number of procedures are being electively designed for hybrid suites. Examples include perventricular closure of ventricular septal defect, percutaneous aortic valve replacement and endovascular repair of aortic aneurysm. In perventricular closure of ventricular septal defect, right ventricle (lower chamber of the heart) is exposed surgically and a catheter based device is used during the operation to close the defect in the septum (separating wall between left and right ventricles). In percutaneous aortic valve replacement, it could be either a femoral or trans apical approach. In femoral approach, the artery (blood vessel carrying oxygenated blood) in the thigh is surgically exposed and further procedure of valve replacement is done using a catheter based device. Trans apical approach involves making a small operation in the lower left portion of the chest where the heart beat is felt and then introducing the device directly to the left ventricle by a catheter based approach. Endovascular repair of aortic aneurysm (enlargement of the main blood vessel of the body carrying oxygenated blood) also involves opening up of the femoral artery in the thigh surgically and further procedure is by catheter based technique. The latter two procedures – endovascular repair of aortic aneurysm and percutaneous aortic valve replacement by the femoral approach can be done in the conventional cardiac catheterisation laboratory as well, without going for a hybrid suite because the surgical exposure is only minimal in these cases.
Even though chest pain as a symptom is common in children, unlike in adults, it is seldom due to heart disease. Most often the cause of chest pain in children is not a major life threatening disease. Still chest pain can cause restriction of activities, absence from school and cause of anxiety to children and their parents. A good history and physical examination gives a lot of information to exclude any potentially serious condition causing chest pain, though it is rare. Costochondritis or inflammation of the joint between the breastbone and the ribs is a common cause of chest pain adolescent and pre-adolescent girls. It can be caused by viral illness or due to frequent coughing due to respiratory illness. It can be identified by localised tenderness at costochondral joint, the joint between the breastbone and the ribs. Injury to muscles and bones of the chest can be a cause of chest pain in children, but this cause is usually obvious from the history. But this can also occur following the lifting of heavy objects, frequent coughing or a lot of aerobic exercise. Stress or anxiety is also a common cause of chest pain though it may be difficult to elucidate because the cause of stress may not be obvious. Exam related stress and other usual causes of stress have to be thought of. Stress can also cause worsening of chest pain due to another cause. Hence other causes have to be excluded before attributing a sole etiological role for stress. Pleurisy or inflammation of the covering of the lung is another important cause of chest pain which characteristically increases on breathing in and has a catching nature. Sometimes chest pain can occur due to collection air (pneumothorax) or fluid in the pleural cavity surrounding the lungs. But in this case shortness of breath is usually a prominent associated symptom. Reflux esophagitits or inflammation of food pipe due to reflux of acid from the stomach can also cause chest paint. This causes a burning type of chest pain felt in the center of the chest.
Chest pain due to heart disease in children
Though rare, some cardiac causes of chest pain in children are worth noting. Pericarditis or inflammation of the covering of the heart can cause chest pain in children. Most cases of pericarditis are self limited, but can rarely become a serious problem. It causes a shart pain which may be relieved by sitting and leaning forwards. Fever may be associated with pericarditis. Abnormalities of the coronary arteries which supply oxygenated blood to the heart can occur as a congenital anomaly or secondary to conditions like Kawasaki disease. Thickening of heart muscles due to heritable conditions like hypertrophic cardiomyopathy have also to be thought of. Mitral valve prolapse of bending backwards of the mitral valve between the left atrium (upper chamber) and the left ventricle (lower muscular chamber) can also cause chest pain, more often in adolescent females. Most often it is only a minor abnormality though rarely it can cause a leakage of the valve which can be significant. Another rare cause of chest pain could be an aneurysm of aorta (swelling of the great vessel which arise from the left ventricle). This is quite rare in children and can occur due to a condition known as Marfan syndrome. Rarely fast heart rate due to abnormal heart rhythms may also be felt as a chest discomfort by some children.
Coronary arteries are the blood vessels which supply oxygenated blood to the heart. Blockages can develop in these blood vessels as age advances due to various disease processes. A critical blockage in the coronary artery is often removed by a procedure known as balloon angioplasty. Once the vessel is opened by balloon angioplasty a scaffolding [...]
Infection of the heart valves is known as endocarditis. Vegetations in this setting mean small excrescences attached to valves composed of bacteria, white blood cells and components of a blood clot. These are freely mobile and may break off from the valves to be carried by the blood stream and get lodged in other small [...]
Palpitations due to a fast rhythm from the upper chambers of the heart is known as supraventricular tachycardia (SVT). Supraventricular tachycardia is seldom fatal and can often be terminated easily in a cardiac care set up. Sometimes it can be terminated even without medications by a cough, strain or a gag reflex or a splash [...]
Pacemakers are devices with electronic circuitry which can give electrical pulses to the heart which has a defective natural pacemaker. Natural pacemaker of the heart is a group of cells situated in the upper right chamber of the heart known as sinus node. Sometimes a pacemaker is needed when the pulses of the sinus node [...]
