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“Congenital Complete Heart Block Management of a newborn baby”
– An in-depth case study by Dr. Debasree Gangopadhyay, pediatric cardiologist (MD), FNB, R.N.Tagore Narayana, Hospital, Mukundapur, Kolkata.
Understanding Congenital heart defects
Congenital heart defects (CHDs) are problems with the structure of the heart that are present from birth. These defects can affect how blood flows through the heart and to the rest of the body. Some defects are simple and may not need treatment, while others are serious and require surgery or other care soon after birth.
Common Symptoms of Congenital Heart Defects:
- Fast breathing or trouble breathing
- Tiredness during feeding (in babies)
- Poor weight gain
- Bluish color of the lips, skin, or fingernails (called cyanosis)
- Swelling in the legs, belly, or around the eyes
- Tiredness and weakness (in older children)
- Irregular heartbeat or heart murmur
If your child shows any of these signs, it is important to see a pediatric cardiologist for proper testing and care. Early diagnosis and treatment can help children with CHDs live healthy and active lives.
What is Congenital Complete Heart Block (CCHB)?
Congenital Complete Heart Block (CCHB) is a rare heart problem that some babies are born with. In this condition, the heart’s electrical signals do not travel properly from the upper chambers (atria) to the lower chambers (ventricles). This causes the heart to beat much slower than normal.
Congenital Complete Heart Block (CCHB) can happen alone or with other heart defects. In many cases, it is linked to the mother’s immune system, especially if she has certain autoimmune conditions.
Babies with CCHB may show signs like slow heart rate, tiredness, poor feeding, or breathing problems. Treatment often includes careful monitoring, and in serious cases, doctors may place a pacemaker to help the heart beat normally. With proper care from a pediatric cardiologist, many babies with CCHB can grow up healthy.
Introduction to Congenital Complete Heart Block Management- A Detailed Case Study
Congenital Complete Heart Block (CCHB) is a rare but serious type of congenital heart disease where the electrical signals in a newborn’s heart do not pass properly from the upper chambers (atria) to the lower chambers (ventricles). This condition can lead to dangerously slow heart rates and life-threatening complications if not treated in time. This case study explains how a newborn with CCHB was diagnosed and successfully managed through expert care in pediatric cardiology.
Initial Symptoms
A baby girl was born to a 26-year-old mother. However, the mother went for a routine check-up during the third trimester of pregnancy. A slow fetal heart rate was noticed during the ultrasound. To understand the reason, we did a fetal echocardiography test. The fetal echo report showed that the baby had a very slow heartbeat (around 55–60 beats per minute). This was much lower than the normal fetal heart rate. The test confirmed a condition called Congenital Complete Heart Block, where the heart’s electrical signals do not pass properly from the upper to the lower chambers.
After birth, the newborn showed the following symptoms:
- Persistent low heart rate (a few times it was a very low heart rate)
- Poor feeding
- Sleepiness and low energy
- Mild cyanosis (bluish skin tone)
- Weak cry and difficulty maintaining oxygen saturation
These early signs led to immediate referral to specialist heart centre.
Diagnosis
The baby underwent a complete cardiac evaluation at a neonatal intensive care unit (NICU). The following diagnostic steps were taken:
Electrocardiogram (ECG):
This is a simple and painless test that records the electrical activity of the heart. The ECG showed a complete block between the upper and lower chambers of the heart, known as complete atrioventricular (AV) block. This means the electrical signals from the top chambers (atria) were not reaching the bottom chambers (ventricles), causing the heart to beat too slowly. This confirmed Congenital Complete Heart Block (CCHB).
Echocardiogram (Echo):
The ultrasound of the heart was done to check if there were any structural problems in the baby’s heart. The echo results were normal, which means there were no holes or defects in the heart’s walls or valves. So, the baby had isolated CCHB – a heart rhythm problem without any structural heart disease.
Blood Tests of the Mother:
Since some cases of CCHB happen due to the mother’s immune system, we advised the mother’s blood test for special antibodies. The results were positive for anti-Ro (SSA) and anti-La (SSB) antibodies. These antibodies can cross the placenta during pregnancy and damage the baby’s heart conduction system. This confirmed that the cause of the baby’s heart block was maternal autoimmune disease.
With no structural heart disease present, the final diagnosis was Congenital Complete Heart Block due to maternal autoimmune antibodies.
Line of Treatment (LOT)
The treatment approach was carefully planned by a team of experts in pediatric cardiology and neonatology:
Immediate Support & Care
- Continuous cardiac monitoring in NICU
- Oxygen support
- Intravenous fluids and nutrition
- Temporary isoproterenol infusion to maintain adequate heart rate and cardiac output
Decision for Pacemaker Implantation
Since the baby’s heart rate stayed very low and the baby was not improving, we decided to implant a permanent pacemaker. This small device helps control the heartbeat. Our pediatric cardiology team decided on early permanent pacemaker implantation.
Pacemaker Implantation
Pacemaker surgery was carried out under the care of a pediatric cardiac surgeon. A single-chamber epicardial pacemaker was placed.
The surgery was done carefully with the help of a team including:
- Anesthesia team trained in neonatal care
- Pediatric cardiac surgeon
- Post-operative ICU team
- Pediatric cardiology team for pacemaker programming
Post-surgery, the baby recovered well with a good heart rate and improved feeding, activity, and oxygen saturation.
Monitoring Growth and Long-Term Pediatric Cardiac Care
The child was discharged after one week of postoperative care with regular follow-up schedules for:
- Pacemaker check-ups every 3 months
- Monitoring growth and development
- Regular ECGs and echocardiograms
- Preventive care for infections
- Guidance for parents on signs of complications and device care
Over time, her growth and development remained normal. As a pediatric cardiologist, I closely monitored her through early childhood.
Success Story
Now that she is 10 years old, she is in school now. The girl is active, and she enjoys playing with her friends. Though she had to go through a lot at such a young age, she is fit and fine now. As a pediatric cardiologist, I still monitor her closely. We check her pacemaker regularly, track her growth, and make sure she continues to stay healthy. We also guide her parents on how to take care of the device and what signs to watch for.
Her story is an example of how early diagnosis, timely treatment, and proper follow-up can make a big difference. This case highlights the importance of early diagnosis and specialized treatment in pediatric cardiology. With advanced pediatric cardiac treatment and proper medical support, children with congenital heart disease can lead a happy and healthy life.
The success of her case is a result of:
- Timely diagnosis of congenital heart disease
- Expert care from a pediatric cardiac team
- Proper coordination for pacemaker implantation
- Long-term pediatric cardiac care and monitoring
Conclusion
Congenital Complete Heart Block, though rare, can be life-threatening without prompt treatment. This case shows how early intervention and expert pediatric cardiac care can ensure a healthy future for newborns with complex heart conditions. Regular monitoring of growth and lifelong follow-up are essential for children with implanted pacemakers, but with proper care, they can lead happy, normal lives.
Dr. Debasree Gangopadhyay is a highly respected pediatric cardiologist based in Kolkata, India, specializing in the diagnosis and treatment of heart conditions in children. With a compassionate approach and a commitment to excellence, Dr. Gangopadhyay has made significant contributions to the field of pediatric cardiology. Her expertise includes managing congenital heart defects, arrhythmias, and other cardiovascular conditions in young patients. Dr. Gangopadhyay is dedicated to providing personalized care and staying updated with the latest advancements in pediatric cardiology. She is passionate about educating families on heart health and actively participates in research and community outreach programs.
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