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Child Heart Hospital in Mumbai, India

best hospital for pediatric cardiology in mumbai, india


What are the different kinds of heart defects?

Holes in the heart: These are the most common kind of heart defects.  If present between the upper two chambers of the heart, they are called ASDs and if present between the lower two chambers of the heart, they are called VSDs.

Narrowing of vessels or valves: The main arteries leaving the heart may be narrow at a point or one of the 4 valves of the heart may not open completely. 

Wrong connections of vessels with chambers:  Each part of the heart has a specific function. The left heart deals with receiving pure blood from the lungs and pumping it to the body. The right side of the heart receives impure (blue) blood from the body and pumps it to the lungs where with each breath blue blood becomes red and returns to the left heart. In certain heart defects (transposition, TAPVC) the vessels that enter or leave the heart are connected abnormally. Hence pure blood may end up going back to the lungs or impure blood may be carried to the body.
Malformed Chambers: of the 4 chambers of heart, 2 upper and 2 lower, any may be small and non-functional. Hypoplastic left heart syndrome is an example where the left sided chambers and vessels are small.

Why do babies get Heart Defects?

A lot of research has been done on this. The truth is that there seem to be too many factors involved, such that no single factor can be blamed in most cases. The heart is formed in the first 2 months of pregnancy. Hence what happens in that period alone determines how the heart is formed. Some factors thought to play a role include genetic mutations, maternal diabetes, certain medicines taken in first trimester and invitro fertilization.

Can heart defects be picked up in pregnancy?

Since the heart is formed early on in pregnancy, it seems logical that sonography of the unborn baby’s (fetus) heart after the third month of pregnancy should detect heart defects. However, at present there is limit to resolution of the sonography machines. Sonography of the Foetal heart is called Fetal echocardiography. World over, major heart defects can be detected by 18-22 weeks of pregnancy (4th to 5th month). Specially trained radiologists and paediatric cardiologists perform this test. However many minor heart defects may not be picked up in this manner. Knowledge about the heart defect prior to birth of the baby may allow the would-be parents to plan for the delivery and further treatment in a timely manner. In India, this test is underutilized. This test is available at Fortis.

What are the Tell-tale signs of a congenital heart defect in a child?

  • Major defects may be life threatening after birth. Usually the newborn looks bluish or cold and lethargic after the 1st day of life. There is no interest in feeding and there is rapid breathing.

  • Babies with large holes in the heart get tired while breast feeding. This starts to happen usually after 1 month of age. They gasp for breaths and sweat in between feeds. 

  • The weight gain of the baby falls below expected for age (GROWTH CHART).

  • The baby may get frequent cold and cough and pneumonias.

  • Some babies turn blue with crying or cold exposure or with exertion. 

  • Older children get tired with exertion.

What is the Treatment for a Heart Defect?

Only certain milder forms of holes or malformed valves can be left alone but still have to be kept under follow-up. The rest of the various kinds of heart defects require treatment to repair the defect. The hole needs to be closed, the valve needs to be opened up and the wrong connection needs to be reconnected normally. 

Surgery: most heart defects are repaired by surgery. The surgery (open heart surgery) involves entering the heart by making a cut in its wall after bypassing the heart with a (bypass) machine. Some surgeries can be done off-pump as well. While a few require the body to be cooled and the circulation arrested. Open heart surgery has been performed since the 1950s. Successful heart surgery in a baby or child involves an extreme set of skills in the operating surgeons complimented by a vigilant team in the operation theatre. The team consists of perfusionists, nurses, and anesthesiologists. Typically such teams are comfortable handling babies with weight less than 2 kilos to a fully grown person. 

Once the baby is shifted to the intensive care unit, another team takes care of his recovery. This may take anywhere from 2 days to more than 2 weeks. The baby needs multiple intravenous medicines, support for breathing, feeding and all round 24 hour care. The paediatric cardiac intensivists take care of these aspects. 

Once the baby is discharged home, recovery is generally rapid. For the 5 most common heart defects that are prevalent, babies start thriving: gaining weight and catching up with their milestones and are soon on the way to good health. Most kids come off all medicines at the first follow up visit post surgery. Periodic screening at the paediatric cardiac OPD is essential though. 

Cardiac catheterization: Some heart defects can be repaired without surgery. A plug or umbrella shaped device is used to close certain holes. This detachable device can be placed in the hole via a special tube (catheter) inserted in the heart from the groin vessels. The interventional paediatric cardiologist does this under live x-ray guidance. The recovery is rapid as there are no cuts on the skin/muscle etc and the child is discharged home the day after the procedure. This kind of surgery-less procedure is performed in the cardiac cath lab and has become the standard of care for certain types of holes in the heart. Other heart defects handled in the cath lab routinely include narrow valves or vessels and abnormal connections between vessels (PDA).

Medicines:  medicines play a very small role in treatment of heart defects. None of the medicines offer a cure of the defect (the only exception is closure of PDA in premature babies using medicine).

Heart/Heart Lung Transplant: The heart of a brain-dead person can be donated to a needy child with a failed heart who has no other surgical option left. A recipient of a donated heart need lifelong medicine and careful follow up. This is done at very few places around the world/India. This is available at our centre. 

The best interest of the child is the bottomline for the team. No matter which surgeon or cardiologist in the team you will meet with, the entire team contributes to the care of the child. The proposed treatment plan is discussed in a combined meeting, potential high risk markers are identified so that appropriate preparation can be made. Children are usually admitted in the ward (or ICU) a day prior to the procedure or surgery. Intravenous lines are put and various pre-operative laboratory tests are done. All care is taken to ensure that the child stays pain-free and has the least stressful experience in the hospitalization. 

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