THE new sunday express MAGAZINE Heart Break Voices Dr Vikram Sampath Debashis Chatterjee Ajai Sahni Ravi Shankar Gaurav Yadav Swami Sukhabodhananda Buffet People Wellness Books Food Art & Culture Entertainment september 13 2026 SUNDAY PAGES 12 In India, one in every 100 babies born develop cardiac disease. The care exists, but for too many it is too far away A By Toufiq Rashid She was diagnosed with Takayasu’s arteritis, a rare autoimmune disease that causes blood vessels to narrow. Her blood pressure was dangerously high. “The heart failure was not an isolated heart problem; it was the consequence of different conditions in the body that had driven the child’s blood pressure to dangerous levels,” says Dr Vikas Kohli, Senior Pediatric Cardiologist at Apollo. Suzanne underwent stenting and ballooning procedures in vessels supplying blood to the heart and kidneys, followed by months of hospital care. “Her heart function has improved, her blood pressure medicines have been reduced, and she is taking small but significant steps towards normal life,” says her father, Churchill. He hopes she will soon return to school. The Geography of Cure Specialised centres remain concentrated in major cities, families often have to travel hundreds of kilometres, and the cost of treatment, lack of awareness and delayed referrals can turn a treatable condition into a crisis. The challenge, therefore, is no longer simply whether India can treat congenital heart disease. In many cases, it can. The bigger question is whether children can reach the right care early enough. The problem is also lifelong. As survival improves, more children with CHD reaching adolescence and adulthood need continued specialist follow-up rather than simply a successful childhood operation. For Dr Kohli, who treated both Tejbir and Suzanne, the message is ultimately hopeful: once the appropriate intervention is done, “the patient is as good as normal in most cases, however some do need follow up.” Tejbir’s story began with a diagnosis before birth. Suzanne’s began with a crisis hundreds of kilometres from specialist care. Both eventually reached the treatment they needed. The next frontier for India is to ensure that geography awareness, specialist availability , and affordability do not determine which children get that chance. This is not simply a medical failure; it is a geographical one. The states where the shortage is most acute read like a casualty list: Bihar, Uttar Pradesh, Punjab, Jammu and Kashmir, Himachal Pradesh. In some of these states, just one or two paediatric cardiologists serve populations the size of small countries. The blue baby you can’t see For decades, the image of a sick child’s heart in India was a cinematic one: the blue-lipped infant, the murmur a doctor 7 % catches almost by accident, the operating table, the recovery, the redemption arc. But paediatric cardiologists indicate a parallel journey which doesn’t involve a defect at all but a perfectly normal-looking teenager. “Early-onset hypertension, early-onset diabetes, early-onset obesity will cause early-onset heart disease,” says Dr Kohli. The data back him up, data that are startling. A review of 64 Indian studies found roughly 7 per cent of children and adolescents already have hypertension. The World Obesity Atlas estimates 41 million Indian children are overweight or obese in a country simultaneously fighting undernutrition in different corners of the population: malnourished toddlers in one district, and metabolic syndrome brewing in a classroom 200 kilometers away. This is not simply about children being “too fat”. It is about what that weight may mean for their health trajectory. Childhood obesity increases the likelihood of metabolic abnormalities, including high blood pressure and dyslipidemia—a condition causing unhealthy levels of blood fats such as cholesterol and triglycerides—while also increasing the chances of obesity persisting into adulthood. Southern states including Kerala, Tamil Nadu, and Andhra Pradesh, along with Union Territories such as Puducherry and Chandigarh, report particularly high concentrations of overweight and obese individuals. Together, these numbers raise a crucial question: are we waiting until adulthood to detect a problem that may already be taking shape during childhood and adolescence? Dr Nishith Chandra, at Fortis Escorts Hospital, remembers his youngest heart-failure patient: 19, maybe 20 years old. “For a patient to have had a heart attack at this age,” he says, “the disease must have started very early in his life. Maybe adolescence or even earlier.” Thirteen-year-old Ridhi (name changed) from Delhi started getting headaches. Her energy was low: her parents, both physicians, spent days chasing down the symptoms. The eventual diagnosis was high blood pressure. Her hypertension was not chronic, but it was an alarm that cardiovascular risks can accumulate much earlier than usually imagined. The warning signs, therefore, may be visible well before adulthood. “A child may not be born with a defective heart. The cardiovascular risk may instead accumulate during childhood,” Dr Chandra says. Cardiovascular disease may announce itself in adulthood, but its foundations can be laid much earlier through diet, sleep, physical activity, weight, blood pressure, and the metabolic changes that accompany them. of Indian children and adolescents have hypertension, according to a systematic review of 64 studies Ai generated n invisible scourge is haunting India, its dark shadow already beginning to the spread across the most vulnerable of all: children. And the menace is childhood heart disease. One in every 100 babies, or an estimated 2,00,000-2,40,000 children are born with Congenital Heart Disease (CHD) in India each year. Around one-fifth are estimated to have serious defects requiring intervention in the first year of life. An estimated 3.5 million adults are also living with CHD in the country . But all is not bleak, though the contrast is disheartening. There is Tejbir Singh: a vibrant, energetic two-and-a-half-year-old boy living in Punjab. And there is nine-year-old Suzanne in Imphal. When Tejbir’s mother was 21 weeks pregnant, an ultrasound changed the course of his life. The scan revealed a serious heart abnormality, giving the medical team and the family a critical help in treating CHD: the time to prepare and plan. A stent put in his heart at seven days of age, followed by open-heart surgery after nine months, helped turn a potentially life-threatening diagnosis into a manageable one. Nineyear-old Suzanne was brought to hospital with fever, severe hypertension, and abnormal heartbeats. Tests showed she had an enlarged heart. Since Imphal had no paediatric cardiologist, her family had taken her to Apollo Hospital in Delhi. Tejbir: Time to Prepare Ai generated representational pictures When Tejbir Singh’s mother was 21 weeks pregnant, an ultrasound revealed a serious heart abnormality. The early diagnosis gave doctors and his family precious time to prepare. A stent was placed in his heart at seven days old, followed by open-heart surgery at nine months. Today, the vibrant two-and-a-half-year-old from Punjab is growing up with a condition that was once potentially life-threatening, but is now manageable. A country that can fix hearts, if you can find one Here is the strange paradox of Indian medicine in 2026: the expertise exists. Survival rates for complex congenital heart surgery at India’s top centers now rival those in London or Boston: above 80 to 85 per cent for serious defects, above 95 per cent for the more common ones. A 2026 meta-analysis of 33 Indian studies puts the incidence of congenital heart disease at just over one per cent of live births, which sounds almost reasonable until you do the arithmetic: 2,00,000 to 2,40,000 babies a year, in a country where the specialists who can treat them are clustered in a handful of cities. In Kashmir, a 10-year-old boy spent years essentially under house arrest by his own heart. His grandmother was afraid he wouldn’t survive the surgery he needed, so instead he didn’t have it. He watched other children play from a window. That was his childhood: 2-2.4 lakh babies are born with congenital heart disease in India every year 7.6% of Indian adolescents aged 10-19 have hypertension, according to a meta-analysis published in the Indian Journal of Pediatrics restrictions, distances, a door he wasn’t allowed through. “Seven out of ten children with congenital heart disease die in Kashmir,” says Dr Altaf Bhukari, a physician from Kashmir based in Saudi Arabia, who, in 2021, founded a small NGO called the Health and Hope Foundation after realising there was no organised system to get sick children out of the Valley and into surgery “A few children , . would get help. But most of the kids wouldn’t.” He estimates 2,000 children are born with heart defects in Kashmir every year. Some 1,500 of them need real intervention. Roughly 80 per cent, he believes, don’t get it in time. A relevant case is Usman’s, eight months old when diagnosed with Tetralogy of Fallot, a complex congenital heart defect that limits the amount of oxygen reaching the body Even . after he was referred to a hospital outside the state, surgery was ruled out due to his low WBC counts. Even an attempt to place a stent failed. “When it became a matter of life and death, the doctors at Amrita Hospital, on the family’s insistence, took a leap of faith and 35.1% of children aged 10-12 had blood-pressure readings in the Stage 1 or Stage 2 hypertension range; among those aged 13-19, the figure was 25.1% Suzanne: A Heart Under Pressure Nine-year-old Suzanne from Imphal arrived at hospital with fever, dangerously high blood pressure and abnormal heartbeats. Tests revealed an enlarged heart and Takayasu’s arteritis, a rare autoimmune disease that narrows blood vessels. With no paediatric cardiologist in Imphal, her family travelled to Delhi, where she underwent stenting and ballooning of vessels supplying the heart and kidneys. performed a very difficult operation on him. The recovery was slow, but he is well now,” says Dr Bhukari. Usman is six years old today . Dr Ashish Katewa, Professor and Head of Pediatric Surgery Amrita Institute of Medical , Sciences, Faridabad, NCR, who operated on Usman, says many such surgeries are performed under the Ayushman Bharat scheme, as the children come from low-income families. But even when the cost of surgery is covered, reaching the hospital, arranging accommodation and managing the logistics of prolonged treatment can remain overwhelming for families. Prevention Beats Cure Survival for many conditions at specialist centres is now above 80-85 per cent, and for some common defects, above 95 per cent. Knowing before delivery that a baby has a critical heart defect allows doctors to plan the birth at a specialist centre, prepare neonatal Turn to page 2 95% of children with some of the more common congenital heart defects now survive surgery at leading Indian centres 1% of live births in India involve congenital heart disease, according to a 2026 meta-analysis of 33 Indian studies 80-85% is the survival rate for serious congenital heart defects at leading Indian specialist centres, comparable with outcomes at major centres in London and Boston