Congenital heart defects are complications with the heart structure that are present right from the day of birth. Congenital heart defects can change the normal stream of blood flow through the heart.
How the normal heart functions :
The heart works like a pump and beats about 100,000 times a day. The heart has two sides demarcated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to take in oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it onto the body.
The heart is divided into four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body. For babies with congenital heart defects, the heart structure is different from the normal heart structure. Some part of the heart doesn’t form properly before birth, which changes the normal flow of blood through the heart. Congenital heart defects are the most common type of birth defects. They affect 8 out of 1,000 newborns.
There are many types of congenital heart defects. They range from very simple defects with no symptoms to complex defects with severe life-threatening symptoms. Many of these defects are simple conditions which need no treatment or are easily fixed. Some babies are born with congenital heart defects. These defects require unique medical care soon after birth. These defects can involve :
The interior walls of the heart
The valves inside the heart
The arteries and veins that carry blood to the heart or the body.
Examples of simple congenital heart defects :
Holes in the heart : some babies are born with holes in the septum. The holes allow blood to mix between the two sides of the heart.
- Atrial septal defect (ASD) : The hole in the part of the septum that allows oxygen-rich blood from the left atrium to flow into the right atrium instead of flowing into the left ventricle. ASDs can be small, medium, or large. About half of all ASDs close on their own over time. Medium and large ASDs that need treatment can be repaired using catheter procedure or open heart surgery.
- Ventricular sepal defect (VSD) : a VSD is a hole in the part of the septum that separates the ventricles and the lower chambers of the heart. VSDs can be small, medium, or large. Small VSDs don’t cause problems and may close on their own. Medium VSDs are less likely to close on their own and may require treatment.
- Patent ductus artists (PDA) : is a fairly common heart defect that can occur soon after birth. In PDA, abnormal blood flow occurs between the aorta and the pulmonary artery.
- Narrowed valves : This is the most common valve defect and is known as pulmonary valve stenosis, which is a narrowing of the pulmonary valve. This valve allows blood to flow from the right ventricle into the pulmonary artery. The blood then travels to the lungs to pick up oxygen.
Examples of a complex congenital heart defects :
Complex congenital heart defects need to be repaired with surgery. Advances in treatment procedures now allow doctors to successfully repair even very complex congenital heart defects.
The most common complex heart defect is Teratology fallot which is a rare combination of four defects.
- Pulmonary valve stenosis
- A large VSD
- An overriding aorta
- Right ventricular hypertrophy.
In Tetralogy fallot, not enough blood is able to reach the lungs to get oxygen and poor blood flows to the body which must be repaired with open-heart surgery, either soon after birth or later in infancy. The timing of the surgery will depend on how thin or narrow the pulmonary artery is.
Causes of the congenital heart defects :
However, doctors also don’t know why congenital heart defects occur exactly. It occurs during pregnancy. Hereditary may play a role in some heart defects. For example, who has a congenital heart defect may be more likely than other people to have a child with the defect. Rarely more than one child in the family is born with a heart defect.
Children who have genetic disorders, such as Down syndrome often have congenital heart defects. In fact, fifty percent of all babies who have Down syndrome have congenital heart defects.
Smoking is also one of the causes of these defects. Mother's Smoking during pregnancy may risk their unborn babies linked to several congenital heart defects, including septal defects.
Signs and symptoms of congenital heart defects :
In many cases, these defects don’t show any signs and symptoms. A doctor may not even detect signs of a heart defect during a physical exam.
In some cases, heart defects do cause signs and symptoms. They depend on the number, type and severity of the defects. Severe defects can cause signs and symptoms usually in newborns. Some symptoms are characterised by :
- Rapid breathing
- Poor blood circulation
- Cyanosis (a blue tint to the skin, lips, and fingernails)
- Fatigue
Congenital heart defects don’t cause chest pain or other painful symptoms.
Heart defect can cause heart murmurs unusual sounds during the heartbeat. Doctors can hear heart murmurs using a stethoscope. However, not all murmurs are signs of congenital heart defects. Healthy children also have heart murmurs.
Babies who have congenital heart defects may have cyanosis and are tired easily while feeding, as a result they may not gain weight or grow as they should.
Many types of congenital heart defects cause the heart to work harder than it should. With severe defects, this can lead to heart failure. Heart failure is a condition in which the heart can’t pump enough blood to the body. Symptoms of heart failure are shortness of breath, fatigue with physical activity. A build up or accumulation of blood and fluid in the lungs.
How to diagnose these defects :
A diagnosis is done generally during pregnancy or soon after birth. Minor defects often have no signs or symptoms. Doctors may diagnose them based on the result from a physical exam or during tests done for any another reason.
During the physical exam, the doctor will listen to your child’s heart and lungs with a stethoscope to look for signs of a heart defect, such as cyanosis, shortness of breath, rapid breathing, delayed growth, or signs of heart failure.
The diagnosis and treatment of complex heart defects have greatly improved over the past few decades. As a result, almost all children who have complex heart defects survive to adulthood and can live active, good and normal lives.
Diagnostic tests :
Echocardiography : it is a painless test that uses sound waves to create a moving picture of the heart. Echo is an important test for both diagnosing a heart problem and following the problem over a long period of time. The test can show or detect problems with the heart’s structure and how the heart is reacting to them. Echo will help your child’s cardiologist decide if and when treatment is needed.
During pregnancy if your doctor suspects that your baby has a congenital heart defect, fetal echo can be considered. This is usually done between 18 to 22 week of pregnancy. If your child is diagnosed with a congenital heart defect before birth your doctor can plan treatment before the baby is born.
- Electrocardiogram : An EKG is also a simple painless test that records the heart’s electrical activity. EKG also records the strength and timing of electrical signs as they pass through the heart.
- Chest X-ray : it is a basic test that creates a picture of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged or in the permissible limit. It also shows whether the lungs have an accumulation of extra blood flow or fluid, which may be a sigh of heart failure.
- Pulse oximetry : I n this test a small sensor is attached to a finger or toe. The sensor gives an estimate of how much oxygen is in the blood. It is used to detect the rate at which oxygen is being taken in.
- Cardiac catheterization : A catheter is put into a vein in the arm, groin, or neck. The connecting tube is threaded to the heart. A special dye is injected through the catheter into a blood vessel. The dye allows the doctor to see blood flowing through the heart and blood vessels on an x-ray image. This can help figure out whether blood is mixing between the two sides of the heart.
Treatment of congenital heart defects :
Doctors repair congenital heart defects with catheter procedures or surgery. Although many children who have congenital heart defects may not need treatment. The treatment depends on the type and severe intensity of one’s heart defect. Other factors include child’s age, size, and general health.
Catheter procedures :
Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin where the catheter is inserted into a vein or an artery. Doctors don’t have to surgically open the chest or operate directly on the heart to repair the defect. In this procedure, recovery may be easier and quicker.
The use of catheter procedures has increased a lot in the past 20years.
Surgery :
A child may need open heart surgery if his or her heart defect can’t be fixed using a catheter procedure. Sometimes one surgery can repair the defect completely. If that’s not possible the child needs more surgeries over months or years to fix the problem.
Generally surgery may use to close holes in the heart with stitches or a patch, to repair or replace the heart valve, and widen arteries or openings to heart valves. Sometimes babies are rarely born with multiple defects that are too complex to repair. These babies may need heart transplantation. In this procedure, the child’s heart is replaced with a healthy heart from a deceased child. The heart has been donated by the child’s family.
Outlook for the patients :
The outlook for children who have congenital heart defects is much better today than in the past. Advances in testing and treatment allow most of these children to survive to adulthood. They are able to live active, productive lives.
Living with congenital heart defect :
Many of these children need only occasional checkups with a cardiologist as they grow up. Children who have complex heart defects need long-term care from trained specialists. This will help them stay healthy as possible and maintain a good quality of life.
Ongoing care :
KIMS provides the best possible ongoing medical care for children with congenital heart defects. Many complex treatments have been researched and simplified by our special team of doctors. Our structural heart disease interventional cardiology procedures cover all the structural defects that are minor or life threatening and the outcome of surgeries is quite positive.
At KIMS, the patient feels like home. Expert Medical advice and individualized treatment options with personal care are our integral part.