Congenital Heart Defects

• Congenital heart defects are problems with the heart’s structure that are present at birth. Congenital heart defects change the normal flow of blood through the heart.
• Congenital heart defects are the most common type of congenital disability, affecting 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with congenital heart defects.
• There are many types of congenital heart defects ranging from simple to very complex.
• Doctors don’t know what causes most congenital heart defects. Heredity may play a role.
• Although many heart defects have few or no symptoms, some do. Severe defects can cause symptoms such as:
     ○ Rapid breathing.
     ○ A bluish tint to skin, lips, and fingernails. This is called cyanosis.
     ○ Fatigue (tiredness).
     ○ Poor blood circulation.
• Severe heart defects are usually diagnosed while a baby is still in the womb or soon after birth. Some defects aren’t diagnosed until later in childhood or even in adulthood.
• An echocardiogram is an important test for both diagnosing a heart problem and following the problem over time. This test helps diagnose problems with how the heart is formed and how well it’s working. Other tests include EKG (electrocardiogram), chest x-ray, pulse oximetry, and cardiac catheterization.
• Doctors treat congenital heart defects with catheter procedures and surgery.
• Treatment depends on the type and severity of the defect.
• With new advances in testing and treatment, most children with congenital heart defects grow into adulthood and live healthy, productive lives. Some need special care all through their lives to maintain a good quality of life.

Congenital heart defects are problems with the heart’s structure that are present at 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
Congenital heart defects change the normal flow of blood through the heart.

There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms.

Congenital heart defects are the most common type of congenital disability. They affect 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with congenital heart defects.

Many of these defects are simple conditions. They need no treatment or are easily fixed. Some babies are born with complex congenital heart defects. These defects require special medical care soon after birth.

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 adulthood and can live active, productive lives.

Most people who have complex heart defects continue to need special heart care throughout their lives. They may need to pay special attention to how their condition affects health insurance, employment, birth control and pregnancy, and other health issues.

In the United States, more than 1 million adults are living with congenital heart defects.

How are congenital heart defects diagnosed?

Severe congenital heart defects generally are diagnosed during pregnancy or soon after birth. Less severe defects often aren’t diagnosed until children are older.

Minor defects often have no signs or symptoms. Doctors may diagnose them based on results from a physical exam and tests done for another reason.

Specialists Involved
Pediatric cardiologists are doctors who specialize in the care of babies and children who have heart problems. Cardiac surgeons are specialists who repair heart defects using surgery.

Physical Exam
During a physical exam, the doctor will:
• Listen to your child’s heart and lungs with a stethoscope
• Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or fingernails), shortness of breath, rapid breathing, delayed growth, or signs of heart failure

Diagnostic Tests

Echocardiography
Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen.

The echo allows the doctor to see any problem with the way the heart is formed or how it’s working.

The echo is an important test for both diagnosing a heart problem and following the problem over time. The test can show problems with the heart’s structure and how it reacts to those problems. The echo will help your child’s cardiologist decide if and when treatment is needed.

If your doctor suspects that your baby has a congenital heart defect during pregnancy, fetal echo can be done. This test uses sound waves to create a picture of the baby’s heart while the baby is still in the womb.
Fetal echo usually is done at about 18 to 22 weeks of pregnancy. Suppose your child is diagnosed with a congenital heart defect before birth. In that case, your doctor can plan treatment before the baby is born.

EKG (Electrocardiogram)
An EKG is a simple, painless test that records the heart’s electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.

An EKG can detect if one of the heart’s chambers is enlarged, helping diagnose a heart problem.

Chest X-Ray
A chest X-ray is a painless test that creates pictures of the chest structures, such as the heart and lungs. This test can show whether the heart is enlarged. It can also indicate whether the lungs have extra blood flow or excess fluid, which is a sign of heart failure.

Pulse Oximetry
For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood.

Cardiac Catheterization
A thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck during cardiac catheterization. The tube is threaded to the heart.

A special dye is injected through the catheter into a blood vessel or one of the heart’s chambers. The dye allows the doctor to see blood flowing through the heart and blood vessels on an x-ray image.

The doctor also can use cardiac catheterization to measure the pressure and oxygen level inside the heart chambers and blood vessels. This can help the doctor figure out whether blood is mixing between the two sides of the heart.

Cardiac catheterization also is used to repair some heart defects.

How are congenital heart defects treated?

Although many children who have congenital heart defects don’t need treatment, some do. Doctors repair congenital heart defects with catheter procedures or surgery.

Sometimes doctors combine catheter and surgical procedures to repair complex heart defects, which may involve several defects.
The treatment your child receives depends on the type and severity of his or her heart defect. Other factors include your child’s age, size, and general health.

Some children who have complex congenital heart defects may need several catheter or surgical procedures over a period of years or need to take medicines for years.

Catheter Procedures
Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin. The catheter (thin, flexible tube) 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(s). This means that recovery may be more comfortable and quicker.

The use of catheter procedures has increased a lot in the past 20 years. They have become the preferred way to repair many simple heart defects, such as atrial septal defect (ASD) and pulmonary valve stenosis.
For ASD repair, the doctor inserts a catheter into a vein in the groin (upper thigh). He or she threads the tube to the heart’s septum. A device made up of two small disks, or an umbrella-like device is attached to the catheter.

When the catheter reaches the septum, the device is pushed out of the catheter. The device is placed so that it plugs the hole between the atria. It’s secured in place, and the catheter is withdrawn from the body.
Within six months, normal tissue grows in and over the device. The closure device does not need to be replaced as the child grows.

For pulmonary valve stenosis, the doctor inserts a catheter into a vein and threads it to the heart’s pulmonary valve. At the end of the catheter, a tiny balloon is quickly inflated to push apart the leaflets or “doors” of the valve.

Then, the balloon is deflated, and the catheter and balloon are withdrawn. This procedure can be used to repair any narrowed valve in the heart.

To help guide the catheter, doctors often use echocardiography (echo), transesophageal echo, and coronary angiography.

TEE is a particular type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from the mouth to the stomach. Doctors also use TEE to examine complex heart defects.

Surgery
A child may need open-heart surgery if their 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 may need more surgeries over months or years to fix it.
Cardiac surgeons may use open-heart surgery to:
• Close holes in the heart with stitches or a patch
• Repair or replace heart valves
• Widen arteries or openings to heart valves
• Repair complex defects, such as problems with the location of blood vessels near the heart or how they are formed

Rarely, babies are born with multiple defects that are too complex to repair. These babies may need heart transplants. In this procedure, the child’s heart is replaced with a healthy heart from a deceased child. The heart is usually a donation from one family to another.

MEDICAL DISCLAIMER:

By reading this website, you acknowledge that you are responsible for your own health decisions. The information throughout this medical website is not intended to be taken as medical advice. The information provided is intended for general information regarding our cardiovascular clinic in Brooklyn, New York. If you experience chest pain, dizziness, nausea, or unusual shortness of breath, please stop and seek medical attention.

If you are interested in finding out more, please contact our Multi-Specialty Facility. Avoid worrisome self-diagnosis; the best cardiology doctors will properly diagnose your problem and refer you to a specialist if necessary. No information on this site should be used to diagnose, treat, prevent, or cure any disease or condition.