WS Chronicle

When we talk about Heart Disease, many people automatically think that means adults, but it is important to know that infants and children can also be affected by diseases and defects of the heart.

What does congenital mean? The term means “present at birth” – in other words, something went wrong during development. In the case of the heart, which forms very early (nearly totally complete within a month of conception) the defect(s) is/are often present before the woman is aware she is pregnant. On average, one out of every 100 children has some type of defect.

Is congenital heart disease the same as heart disease seen in adults who have heart attacks? No – a congenital heart defect is present at birth. Heart attacks are caused by blockages of the tiny arteries that provide blood flow to the heart muscle itself, the coronary arteries. These blockages take years to form and are made up of fatty deposits.

How is a heart defect detected in a child? Depending on the defect, the child may appear totally normal at birth and the defect detected at a regular check-up when the primary care provider detects an abnormal sound when listening to the heart; this can be as an infant, child, teenager or not detected until adulthood. In other cases, the infant is critically ill immediately after birth, either in shock or is cyanotic (“blue baby”).

Does a heart murmur mean that a child has a heart defect? No – the word murmur simply means “sound.” It is a common misconception that murmur means a defect. Many heart defects do produce abnormal murmurs, but many children, especially pre-schoolers, have normal murmurs related to very thin chest walls. It is similar to being able to hear the water flowing in the pipes in a mobile home – the pipes are normal, but one can hear the sound due to the thin walls.

What types of congenital heart disease are there? There is a huge variety of defects. There can be abnormalities of any of the four heart valves (either some degree of not opening well or leaking), abnormal openings between the chambers (so called “holes” in the heart) or underdevelopment of entire chambers or major vessels leading to the lungs or body.

How is the defect diagnosed? Cardiac ultrasound is one of the main tools used to diagnose heart defects. A chest x-ray and EKG are sometimes helpful as well. Additionally, newer means such as MRI and CT scans (other types of X rays) are being used more frequently. Cardiac catheterization was the main way defects were diagnosed before the advent and improvement in cardiac ultrasound. The procedure is performed with the child asleep (under anesthesia). Then a very small long tube (thin spaghetti size) is passed from a blood vessel (usually one of the large veins or arteries in the leg) up to the heart. Pressures in the different locations in the heart and blood vessels can be measured and very detailed x-ray movie pictures can be made.

Do all congenital heart defects require treatment? No – many defects simply need to be monitored by a pediatric cardiologist as the child grows and matures. Others require surgery, either urgently after birth or at some point during childhood. Some defects can be helped with catheter techniques.

Heart catheterization Echo has nearly replaced the heart catheterization as a diagnostic tool. In other words, the exact defect can nearly always be defined by echo. There are cases, however, where more information is needed such as more exact determination of the pressure in the lung blood vessels and/or better images of those vessels – an area where echo has limitations. There are also some heart/vessel abnormalities that can be treated with catheter techniques – an interventional catheterization.

What is an interventional catheterization? Currently, the majority of heart catheterizations in pediatrics are done now with the goal of an intervention. A variety of defects involving poor opening of valves and narrowing of blood vessels can be opened up with small balloons. During the procedure, the tube is passed across the valve or vessel that doesn’t open fully, a deflated specially designed balloon is passed across the narrowing and the balloons inflated, deflated and removed. This opens up the narrowing and relieves the obstruction.

Is congenital heart disease dangerous? In some cases. In most cases, the child has a near normal life-expectancy, although there may be some limitations with high-level varsity sports. In general, all regular childhood activities are allowed. Some defects, however, have a high likelihood of death and may not be “repairable” – in those cases, sometimes heart transplant is the only option. Can congenital heart disease be prevented? Not at this time because it is not known why heart defects occur. Hopefully eventually we will understand what causes the defects and can prevent them.

Do you need further information or have questions or comments about this article? Please call toll-free 1-877-530-1824. Or, for more information about the Maya Angelou Center for Health Equity, please visit our website: http://www.wakehealth.edu/MACHE.