Congenital heart defect is a problem of the heart that occurs in babies as they are developing during pregnancy (in the mother’s womb), before the baby is even born. These congenital heart defects are the most common type of birth defects. A baby’s heart starts its development at conception (when the male egg fertilizes the female egg), but the heart completes its development at eight weeks into the pregnancy. Therefore,
congenital heart defects happen during this critical first eight weeks of the baby’s development. The body forms in a very precise manner and these steps must take place in sequence, order for the heart to form rightly. Mostly, congenital heart defects are the result of one of these crucial steps not happening as they should or at the right time. For instance, if a hole is left where a septum or dividing wall should have formed or only one blood vessel is there, where two should have been. These congenital heart defects (CHDs) defects vary in severity, ranging from tiny pin-point holes between the chambers of the heart that may resolve spontaneously, to serious significant malformations that can require numerous surgical procedures for repair.
What are the causes for congenital heart defects ?
A congenital heart problem is initiated when the baby is in-utero (in the mother’s womb). As mentioned above, for the heart to form, a very complex series of events take place. These include formation of the heart chambers (to simplify, those are the rooms of the heart), heart septae (dividing walls of the heart), and incoming and outgoing blood vessels of the heart. Disruption at any point during this formation stage can result in a congenital heart defect. The causes can be attributable either to genetics or to the environment, or sometimes to a combination of both. Pregnancy is a defining period for the development of the baby’s heart, and certain infections such as rubella or German measles, use of alcohol, tobacco or certain medicines, and maternal obesity in the phase of pregnancy can cause these cardiac defects. Having a parent with congenital heart disease also ups the risk.
The genetic disorders that can cause congenital heart defects include Down’s syndrome (this is a genetic disorder wherein uncharacteristic cell division causes an extra full or partial copy of chromosome 21), Turner’s syndrome (a genetic defect seen only in women wherein affected women have only a single X chromosome, instead of the usual double set) or Di George’s syndrome (a syndrome that has deletion of a small segment of chromosome 22).
What are the types of congenital heart defects ?
The general classification divides Congenital Heart Defects into the following.
- Hypoplastic defects (Hypoplastic left heart syndrome or hypoplastic right heart syndrome)- when the left or right side of the heart does not form correctly.
- Obstruction defects (pulmonary stenosis or aortic stenosis)- when the pulmonary vessels (outgoing vessels from the heart to the lung) or the aorta (main blood vessel from the heart to the body) is thinned or constricted, this obstructs blood flow lungs or to the lower part of the body respectively and escalates blood pressure above the constriction.
- Septal defects (patent ductus arteriosus, atrial or ventricular septal defects) – these are defects in the heart walls dividing the chambers. They are supposed to be separate and fully formed, but sometimes these walls develop with holes or communications between them.
- Cyanotic heart defects (tetralogy of Fallot, transposition or exchange of great vessels)- These defects result in a low blood oxygen level. That results in cyanosis or a bluish discoloration of the skin and mucous membranes, due to their inadequate oxygenation.
The defects can also vary in that some of them increase blood flow to the lungs (such as in Patent ductus arteriosus, when the normal closure of the patent ductus arteriosus does not occur or in cases of Septal Defects) and some of them decrease blood flow to lungs (such as tetralogy of Fallot, or in transposition or exchange of great vessels).
The most common complex cardiac defects include the Tetralogy of Fallot (TOF), septal defects like atrioventricular septal defects (ASD), coarctation of the aorta, transposition of the great arteries and hypoplastic left heart syndrome.
What are the warning signs and symptoms of congenital heart disease ?
The signs and symptoms noted are related to the kind of heart defect and its severity. You may notice the symptoms early in life, or sometimes, it may remain asymptomatic for a very long duration or all through your child’s life. Signs and symptoms include difficulty in breathing, cyanosis (bluish discoloration of skin and mucous membranes or the lining of cavities of the body), clubbing (it is a differently shaped downward sloping of the nails), fainting and abnormal heart sounds (heart murmurs that can be detected on stethoscope).
How can congenital heart defects be diagnosed ?
Many congenital heart defects can be detected even when the baby is in the womb or in the prenatal stage itself. This diagnosis test can be done in the second trimester of pregnancy by either an abdominal or transvaginal ultrasound (through an ultrasound probe inserted via the vagina). Non-invasive tools that accurately delineate heart defects are cardiac tests like electrocardiography and echocardiography, chest radiography and magnetic resonance imaging. The invasive tools include cardiac catheterization. Catheterization can give accurate
measurement of lung vascular resistance and volume of shunting. Angiography can provide information on the location of a defect and the number of defects.
How are congenital heart defects treated ?
A baby may even “outgrow” the simpler type of heart problems, like patent ductus arteriosus or atrial septal defect. These heart defects may merely close up on their own with growth and development. Other babies may have a mixture of heart defects that necessitates numerous operations throughout their lives.
What is congenital heart surgery ?
Surgery is the treatment for complex congenital heart defects. The common congenital heart defects requiring surgery are listed below with their treatments. Tetralogy of Fallot: A temporary operation may be done at first but it has to be followed by complete repair. If possible, the first operation can be made into a complete repair.
Septal Defects: Sealing a big septal defect by open-heart surgery typically is done in infancy or childhood even in patients with hardly any symptoms, to put a stop to complications afterwards. What is done usually is a patch of synthetic material or pericardium (the outer lining of the heart) is stitched over the septal defect to secure it entirely. Later this patch gets incorporated in the healing tissue and becomes a permanent element of the heart. Coarctation of the Aorta: Coarctation of the aorta, otherwise called as aortic coarctation, is a narrowing of the aorta, the major blood vessel of the heart supplying oxygen and nutrients to the whole of the body. If this occurs, your heart pumps harder to force blood out through the narrowed segment of your aorta.
It can be corrected by a coarctoplasty surgery that opens the narrowed arteries carrying blood from the veins to the aorta. A stent can be inserted into the aorta to maintain the patency of the aorta. The coarctoplasty can be either done by catheterization or by open surgical repair. Transposition of the great arteries: An arterial switch operation is a surgery done to reverse transposition of the great arteries exiting the heart (TGA) with or without ventricular septal defect (VSD).
Hypoplastic left heart syndrome: The procedure is done in two steps.
- By first establishing systemic circulation: A part of the pulmonary artery is divided from the main pulmonary artery and then channeled to join the upper aorta.
- By then routing the pulmonary circulation: As the rest of the pulmonary artery is now disconnected from the heart, certain shunt techniques must be used to provide blood to the lungs.
Who treats congenital heart defects ?
In case your baby is diagnosed with congenital heart problems, you need to see a specialist called the paediatric cardiologist. These doctors diagnose and manage congenital heart defects. They treat a child’s heart health both before and after surgical repair of the heart. Specialist surgeons correcting heart problems in the operating room are known as paediatric cardiovascular or cardiothoracic surgeons. As the child with the congenital heart defect reaches adulthood, they will shift to the appropriate type of cardiac care. Children with a simple congenital heart defect can generally be treated by a community adult cardiologist. Those with more complex types of congenital heart defect will need to be cared for at a centre that specializes in the adult congenital heart
disease. For adults with this disease, they need guidance on physical activities, career, employment, insurance, lifestyle, family planning and long-term care. Expectations for lasting outcomes and possible complications and risks, must be discussed with your child’s doctors as part of a good transition from paediatric care to adult care.
Are congenital heart defects preventable ?
Congenital Heart Defects which are caused by maternal infection of rubella, can be prevented by vaccination against rubella. Folic acid supplementation in pregnancy also can help prevent heart defects. Certain medicines like dispirin/ aspirin are to be avoided in the third trimester of pregnancy.
How to find pediatric cardiac surgeons for congenital heart surgery ?
Now you can find pediatric cardiac surgeons for congenital heart surgery from different hospitals and destinations on a single platform, Hinfoways. You can avail opinions and information from multiple pediatric cardiac surgeons, get approximate cost of congenital heart surgery from various heart hospitals, compare things and then choose a pediatric cardiac surgeon for congenital heart surgery.
Find and choose a pediatric cardiac surgeon for congenital heart surgery on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
