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Heart Defects

Congenital heart defect affects about eight per 1000 babies. The child can present in many ways depending on the type and severity of the heart defect. The heart has four chambers, the upper atria and the lower ventricles and functions as right side and left side of the heart.

The de-oxygenated blue blood returns from the body (systemic circulation) into the right side of the heart and is then pumped through the pulmonary valve into the lungs (pulmonary circulation) for oxygenation. The pink oxygenated blood enters into the left side of the heart and is then pumped into the body through the aorta. The systemic pressure is much higher than the pulmonary pressure.

How would your child present?

Children with congenital heart defect present in the following ways:

  • Heart murmur – This is the sound produced by a disturbance or turbulent blood flow, for example through a hole in the heart or a narrowed valve. This murmur can be very soft at birth and may be detected later in an otherwise healthy looking child.
  • Blue colour (cyanosis) – Your baby can be blue from early infant life. This cyanosis results from excessive de-oxygenated blood in the systemic circulation.
  • Heart failure – Your baby may have rapid breathing or breathlessness at rest or during feeding.
  • Failure to gain body weight due to heart failure or the lack of oxygen in cyanotic heart disease.

Diagnosis of the types of heart defect. Your doctor will carry out some investigations which include:

  • Electrocardiography (ECG) to look for the abnormal electrical activity of the heart.
  • Chest x-ray to look at the size and shape of the heart and the blood vessels of the lungs.
  • Echocardiography –  scanning of the heart will demonstrate the abnormalities in the heart hence a correct diagnosis can be made in most patients.
  • If necessary, your baby will be referred to a heart specialist for further assessment for management of the heart.

Treatment

Points to remember :

  • An accurate diagnosis is important to plan for the management.
  • The heart condition of your baby is dynamic and the deterioration can be subtle.
  • Dental hygiene and antibiotic given during dental procedures and surgery is important to prevent bacteria growing inside the heart.
  • Your baby may not need any intervention or surgery if the defects do not cause any impact on the blood circulation or body, eg in mild PS, small ASD and small VSD.
  • Babies with cyanotic heart defect should be assessed as to whether palliative surgery (to make your baby feel better) or corrective surgery can be done. Types of heart defect (the list is long and only the common defects are mentioned).

Type of heart defect:

  1. Pink (acyanotic) heart defects with shunt
    • Ventricular septal defect (VSD) is a hole between the two ventricles resulting in left to right flow through the opening. Some VSD will close by itself with time. The decision for open heart surgery will depend on the size and site of the VSD.
    • Atrial septal defect (ASD) is a hole between the two atria. Moderate ASD may be closed by an occluder (without open heart surgery) and large ASD needs open heart surgery.
    • Atrio-ventricular septal defect (AVSD): This condition is often associated with Down syndrome and open heart surgery if offered should be done as early as in the first year of life.
    • Patent ductus arteriosus (PDA) is a blood vessel connecting the aorta and the pulmonary artery. Small and moderate PDA can be closed by an occluder (without incision scar on the chest) and large PDA needs surgical closure. In babies born prematurely, the PDA can remain open during illness and medication can be given to try to close it.
  2. Blue (cyanotic) heart defects
    • Transposition of great arteries (TGA) : In this defect, the blood vessels leaving the ventricles are switched resulting in an increase in pulmonary blood flow and heart failure. Some of these babies require a very urgent procedure within the first few hours of life.
    • Fallot tetralogy – In this defect there is a presence of a VSD together with variable narrowing of the pulmonary valve resulting in very little blood flow into the pulmonary circulation. A palliative surgery may be done prior to the corrective surgery.
  3. Heart defect with obstruction
    • Pulmonary stenosis (PS) where there is a narrowing of the valve between the right ventricle and the pulmonary artery. This narrowed valve can be dilated by using a balloon inserted through the blood vessel in the leg.
    • Aortic stenosis (AS): There is narrowing of the valve between the left ventricle and aorta. The child may have to limit his physical activities especially those strenuous and competitive sports.

Further Children

This condition is preventable through childhood immunisation.

The majority of patients should carry on their usual childhood activities. Children with complex cyanotic heart defect are not likely to be as active as normal children even after undergoing heart surgery.

Care of Teeth Endocarditis

The germs from dental cavities can lead to bacterial growth inside the heart causing a very serious condition known as infective endocarditis.

Support Groups

No parent support parent group for the majority of congenital heart defect. Your doctor can answer most of your queries. Down syndrome support group is available.

Last reviewed : 26 April 2012
Content Writer : Dato’ Dr. Jimmy Lee Kok Foo
  : Dr. Leow Poy Lee
Reviewer : Dr. Sharifah Ainon bt. Ismail Mokhtar

 

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