Congenital Heart Disease in Children
Children with congenital heart disease are born with a problem in the structure of their heart. Some cases of congenital heart disease are simple and may not require any treatment. However, there are others that are complex and require several surgeries over the years.
Parents whose children suffer from congenital heart disease should try to learn about the condition and understand it so as to know what to expect.
Symptoms of Congenital Heart Disease
Complex congenital heart defects are noticed as soon as the baby is born or during the first months after birth. Signs and symptoms of complex congenital heart disease include:
- rapid breathing
- pale gray or blue skin color (also known as cyanosis)
- shortness of breath especially during feeding and this leads to poor weight gain
- swelling in the belly, legs or areas around the eyes
Symptoms of less serious congenital heart disease are not easily diagnosed until much later into childhood. Signs and symptoms of less serious congenital heart disease in older children are:
- swelling in the feet, hands or ankles
- getting tired easily during activities or exercise
- easily experiencing shortness of breath during activity or exercise.
- fainting during exercise
Serious or complex congenital heart disease is often diagnosed before or soon after birth. If a parent notices that their child has any of the symptoms listed above, they should call the child’s doctor.
It is important to call the doctor if the parent notices any signs or symptoms associated with less serious congenital heart disease. These signs and symptoms are likely to start as the child grows. The doctor will determine if the symptoms are caused by a heart defect or a different medical condition.
Causes of Congenital Heart Disease in Children
Before looking into the causes of this disease, it is important to understand how the heart works.
How the heart works
In order to understand the causes of congenital heart disease, it is necessary to understand how the heart works. The human heart is divided into four hollow chambers. Two on the left and two on the right.
The heart uses chambers on both sides to perform different tasks such as pumping blood throughout the body. Heart chambers on the right side move blood to the lungs through the pulmonary artery.
When the blood gets into the lungs, it gets oxygenated and goes back to the left side of the heart through the pulmonary vein. The left side of the heart pumps blood through the aorta and blood goes out to the rest of the body.
Development of Congenital Heart defects
The heart of the baby begins to form during the first six weeks of pregnancy. When formed, it starts beating. During this important time, blood vessels that transport blood to and from the heart also develop.
Heart defects may begin to form at this critical time. It is not clear what causes heart defects but researchers believe that genetics, environmental factors, social factors such as smoking, some medications and certain medica conditions could play a role in the development of these defects.
There are many types of congenital heart defects that can be categorized as follows:
- Abnormal connections in the heart or blood vessels
Abnormal connections in the heart often allow blood to flow where it would not flow to under normal circumstances. Holes that form in the walls that are between heart chambers are some examples of congenital heart defects that create abnormal connection.
Abnormal connections may cause deoxygenated blood to mix with oxygenated blood. When this happens, amount of oxygen sent through the body of the child is reduced. A child with abnormal connections will have fingernails and a skin that looks pale grey or blue.
The mix-up of oxygenated and deoxygenated blood due to abnormal cells causes the lungs and the heart to work extra hard to accommodate this abnormal flow of blood. There are different types of abnormal connections in blood vessels and in the heart and they include:
- Atrial septal defect – this is a hole that forms between the upper chambers of the heart.
- Patent ductus arteriosus – this is a connection between the aorta and the lung artery. This connection opens as the baby grows and normally closes hours after birth. In some babies however, this connection does not close and remains open. This results in an abnormal flow of blood between the two arteries.
- Ventricular septal defect – this is a hole that forms between the left and right chambers of the lower heart also known as ventricles.
- Total or partial anomalous pulmonary venous connection – this occurs when some or all blood vessels from the lungs also known as pulmonary veins are attached to the wrong area of the heart.
- Congenital heart valve problems
Heart valves are the doorways between blood vessels and heart chambers. These valves close and open to help keep the blood flowing in the direction it is supposed to. If these valves are not bale to open and close as they should, it becomes difficult for blood to flow smoothly.
Heart valves with problems are usually narrowed and are not able to open completely (stenosis). Other valves with defects cannot close completely (regurgitation). There are different types of congenital heart valve problems and they include:
- pulmonary stenosis – this is a defect that occurs on or near the pulmonary valve. The defect causes the opening of the pulmonary valve to become narrow and this slows the flow of blood.
- Epstein anomaly – the valve found between the right upper chamber and the right lower chamber of the heart also known as the tricuspid valves usually malformed and leaks.
- Aortic stenosis – a baby is born with an aortic valve that has one or two valve flaps instead of the usual three flaps. This creates a narrow and smaller opening for the blood to pass. This forces the heart to pump blood through the valve and with time the heart muscles thicken and the heart enlarges.
- Combination of congenital heart defects
Some babies are born with more than one heart defect affecting the structure of the heart and how it functions. Serious heart problems cause significant changes in how the blood flows or heart chambers that are not fully developed.
Tetralogy is a combination of four defects namely:
- a shift in the connection oof the aorta to the heart
- a hole in the wall between the ventricles of the heart
- thickened muscle in the right ventricle
- a narrowed passage between the pulmonary artery and the right ventricle.
There are other examples of complex congenital heart defects that include:
- pulmonary atresia – in this defect, the pulmonary valve is missing and causes abnormal flow of blood to the lungs.
- transposition of the great arteries – this is a serious but rare heart defect. The two main arteries are transposed. There are two types of transpositions. Levo-transposition affects the great arteries. It is rare and its symptoms are not easily identified. Complete transposition of the main arteries is easy to notice during birth or soon after the baby is born.
- tricuspid atresia – in this defect, the tricuspid valve is absent because it is not formed. Instead of the valve, there is a solid tissue between the right lower chamber and the right upper heart chamber.
- Hypoplastic left heart syndrome – in children with this defect, a major part of the heart does not develop, for instance, the left side of their heart may not have developed fully and is not able to pump enough blood to the body as it should.
Risk factors for congenital heart disease
Most of the congenital heart defects occur during the development of the baby in the womb. The exact cause of these defects remains unknown. risk factors for congenital heart defects include;
- rubella – if a mother has rubella during pregnancy, there is a high chance that it will affect the development of the baby’s heart.
- diabetes – women who develop diabetes before getting pregnant can reduce the risk of their baby developing congenital heart disease by controlling their sugar levels before and during pregnancy.
- drinking alcohol during pregnancy – women who drink alcohol while pregnant put their babies at an increased risk of congenital heart disease.
- medications – some medications may increase risk of congenital heart disease and defects. It is aways important to let your doctor know what medications you have been on before trying to get pregnant.
- family history and genetics – children born into families with a history of congenital heart disease are likely to develop it. Some congenital heart defects are hereditary.
- Smoking -smoking during pregnancy increases risk of congenital heart disease.
Complications of Congenital Heart Disease in Children
Possible complications include:
- heart infections – congenital heart defects increase the risk of heart tissue infection that may cause heart valve problems.
- congestive heart failure – this complication develops in children with a major heart defect. Its symptoms include poor weight gain, rapid breathing and gasping breaths.
- heart rhythm problems – also known as arrythmia.
- slower growth and development – children with serious congenital heart defects grow and develop slower than children without any defects.
- mental health disorders – some children with congenital heart disease may develop anxiety and feel stressed or insecure because of their learning difficulties, their size and activity restrictions
- Stroke – this is not common. However, children with congenital heart defects are at an increased risk of stroke because blood clots can travel through the hole in the heart to the brain.
Diagnosis of Congenital Heart Disease
- Before birth – some defects may be detected during pregnancy. Doctors can detect defects in unborn babies using;
- a fetal echocardiogram – pictures are made using an ultrasound to show the heart in motion so as to identify what might be wrong with its structure and valves.
- gene testing – a small sample of the blood is taken before or during pregnancy
- In childhood – other congenital heart defects may be found in infants or kids. These problems can be identified by listening to the child’s heartbeat. If doctors hear an unusual sound, they will order tests such as:
- echocardiogram – this ultrasound is done to take pictures of the heart.
- chest X-ray – an x-ray will show signs of an unusually shaped heart or an enlarged heart and other signs of heart failure.
- electrocardiogram – this test measures the electrical activity of the heart. It can diagnose arrhythmias and parts of the heart working too hard or those that are enlarged.
- Pulse oximetry – this test measures the level of oxygen in the child’s blood using a finger sensor. Too low levels of oxygen will indicate a problem
- MRI and CT scans – these are imaging tests that give a detailed view of the heart.
- cardiac catheterization – this test is done if the other tests indicate congenital heart defect. A catheter is inserted into the heart through the blood vessel in the leg or arm all the way to the heart. A dye is put through it and x-ray videos are used to take videos to help the doctor see inside the heart.
Treatment of congenital heart disease
In today’s world, treatment of congenital hear disease has become easier. Some defects do not require treatment. Treatment can vary from one surgery to several surgeries over the years.
In some cases, children will have to take medications for the rest of their live. They may also need to regularly visit their specialist. Treatment for congenital heart disease includes:
- medications – medications are given to protect the heart from becoming weak due to extra work. For instance, diuretics may be given when surgery is not an option Diuretics help lower fluid levels.
- procedures – technology has enabled doctors to have better and easier ways of fixing heart defects. Catheterization or surgery can be done hour after the baby is born or days or months later.
Some babies will need several procedures. There are two main procedures done for congenital heart disease:
- cardiac catheterization – this procedure is used for 2 major heart repairs which are opening a narrowed artery or valve and closing a hole. For instance, holes found in the wall that separates the 2 sides of the heart are repaired using catheterization.
Catherization is used to also widen stiff or narrowed valves and closing off blood vessels carrying blood to the wrong destination. A catheter may also be fitted with balloon and directed toward an artery or valve that is not working as it should.
Catheterization cannot treat all issues. Children might still need surgery when they grow up.
- Open-heart surgery- in some cases, the child will need open heart surgery. This surgery involves cutting through the breastbone so that the doctor can directly operate on the heart.
Open heart surgery is commonly done for children with a hole in the heart, narrow arteries or problems with the valves. Some children will need more surgeries as they grow because the heart also grows as they grow.
After surgery or a procedure, the baby should be taken to the neonatal intensive care unit. The amount of time the baby spends in this unit depends on their recovery progress and the type of procedure.
When it is time to discharge the baby from the hospital, the doctor will give the parent lots of instructions on home care, what they should do when they have questions and follow up appointments.
Prevention of Congenital Heart Disease in children
It is not 100% possible to prevent congenital heart disease since its cause remains unknown. Mothers at a high risk of giving birth to babies with congenital heart disease should have genetic screening and testing done during pregnancy.
Some of the things that can be done to reduce risk of congenital heart defects and disease include;
- getting proper prenatal care to help keep both the mother and baby healthy
- not drinking or smoking as they can affect the health of the baby. Second hand smoke should also be avoided
- taking multivitamin with folic acid on a daily basis has shown to reduce birth defects in the spinal cord and brain and may also help reduce heart defects
- controlling your blood sugar – pregnant mothers should control their blood sugar levels to reduce risk of the baby developing heart defects.
- managing chronic health conditions. Mothers with underlying health conditions should talk to their doctor on the best way to manage and treat them.
- getting a rubella vaccine during pregnancy can affect the development of the baby’s heart. It is therefore important to ensure that you get vaccinated before getting pregnant.
- pregnant women should check with their doctor before taking any medication since some medications may cause birth defects. Discuss with your doctor all the medications you take not excluding those bought without prescription.
- avoiding harmful substances such as paints and strong-smelling cleaning products when pregnant.