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Congenital Heart Disease

Alternative names: Atrial Septal Defect, Ventricular Septal Defect, Hole in the Heart

What is congenital heart disease?
What are the signs of congenital heart disease?
What causes congenital heart disease?
How does my doctor tell if I have congenital heart disease?
How is congenital heart disease treated?

What is congenital heart disease?

Congenital heart diseases happen when a baby's heart does not develop normally in the womb. These diseases affect the heart's structure and the way it works.

Two common congenital heart diseases are:

  • Atrial septal defect (ASD), or a hole between the heart's two upper chambers (the atria)
  • Ventricular septal defect (VSD), or a hole between the heart's two lower chambers (the ventricles). This is the most common congenital (present at birth) heart disease.

What are the signs of congenital heart disease?

Many children with ASD have no symptoms. But as a child grows to adulthood, ASD can cause these symptoms:

  • Difficulty breathing, especially during exertion
  • A "flopping" in the chest, or heart palpitations

Adults with ASD are at risk for developing:

A baby may not show signs of VSD until several weeks after birth. These symptoms include:

  • Shortness of breath
  • Pale skin
  • Deep, rapid breathing
  • A rapid heart rate (pulse)
  • Frequent respiratory infections
  • A failure to gain weight or grow
  • Sweatiness while feeding

What causes congenital heart disease?

There is no specific cause for most types of congenital heart disease, but some conditions do increase a baby's risk of being born with a heart defect. They include:

  • Congenital heart disease in the baby's mother, father, or siblings (genetics)
  • Diabetes in the baby's mother
  • German measles, toxoplasmosis (an infection that is passed through contact with cat feces), or HIV infection in the baby’s mother
  • The baby's mother using alcohol or cocaine during pregnancy

ASD: A baby’s heart normally has a hole in the wall (septum) between the left and right atria before the baby is born. Usually, this hole closes soon after birth. If it does not close completely, blood leaks from the heart's left side back to the right side. This means that some blood is not getting sent to the lungs, and refreshed with oxygen. In time the right atrium can grow larger than the left because of pressure differences.

VSD: As a baby develops in its mother's womb, a wall grows to separate the lower heart chambers, or ventricles. Sometimes this wall, or septum, does not completely form. If the hole that remains is small, often it will close on its own after birth. But with a large hole, too much blood is pumped into the lungs. This can lead to congestive heart failure, where the heart can't deliver enough blood to your body's cells.

In rare cases, a heart attack can cause VSD in an adult. This is not a birth defect.

How does my doctor tell if I have congenital heart disease?

In some cases, a doctor can diagnose congenital heart disease even before a baby is born. When a child is still very young, a doctor can check for congenital heart disease by:

  • Using a stethoscope to listen to the child's heart. ASD and VSD make the sound of blood rushing across the hole in the heart.
  • Taking a chest X-ray to see if the heart is larger than normal, or to see if there is fluid in the child's lungs
  • Using an electrocardiogram (ECG or EKG) to measure the electrical activity of your heart. It helps your doctor see how well your heart beats, and can tell if your heart muscle has been damaged in any way. A technician puts small metal disks—electrodes—on your skin to read the pattern of electrical impulses from your heart. The test only takes a few minutes, and is often used to diagnose a heart arrhythmia, or irregular heartbeat.
  • Taking an echocardiogram, which uses sound waves to make a picture of your heart. Your doctor sees this image on a television monitor, and can examine how well your heart works. The test takes about 45 minutes, and is painless.
  • In some cases, a doctor will use heart catheterization to record information from inside the heart. With the patient awake and under pain medicine, the doctor inserts a thin, flexible tube called a catheter into an artery in the leg, and guides it into the heart. The doctor can then perform many tests, including an angiography, where an injected dye shows the heart and its arteries.

How is congenital heart disease treated?

ASD
Almost half of atrial septal defects will close by themselves before the child is two years old. Surgery is usually recommended in serious cases: if the hole is large, and/or the right side of the heart has grown bigger than normal, and/or the child has high blood pressure in his or her lungs.

Non-surgical

  • A newer procedure uses a thin, flexible tube, called a catheter, to deliver a closure device to the hole in the heart. The surgeon puts the catheter into the body near the groin, and guides it up an artery to the heart. Tiny devices close and block the hole after the catheter is removed.

Surgical

  • In open-heart surgery, a surgeon stitches shut the hole in the heart, or covers it with a Gore-tex patch. Heart tissue will grow over the patch and make it a permanent part of the heart.

VSD
Many children with VSD do not need surgery. The hole may close naturally, or it may be too small to cause damage to the heart and lungs. But if the hole is large, doctors recommend surgery to prevent future problems.

Surgical

  • In open-heart surgery, a surgeon stitches shut the hole in the heart, or covers it with a Gore-tex patch. Heart tissue will grow over the patch and make it a permanent part of the heart.
  • A newer type of surgery uses a thin, flexible tube, called a catheter,to deliver a closure device to the hole in the heart. The surgeon puts the catheter into the body near the groin, and guides it up an artery to the heart. Tiny occlusion devices close and block the hole after the catheter is removed.
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