About Congenital Heart Defects

By Dr. Akhilesh Singh.
Congenital heart defects are problems with the heart’s structure that are present at birth. These defects can involve:
• The interior walls of the heart
• The valves inside the heart
• The arteries and veins that carry blood to the heart or the body
Many of these defects are simple conditions. They need no treatment or are easily fixed. Some babies are born with complex congenital heart defects. These defects require special medical care soon after birth.
The diagnosis and treatment of complex heart defects has greatly improved over the past few decades. As a result, almost all children who have complex heart defects survive to adulthood and can live active, productive lives.
Most people who have complex heart defects continue to need special heart care throughout their lives. They may need to pay special attention to how their condition affects issues such as health insurance, employment, birth control and pregnancy, and other health issues.
There are many types of congenital heart defects. Some are simple, such as a hole in the septum. The hole allows blood from the left and right sides of the heart to mix. Another example of a simple defect is a narrowed valve that blocks blood flow to the lungs or other parts of the body.
Other heart defects are more complex. They include combinations of simple defects, problems with the location of blood vessels leading to and from the heart, and more serious problems with how the heart develops.
Examples of Simple Congenital Heart Defects
Holes in the Heart (Septal Defects)
Atrial septal defect (ASD).
An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. The hole allows oxygen-rich blood from the left atrium to flow into the right atrium, instead of flowing into the left ventricle as it should. Many children who have ASDs have few, if any, symptoms.
ASDs can be small, medium, or large. Small ASDs allow only a little blood to leak from one atrium to the other. They don’t affect how the heart works and don’t need any special treatment. Many small ASDs close on their own as the heart grows during childhood.
Medium and large ASDs allow more blood to leak from one atrium to the other. They’re less likely to close on their own.
About half of all ASDs close on their own over time. Medium and large ASDs that need treatment can be repaired using a catheter procedure or open-heart surgery.
Ventricular septal defect (VSD).
A VSD is a hole in the part of the septum that separates the ventricles—the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle into the right ventricle, instead of flowing into the aorta and out to the body as it should.
VSDs can be small, medium, or large. Small VSDs don’t cause problems and may close on their own. Medium VSDs are less likely to close on their own and may require treatment.
Large VSDs allow a lot of blood to flow from the left ventricle to the right ventricle. As a result, the left side of the heart must work harder than normal. Extra blood flow increases blood pressure in the right side of the heart and the lungs.
The heart’s extra workload can cause heart failure and poor growth. If the hole isn’t closed, high blood pressure can scar thearteries in the lungs.
Doctors use open-heart surgery to repair VSDs.
Patent Ductus Arteriosus
Patent ductus arteriosus (PDA) is a fairly common heart defect that can occur soon after birth. In PDA, abnormal blood flow occurs between the aorta and the pulmonary artery.
PDA is treated with medicines, catheter-based procedures, and surgery. Small PDAs often close without treatment.
Narrowed Valves
Simple congenital heart defects also can involve the heart’s valves. These valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart (the aorta and the pulmonary artery).
Valves can have the following types of defects:
• Stenosis. This defect occurs if the flaps of a valve thicken, stiffen, or fuse together. As a result, the valve cannot fully open. Thus, the heart has to work harder to pump blood through the valve.
• Atresia. This defect occurs if a valve doesn’t form correctly and lacks a hole for blood to pass through. Atresia of a valve generally results in more complex congenital heart disease.
• Regurgitation. This defect occurs if a valve doesn’t close tightly. As a result, blood leaks back through the valve.
What Are the Signs and Symptoms of Congenital Heart Defects?
Many congenital heart defects cause few or no signs and symptoms. A doctor may not even detect signs of a heart defect during a physical exam.
Some heart defects do cause signs and symptoms. They depend on the number, type, and severity of the defects. Severe defects can cause signs and symptoms, usually in newborns. These signs and symptoms may include:
• Rapid breathing
• Cyanosis
• Fatigue
• Poor blood circulation
Congenital heart defects don’t cause chest pain or other painful symptoms.
Normal growth and development depend on a normal workload for the heart and normal flow of oxygen-rich blood to all parts of the body. Babies who have congenital heart defects may have cyanosis and tire easily while feeding. As a result, they may not gain weight or grow as they should.
Older children who have congenital heart defects may get tired easily or short of breath during physical activity.
Many types of congenital heart defects cause the heart to work harder than it should. With severe defects, this can lead to heart failure. Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. Symptoms of heart failure include:
• Shortness of breath or trouble breathing
• Fatigue with physical activity
• A buildup of blood and fluid in the lungs
• Swelling in the ankles, feet, legs, abdomen, and veins in the neck
Singh is a Healthcare Facilitator based in New Delhi, India
.