Navigating the Complex Landscape of Congenital Heart Defects: Understanding, Challenges, and Hope

Congenital heart defects (CHDs) stand as a multifaceted challenge within the realm of medical conditions, affecting individuals from birth and demanding a nuanced understanding of both their complexity and the hope for effective interventions. In this comprehensive exploration, we delve into the intricate world of congenital heart defects, examining their nature, causes, impact, and the strides made in diagnosis and treatment. As we unravel the layers of this condition, we also shed light on the resilience of those affected and the ongoing efforts to enhance the lives of individuals living with congenital heart defects.

I. Understanding Congenital Heart Defects:

A. Definition and Scope:

Congenital heart defects refer to structural abnormalities in the heart that are present at birth. These defects can affect the heart's walls, valves, arteries, or veins, disrupting the normal flow of blood. CHDs vary widely in severity, from simple defects that may never cause symptoms to complex conditions that require immediate medical intervention.

B. Types of Congenital Heart Defects:

Septal Defects: These involve holes in the heart's walls, leading to abnormal blood flow between its chambers. A common example is atrial septal defect (ASD) or ventricular septal defect (VSD).

Valvular Defects: Conditions like stenosis (narrowing) or regurgitation (leaking) of heart valves can impede blood flow and strain the heart's function.

Cyanotic Defects: These defects cause a shortage of oxygen in the blood, leading to a bluish tint in the skin and lips. Tetralogy of Fallot is a notable example.

Obstructive Defects: Conditions such as coarctation of the aorta or pulmonary stenosis create obstacles to blood flow, requiring the heart to work harder.

C. Causes of Congenital Heart Defects:

While the exact causes of CHDs often remain unknown, a combination of genetic and environmental factors contributes to their development. Genetic mutations, maternal illnesses or medications during pregnancy, and exposure to certain environmental factors may increase the risk of CHDs.

II. Diagnosis and Screening:

A. Prenatal Screening:

Advancements in medical technology have enabled the detection of congenital heart defects during pregnancy. Fetal echocardiography, a specialized ultrasound, allows healthcare professionals to assess the structure and function of the fetal heart, aiding in early diagnosis and intervention.

B. Postnatal Diagnosis:

Some congenital heart defects are diagnosed soon after birth through physical exams and observations of the newborn's color, breathing patterns, and overall health. Further diagnostic tools, such as echocardiography, electrocardiography (ECG or EKG), and imaging studies like magnetic resonance imaging (MRI), help healthcare providers assess the severity and type of CHD.

III. Challenges and Impact:

A. Medical Complexity:

The medical complexity of congenital heart defects can vary widely, with some cases requiring immediate intervention, while others may not surface until later in life. The intricate nature of these conditions demands a multidisciplinary approach, involving pediatric cardiologists, cardiothoracic surgeons, and other specialists.

B. Emotional and Psychological Impact:

The diagnosis of a congenital heart defect often brings emotional and psychological challenges for both individuals and their families. Coping with the uncertainty, potential surgeries, and long-term medical care can be overwhelming. Support networks, counseling services, and patient advocacy groups play crucial roles in helping families navigate these challenges.

C. Lifelong Management:

While advancements in medical science have significantly improved outcomes for individuals with congenital heart defects, many require lifelong management. This may involve medication, routine check-ups, and, in some cases, multiple surgeries throughout their lives.

IV. Treatment and Interventions:

A. Medications:

Certain medications can help manage symptoms and improve the heart's function. Diuretics, anticoagulants, and medications to regulate blood pressure may be prescribed based on the specific needs of the individual.

B. Surgical Interventions:

Many congenital heart defects require surgical interventions to correct structural abnormalities. Procedures range from closing septal defects to repairing or replacing heart valves. The timing of surgery depends on factors such as the severity of the defect and the overall health of the individual.

C. Interventional Cardiology:

Advancements in interventional cardiology have led to less invasive procedures for certain congenital heart defects. Catheter-based interventions, such as balloon angioplasty or stent placement, can be used to address issues like narrowed blood vessels or valve problems without the need for open-heart surgery.

V. Research and Advances:

A. Genetic Research:

Ongoing genetic research holds promise for identifying the underlying genetic factors contributing to congenital heart defects. Understanding the genetic basis of CHDs may lead to targeted therapies and more personalized treatment approaches.

B. Fetal Interventions:

Research in fetal medicine is exploring the possibility of interventions while the baby is still in the womb. This groundbreaking field aims to correct or alleviate certain congenital heart defects before birth, potentially improving long-term outcomes.

C. Stem Cell Therapy:

Explorations into stem cell therapy for congenital heart defects offer potential avenues for regenerating damaged cardiac tissue. While in the early stages of research, this innovative approach holds promise for future treatment modalities.

VI. Living with Congenital Heart Defects:

A. Patient Advocacy and Support:

Patient advocacy groups and support networks play a vital role in empowering individuals living with congenital heart defects and their families. These communities provide resources, emotional support, and platforms for sharing experiences, fostering a sense of connection and understanding.

B. Lifestyle Considerations:

Individuals with congenital heart defects often benefit from adopting heart-healthy lifestyles. Regular exercise, a balanced diet, and appropriate medical management contribute to overall well-being. However, it's crucial to consult healthcare professionals to determine the most suitable lifestyle choices for each individual case.

C. Advancements in Adult Congenital Heart Care:

With improved medical interventions and long-term management strategies, more individuals with congenital heart defects are surviving into adulthood. Specialized care for adults with congenital heart disease is emerging as a critical field, addressing the unique challenges faced by this growing population.

VII. Conclusion: Embracing Hope and Resilience

In the intricate tapestry of congenital heart defects, each thread tells a story of resilience, medical advancements, and the enduring human spirit. The journey of those affected by CHDs encompasses challenges, triumphs, and the unwavering pursuit of a fulfilling life. As research progresses, treatment options expand, and support networks strengthen, there is hope that the narrative surrounding congenital heart defects will continue to evolve, emphasizing not only the complexities but also the possibilities for a brighter and healthier future. By fostering awareness, advancing medical knowledge, and embracing a holistic approach to care, we can collectively contribute to a world where individuals with congenital heart defects can thrive and lead fulfilling lives.

PDA (Patent Ductus Arteriosus) - A Parents' Guide For Premature Babies

As a parent in the NICU I lost count of how many times I got the PDA demonstration. I think most nurses love to demonstrate their medical knowledge and the PDA is something that they all feel they know something about. Out comes the giant picture of the blue and red heart and then comes the spiel. I heard it enough times that I should know it verbatim. Unfortunately every version was different, so without further research I would have been left confused. I often noticed other couples getting the cot-side impromptu presentation nodding along furiously then looking bemusedly at each other when the nurse disappeared.

PDA stands for Patent Ductus Arteriosus. Patent in this sense means "open", not "shiny" as in patent leather shoes. So, the Ductus Arteriosus is open, it should be closed.

What is the Ductus Arteriosus?

Pre-birth we all live in water, amniotic fluid. There's an argument that even after birth we all live in water, only we carry our ocean around with us. The word "amniotic" comes from the Ancient Greek word for bowl. So, as we live our pre-birth goldfish like existence in our bowl of water, how do we breathe? Well, our mothers do our breathing for us. Oxygenated blood is passed through the placenta from the mother to the fetus, thus leaving the fetus' lungs alone to concentrate on developing. That is why they are the last of the organs to develop before birth. This is also why so many premature babies have breathing difficulties and are constantly monitored for oxygen saturation. It is very difficult for the premature baby to maintain suitable oxygen saturation in her own blood using her own undeveloped lungs. To compensate for this, the baby is given an air supply with more concentrated oxygen levels than normal air (which is around 21% oxygen, the rest being mostly nitrogen).

So, what does the DA do? Well, when it is "patent" (ie "open") it allows the blood to flow through the heart without going through the lungs. There's no point pushing the blood through the lungs when they are immature and fluid-filled, they can not yet oxygenate the blood. In a full-term birth, the duct will close itself off anywhere from a few hours after birth to a few weeks. It does this by becoming more fibrous and eventually sealing itself off.

What does this mean for a Premmie?

In most preterm births the PDA will remain. The amount it is open is normally described in millimeters and can be anything from less than half a millimeter open to a few millimeters open. Normally, a PDA is evident to the doctor listening through a stethoscope as a background murmuring like a motorbike. An echo-cardiogram will almost certainly be performed to measure how open the duct is. This is a simple non-invasive test, just like an ultrasound.

After the test, the doctors will determine a course of action to close the DA if required. Well, that's if you're in a NICU which has a philosophy of closing PDAs. Like many matters in the NICU, there will be a philosophy in that Unit which is unique to that unit. Some will try to close the PDA with gusto, others will decide if the PDA is "hematologically significant" and take action based on that. That means, they will decide if the DA being open is a problem or not.

Treatment will either be pharmaceutical or surgical. The surgery is relatively uncomplicated. They will "ligate" the PDA, ie tie it off. Normally they will opt for a pharmaceutical approach to begin with. Commonly, a course of indomethacin is prescribed. The indomethacin is normally given as a course, the frequency and strength of which again will vary from NICU to NICU. Why this would vary is not clear to me. Surely some consensus of medical best practice has been reached and adopted by all clinicians? Not so, unfortunately. This variability is a recurring theme for most most decisions concerning premature babies. All I can suggest is that you research thoroughly, arm yourself with as much knowledge as you can and not be afraid to ask questions in the NICU. There really is no such thing as a stupid question.

In some countries a more successful drug for closing the PDA has been Ibuprofen, which is commonly taken for headaches. This isn't approved for use in all countries yet though, so may or may not be offered depending on your location.

Hopefully, the first course of drugs will close the PDA or at least reduce it to a size that is no longer significant. If not, another course of indomethacin may be prescribed. From memory, it has around a 30% efficacy so two courses will make it more likely than not that the DA will be closed but it is still reasonably possible that it won't be. There's a limit to how many courses of indomethacin will be administered. Two in our case, but again this will depend on the dosage used, which is variable unit to unit. Hopefully by this point the DA will now be significantly smaller. If not, surgery will probably be necessary. This surgery is a lot less invasive than it used to be.

( Scott L Miller ) 

Heart Diseases Part IX - Congenital Heart Disease

Congenital heart diseases affect any part of the heart such as heart muscle, valves, and blood vessels. Congenital heart disease refers to a problem with the heart's structure and function due to abnormal heart development before birth. Every year over 30,000 babies are born with some type of congenital heart defect in US alone.

Congenital heart disease is responsible for more deaths in the first year of life than any other birth defects. Some congenital heart diseases can be treated with medication alone, while others require one or more surgeries. The causes of congenital heart diseases of newborns at birth may be in result from poorly controlled blood sugar levels in women having diabetes during pregnancy, some hereditary factors that play a role in congenital heart disease, excessive intake of alcohol and side affects of some drugs during pregnancy. Congenital heart disease is often divided into two types: cyanotic which is caused by a lack of oxygen and non-cyanotic.

1. Cyanotic 

Cyanosis is a blue coloration of the skin due to a lack of oxygen generated in blood vessels near the skin surface. It occurs when the oxygen level in the arterial blood falls below 85-90%. The below lists are the most common of cyanotic congenital heart diseases:

a)Tetralogy of fallot - Tetralogy of fallot is a condition of several congenital defects that occur when the heart does not develop normally. It is the most common cynaotic heart defect and a common cause of blue baby syndrome.

b)Transportation of the great vessels - Transportation of the great vessels is the most common cyanotic congenital heart disease. Transposition of the great vessels is a congenital heart defect in which the 2 major vessels that carry blood away from the aorta and the pulmonary artery of the heart are switched. Symptoms of transportation of the great vessels include blueness of the skin, shortness of breath and poor feeding.

c)Tricuspid atresia - In tricuspid atresia there is no tricuspid valve so no blood can flow from the right atrium to the right ventricle. Symptoms of tricuspid atresia include blue tinge to the skin and lips, shortness of breath, slow growth and poor feeding.

d)Total anomalous pulmonary venous return - Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect that causes cyanosis or blueness. Symptoms of total anomalous pulmonary venous return include poor feeding, poor growth, respiratory infections and blue skin.

e)Truncus arteriosus - Truncus arteriosus is characterized by a large ventricular septal defect over which a large, single great vessel arises. Symptoms of truncus arteriosus include blue coloring of the skin, poor feeding, poor growth and shortness of breath. There are many more types of cyanotic such as ebstein's anomaly, hypoplastic right heart, and hypoplastic left heart. If you need more information please consult with your doctor.

2. Non-cyanotic 

Non-cyanotic heart defects are more common because of higher survival rates. The below lists are the most common of non-cyanotic congenital heart diseases:

a)Ventricular septal defect - Ventricular septal defect is a hole in the wall between the right and left ventricles of the heart causing right and left ventricles to work harder, pumping a greater volume of blood than they normally would in result of failure of the left ventricle. Symptoms of ventricular septal defect include very fast heartbeats, sweating, poor feeding, poor weight gain and pallor.

b)Atrial septal defect - Atrial septal defect is a hole in the wall between the two upper chambers of your heart causing freshly oxygenated blood to flow from the left upper chamber of the heart into the right upper chamber of the heart. Symptoms of atrial septal defect include shortness of breath, fatigue and heart palpitations or skipped beats.

c)Coarctation of aorta - Coarctation of aorta is a narrowing of the aorta between the upper-body artery branches and the branches to the lower body causing your heart to pump harder to force blood through the narrow part of your aorta. Symptoms of coarctation of aorta include pale skin, shortness of breath and heavy sweating.

There are many more types of non-cyanotic such as pulmonic stenosis, patent ductus arteriorus, and atrioventricular cana. These problems may occur alone or together. Most congenital heart diseases occur as an isolated defect and is not associated with other diseases.

( Kyle J Norton )

Pediatric Cardiac Surgery - Understanding Congenital Heart Defects

Congenital heart defects are a malformation in one or more structures of the heart or blood vessels that occurs before a child is born, during the development of the fetus. This developmental defect can affect approximately 8 out of every 1000 children and stems from a variety of causes. While some expectant mothers will fault their own actions when this occurs, fearing the worst for their children, modern technology has brought us to a point where traditional treatments using medication and pediatric cardiac surgery are able to correct most heart defects.

Pediatric Heart Surgery - The Underlying Cause of Congenital Heart Defects

In the majority of patients, the cause for their congenital heart defect is not directly or readily known. Through research however, pediatric specialists have discovered a number of factors that can contribute to or are associated with an increased chance of a child developing a congenital heart defect. This includes:

* Genetic abnormalities or abnormalities in the chromosomes (e.g. - Down syndrome)

* Alcohol or recreational drug use/abuse during pregnancy

* Taking certain prescription medications during pregnancy

* Viral infections during the first trimester of pregnancy, such as rubella

In cases where there is a family history of heart defects, a child has double the chance (16 in 1000) of being born with a defect that may require corrective pediatric cardiac surgery or some other form of treatment.

Defining Congenital Heart Defects

There are several defects that are detected and treated early on in infancy.

Heart Valve Defects - Any one or more of the valves in the heart may malfunction through narrowing or stenosis. Also, complete closure of a valve that impeded/prevents blood flow can occur. Other heart defects include leaky valves that don't close. This reduces the pressure, forces the heart to work harder and allows blood to leak backwards as the chambers of the heart compress.

Patent Ductus Arteriosus - This defect allows blood to bypass the lungs as it circulates, forcing unoxygenated blood back through the body. This starves the body of oxygen and as a result the heart must work harder to oxygenate the tissues of the body.

Transposition of Greater Vessels - Blood from the left and the right side of the heart intermix because the arterial connections in the heart are incorrect.

Aortic Coarctation - This is a pinched Aorta. The narrowing of the Aorta can increase pressure and reduce circulation through the body, creating a variety of symptoms including a failure to thrive. It may also be present with no symptoms.

Pediatric Cardiac Surgery - Diagnosing Congenital Heart Disease

It's important to note that while congenital defects typically develop early on, they can be diagnosed before birth, after birth, throughout childhood later in life when the patient is an adult. For some adults, they live with a heart defect and present with no symptoms or issues. Depending on the patient, the assumed defect, the age of child and other factors, a number of tests can be ordered to check for and confirm a diagnosis. This includes:

* Echocardiogram

* Cardiac Catheterization

* Chest X-ray

* Electrocardiogram

* MRI

Pediatric Heart Surgery & Other Treatments for Congenital Heart Defects

It's typical for congenital heart defects in children to require pediatric cardiac surgery or some kind of interventional procedure in order to repair the defect. To ensure the heart is able to recover and grow normally after birth, children are often treated with medication to help improve the function of the heart after surgical repairs are complete.

Grote Pitman Campbell

Hole In Heart - Congenital Heart Defect

If you have a hole in heart then you could be in big trouble. This is what is called a congenital heart defect and occurs between the chambers of the heart in the tissues that separate the chambers called the septum.

Congenital heart defects, or septal defects, are fairly common, according to the AHA, or American Heart Association. The AHA estimates that approximately 1.3 million people have this type of heart defect. These defects can have quite serious side effects.

The first and foremost symptom that may be noticed is an arrhythmia. An arrhythmia is when the heart is unable to beat a nice constant rhythm. The heart beat is erratic and speeds up or slows down at irregular intervals. The heart can even skip a beat or two. If the heart muscle stretches out due to blood pumping between the chambers then the heart will not ever be the same and cannot recover. You may be able to tell you have an arrhythmia just by feeling your heart beat. If it seems irregular, talk to your doctor about the causes.

Another problem that may arise with a hole in heart is pulmonary hypertension. Blood is pumped from the right lower ventricle of the heart to the lungs to get oxygen. Then the blood goes back to the heart where it is supposed to be pumped through to the rest of the body.

If there is a septal defect the blood really does not know exactly where to go and the heart has to work so much harder to get the blood from the wrong chamber to the correct one. 

When bad blood continually mixes with good blood then the arterial walls start to change and they get thicker increasing the pressure of the blood flowing through them. This can be a precursor to congestive heart failure, a very serious condition.

Because the blood is not flowing normally, then the chance for blood clots forming in the heart and traveling to other parts of the body is enormous. If the blood pools in the right side of the heart and there is a septal defect the clot can travel through the defect to the left side of the heart and get pumped out to any number of bodily structures, including the brain. This is called a stroke, also, very serious.

When the heart has a hole in it, it has to work a lot harder than a normal heart. The energy drain on the rest of the body is huge and there is not much left for the body to have for normal growth and development. This is called failure to thrive. Children with this condition just do not seem to ever have enough energy to play like the other normal kids.

Because the heart has to work harder it gets taxed. Well, these are some taxes that it may not be able to pay for an extended period of time. This is called heart failure. If too many arterial changes have occurred because a hole in heart caused pulmonary hypertension, the heart will eventually fail.

"This article is not to be considered medical advice of any kind and is only for informational and entertainment purposes only. As always you, the reader, should consult with your personal physician or another Licensed Health Professional."

Tomazu Scurcia

Congenital Heart Defect

Congenital heart defect is a defect in the composition of the heart and vessels of a newborn. The majority heart defects either block blood flow in the heart and vessels near it or cause blood to flow through the heart in an abnormal pattern, although other defects affecting heart rhythm such as long QT syndrome can also occur. Heart defects are among the most common birth defects and are the leading cause of birth defect-related deaths.

Congenital Heart Defects - Symptoms

Congenital heart defects because a wide range of symptoms. Your baby may have only mild symptoms and tire easily, for example. They may have serious symptoms, like severe difficulty breathing. Or your baby may not have any symptoms that you observe at birth but may develop them later as he or she grows.

Common symptoms of a congenital heart defect include:

o Difficulty breathing. This often is noticed when your baby is active, such as during feeding and crying. 

o Poor weight gain. When most of a baby's energy is spent pumping blood to the body, little is left for eating and growing. Your baby may tire when eating and may take longer than expected to finish feeding. 

o Sudden weight gain or puffiness and swelling of the skin, seen most often around the eyes and in the hands and feet and may be most noticeable when your baby first wakes up. The weight gain or puffiness can be caused by fluid retention that is related to poor blood circulation. 

o Sweating, especially on the head. You may notice that your baby has damp hair and cool, moist skin. 

o Fatigue and fussiness. Your baby may be too tired to play and may sleep most of the time. 

o Less wet diapers than expected. Following the primary week, the majority of the newborn damp at least six diapers in a twenty four hour time. You might also view the baby's urine is gloomy and pungent.

How are they treated?

Some defects get better on its own and may not need treatment. Your baby's treatment will depend on the kind of defect.

Medicines may be used to help the heart work better. Medicines may also treat symptoms until the defect is repaired.

Some defects can be fixed by using a catheter, which does not require opening up the chest. A physician threads a slim tube known as catheter throughout a blood vessel, characteristically one in the groin. The physician threads the catheter into the heart, where the physician uses this to secure holes and open conical blood vessels and valves.

If a baby has a large or complex defect, the baby may need one or more open-heart surgeries. The surgery may be done right away, done over several steps, and deferred until the infant is stronger. Occasionally surgical procedure is delayed if the baby is premature or until the baby is strong enough to handle the surgery. In some cases, the child may need different types of surgery over time as he or she grows.

Complications of congenital heart defects

The majority children who have correct congenital heart defects guide normal lives. Nevertheless, complications at times develop.

Heart failure is a major complication of congenital heart defects. Heart failure may develop many years after the defect is diagnosed. It can cause a variety of symptoms, like severe difficulty breathing and irregular heartbeats. For more information about signs and symptoms related to heart failure, see the topic Heart Failure.

Amanda C Jones

Symptoms of Patent Ductus Arteriosus - Ways to Know If Your Baby Has PDA

Patent Ductus Arterosus or PDA is a birth defect that is associated with the improper flow of blood from higher to lower pressure aorta. Since all babies are almost the same upon birth, the symptoms of PDA will not be noticeable until the baby is first week or a couple of weeks old and to some a few months old, but how do you know when a baby is suffering from a disease when babies show the same symptoms of pain and suffering? To know whether or not your baby is suffering from PDA, you have to know the symptoms of patent ductus Arteriosus.

The symptoms of PDA vary depending on the size of the baby's ductus arteriosus. Some babies have normally small ductus arteriosus and these babies appear to be normal and healthy. Symptoms for this case will not be diagnosed unless the heart beat and heart sound is evaluated by a doctor and for babies with relatively larger ductus arteriosus, signs and symptoms may be different.

Even though the signs and symptoms of PDA are exhibited differently depending on the size of the baby's patent ductus arteriosus, there are some common signs named to help parents and doctors detect whether or not the baby is suffering from PDA. The first common sign is the heart murmur. Healthy babies have very silent heart murmur most especially when they are sleeping. It is almost impossible to hear the murmur unless you listen to it by intentionally placing your ears to the heart area of the baby. However, when a baby is suffering from PDA, the heart murmur is louder which is very much observable and noticeable upon examinations. Another symptom visible upon X-Ray is the congestion of the lungs. When the X-Ray result shows that your baby's lungs are congested, another examination should be done to ensure the diagnosis of the birth defect. Heart enlargement may also be seen during the test and this is also of the signs of PDA.

There are also symptoms of PDA which are noticeable even without the examinations and tests. Fast breathing, poor growth, resistance to feeding or when the baby gets tired while feeding and poor weight will give parents or just the mother alone a hint of the birth defect present in the baby.

Although some cases of Patent Ductus Arteriosus do not require treatment because it recovers by itself as the baby grows, there are cases when ductus arteriosus doesn't. So when you see that your baby exhibits some of the symptoms of patent ductus Arteriosus, take him to the doctor immediately. Tell your doctor the signs you see and request the doctor to perform clinical trials and examinations. It is always taught that prevention is better than cure and knowing the signs and symptoms of a certain disease is always the first step to prevention.

Rare Heart Diseases That Affect Children From Birth

Congenital Heart Defect is a condition, which includes a defect in the walls, valves, arteries, and veins of the heart in a newborn child. This imperfection in heart structure can possibly decrease the blood circulation or make it flow in the wrong direction or get completely blocked. This is a rare disease and approximately 9 out of 1000 kids are born every year, with poorly structured heart.

Types of well-known Congenital Heart Defect

• Coarctation of aorta

Aorta is the main and largest blood vessel that transports the blood from the heart to various parts of the body. In Coarctation of aorta, a section of aorta remains constricted or narrow, at birth. It becomes difficult for the heart to pump blood out through the aorta. This heart issue is found in people with a particular genetic disorder like Turner syndrome.

Symptoms

The curved part of aorta points upwards to the head and straight part points downwards. Coarctation of aorta can happen anywhere within the vessel. However, its tendency to occur at the top or aortic arc (C-shaped curve) is more. This makes it hard for blood to go out, so the blood pressure, before the narrowed segment is high, and after the constricted part, is low.

• Headaches from HBP (high blood pressure) 

• Camps in legs 

• Cold legs or feet 

• Abnormal heart sounds 

• Poor weight gain in babies because difficulty in feeding 

• Fainting or dizziness

Symptoms occur only, when the narrowing is severe in the aorta.

Treatment

The narrowed section is repaired, before the child's age turns 10. It can be repaired through balloon angioplasty or open-heart surgery.

• Hypoplastic Left Heart Syndrome (HLHS)

'Hypoplastic' means 'underdeveloped'. In HLHS the heart's left side that includes the left ventricle, aortic valve, mitral valve and aorta do not get developed in the womb. A healthy heart has two ventricles. Right ventricle pumps blood towards the lungs to get oxygenated, whereas the left ventricle pumps the oxygenated blood to the other parts of the body.

In HLHS, the left ventricle is very small to pump blood effectively. Usually, there is a hole in the wall that divides the right ventricle and left ventricle.

Symptoms

In the womb the fetus receives oxygen from the mother's circulation via placenta. In a couple of days, after birth the HLHS symptoms can be seen. This occurs because the placenta is disconnected and the newborn has to depend on its own heart for oxygenated blood circulation.

• Rapid heart beat 

• Rapid breathing 

• Cool, clammy and pale skin 

• Blue color lips and face 

• Weak pulses in arms and legs (because of poor circulation)

Treatment

Infant with HLHS, at birth will be given an IV (intravenous) to enhance blood flow. A series of heart surgeries are performed to reroute the blood in the right ventricle. The right side will perform the functions of both ventricles. Even if possible, a heart transplant surgery can be performed to provide the infant with a well-functioning heart.

• Patent Ductus Arteriosus

In the womb, ductus arteriosus allows the blood to evade the lungs of the baby. After birth as soon as the baby starts to breath, the responsibility of ductus arteriosus gets concluded and it shuts down automatically, in a few days. In certain cases, ductus arteriosus remains open and can cause abnormal blood circulation. This condition is called Patent Ductus Arteriosus. The cause of PDA is still unknown.

Symptoms

• Shortness of breath or rapid breathing 

• Sweating with playing or crying 

• Fast heart rate 

• Tire out easily 

• Poor eating & poor development

Treatment

PDA treatment focuses on closing ductus arteriosus to prevent complications. Closing of PDA is done either through medications, catheter, or surgery.

• Tetralogy of Fallot

A group of 4 heart defects at birth is called Tetralogy of Fallot. The flow of blood gets deteriorated, due to these defects causing a reduction in oxygen level.

The four defects are - 

1. Ventricular septal defect - There is a hole in the muscle wall between right and left side of the heart. 

2. Pulmonary valve stenosis - It is the narrowing of large blood vessel entrance. 

3. Over-riding aorta - Basically, aorta function starts from the left ventricle but in Tetralogy condition it begins from the center of the heart, just over the hole between two sides. 

4. Right ventricular hypertrophy - Due to the upper three heart defects the right side has to overwork, so the heart muscle on that side gets enlarged.

Symptoms

• Bluish tint on the lips, fingernails and skin 

• The tint darkens during activities like crying 

• Abnormal heart murmur 

• While feeding the baby gets tired easily, which hinders the growth 

• Fingertips have abnormal rounded shape

Treatment

Open heart surgery is applied to repair the defects of Tetralogy of Fallot. The pediatric cardiologists continue to check the child regularly, even after surgery. Sometimes, the child may need additional surgery, as they grow up because sudden complications may develop.

• Transposition of great arteries (TGA)

Basically, in normal condition the blood from heart goes to lungs to get oxygenated through pulmonary artery. After it comes back the aorta pumps the oxygenated blood through the body. In TGA, the blood comes to the heart but is pumped out directly without going towards the lungs for getting oxygenated.

Symptoms

• The baby has bluish colored skin 

• Rapid heart rate and breathing

Treatment

The baby receives intravenous medication, shortly after birth. If a hole is present in the hearts mid-wall then a hole will be made surgically. This allows the oxygen to mix with blood that is pumped out. Balloon atrial septostomy technique is used. Although this is a temporary treatment but the baby will require open-heart surgery called arterial switch operation within 4 weeks after birth, to correct the defect.

Aneurysm

Aneurysm is the swelling in the walls of blood vessels especially arteries. The swelling and widening of blood vessels causes them to weaken over time and they can rupture. The most commonly observed causes of aneurysm are congenital defects, uncontrolled high blood pressure and atherosclerosis (growing of fatty deposits in arteries). Aneurysm is usually classified by shape, size and location of the bulge. It is most common in arteries at the base of the brain referred as brain or cerebral aneurysm, and in aortic arteries known as abdominal aortic aneurysm. Although aneurysm can occur at any age it is most commonly observed in adults than children. Women are also found slightly more susceptible than men in this regard.

Aortic Aneurysm:

Aorta is the main artery that supplies blood from heart to the rest of the body. Aneurysm can develop anywhere in the aorta but they are most commonly found in aorta with in the abdominal region below the kidneys. The majority of aneurysms which actually start in the abdominal path of aorta eventually extend up to iliac arteries. It may occur in the chest near the heart as well (thoracic aortic aneurysm). The aortic aneurysm usually does not show any symptoms. Mild to moderate symptoms of aneurysm can sometimes be seen though. Pain in the effected area is a common symptom. One of the main causes of aortic aneurysm is smoking. The smokers over 60 years of age seem to have atherosclerosis. It has to be stopped immediately as it increases the risk of aneurysm's widening.

Treatment:

To treat the aortic aneurysm a procedure known as stenting is performed. After locating the position of the bulge, an X-ray guided polyester tube (stent-graft) is passed through a small cut in upper thigh leading to aorta. Now the blood instead of flowing through the damaged artery flow through the stent-graft and eliminates the chance of rupture.

Brain Aneurysm:

Brain Aneurysm usually originates from the base of the brain where the larger arteries combine. This area is known as circle of willis. The causes of brain aneurysm are generally genetic disorders which includes connective tissue disorders, polycystic kidney disease or some circulatory disorder. Patient having brain aneurysm may be found having the symptoms such as excruciating headache, problem with vision, thinking and decrease in concentration level, difficulty in speech and perception, pain in neck or eye and extreme tiredness.

Treatment:

Surgical clipping and coil embolization are methods usually applied for the treatment of brain aneurysm. Patient has to go through some test to get the right diagnosis after which the doctor will determine the method of treatment that is best suited to repair the blood vessel.

Congenital Heart Disease and Physical Therapy

Congenital Heart Disease

Congenital heart diseases refers to the structural (anatomical) or physiological defects in the normal functioning of the heart as a result of birth defects that may be diagnosed soon after birth or may take years to produce full blown cardiac insufficiency. Valvular heart defects form the most common variety of congenital cardiac defect that is associated with high morbidity and mortality in adult years if no management options are employed. This is because the metabolic demands of the body increase with growth and development that poses more pressure on the heart leading to cardiac failure or circulatory deficits. With overall prevalence of 26.6%, it was suggested that only 12.1% cases can be detected by clinical evaluation. Among the most prevalent congenital cardiac defects, ventricular septal abnormalities comprise 17.3% of all congenital anomalies followed by atrial septal defects (6.0%) and other less common cardiac diseases. The mortality is highest with cyanotic heart diseases. 

According to the research statistics reported by Julien I.E Hoffman, over 1 million patients were born with congenital heart defects (during 1940 to 2002). Considering the quality of medical services and surgical/ medical advancements, Hoffman suggested that the total number of survivors with mild heart disease (who may reach well into adulthood) is 750,000 with mild heart disease, 400,000 with moderate heart disease and 180,000 with severe disease (with treatment). Without any management or treatment the survival rate may fall to 400,000 with mild disease, 220,000 with moderate disease, and 30,000 with severe heart disease, suggesting very high mortality. 

Congenital heart diseases are also associated with stunted growth and development in children marked by poor weight gain, failure to thrive and frequent hospitalizations while growing up. In addition, these children also develop frequent episodes of shortness of breath, rapid heart rate (also known as tachycardia) and attacks of fatigue associated with decreased exercise endurance.

Physical therapy 

Physical therapy and mild exercises are helpful in the growth and development of children born with congenital heart disease. It is extremely important not to initiate exercise therapies in these children without seeking the guidance from registered physical therapists who work in coordination with the pediatric cardiologist to deliver best exercise regimens in order to optimize health without overloading the heart. Generally, children and adults can perform moderate static exercises of mild intensity without any complications; however, healthcare providers strongly restrict weight lifting in pediatric aged children and even in adults born with cardiac defects. Caution should be maintained to avoid lifting weight of more than 25 pounds in children and more than 50 pounds in adults. Physical therapist and pediatric cardiologist must assess every child individually and advice customized exercises and treatments according to the severity of illness and overall physical health. Treadmill test, bicycling and echocardiography are mainly used as assessment tools as the risk of sudden death increases if vigorous activity is attempted in children born with aortic stenosis, cyanotic heart diseases and coarctation of the aorta. 

Hardcore or traditional gym exercises increase cardiac output that may overload the heart and may increase the risk of complications or sudden cardiac death. On the contrary, exercises performed under the guidance of physical therapists serve multiple benefits. Exercise or physical activities are needed in order to build stamina and maintain exercise endurance especially in school going children who engage in physical activities with peers. Physical therapy improves the pace of mental and physical development that allows children to develop healthy social relationships with peers, muscle and motor coordination and mental concordance. Physical therapy and periodic assessments are also needed in order to know the physical capacity of child and to track worsening of cardiac defect with age (in order to avoid accidents or unwanted incidents at schools) by restricting excessive physical activity. In some children, healthcare providers delay surgery until the child crosses some developmental milestones; however, it is very important that until then child stays in best possible physical shape to lessen the risk of surgical complications. 

According to the scientific peer-reviewed journal- American Family Physician there are 5 stages of physical activity recommendations of Physical Activity in Children with CHD, ranging from no restriction to extreme limitation of physical activity (wheel chair bound). 

Without any physical therapy, the progression into the severe disability is fairly high. It is the duty of parents to promote healthy physical activity but make sure to prevent contact sports or vigorous activities that may affect cardiac functioning. 

Tetralogy of fallot Circulatory System and Disease Information

 How to know Tetralogy of fallot Circulatory System and Disease

 

Source :  Khan Academy

Structural Defects or Birth Defects Information

A birth defect is a problem that occurs while a baby is developing in the mother's body. Birth defects are defined as abnormalities of structure, work or metabolism that are present at birth. These abnormalities lead to mental or physical disabilities or are fatal. Birth defects affect about one in every 33 babies born in the United States each year. More than 150,000 children born with birth defects each year in the United States.They are the leading cause of child mortality, over 20% of all deaths in infants. Babies born with birth defects have a higher probability of disease disability and long-term babies without birth defects.

What can happen if the mother and the baby Rh factors are different. Although some drugs can cause problems, the 200 most commonly prescribed medications, no one is a significant risk of birth defects associated. Environmental causes of birth defects more to do with the health of the mother and the effects of chemicals or disease. If a mother has certain infections like rubella during pregnancy can cause birth defects. Birth defects are multifactorial. Caused by a combination of genetic and environmental factors and include neural tube defects and cleft lip and palate Genetics play a role in some birth defects. Each cell in the body has chromosomes containing genes, to determine the unique characteristics of a person.

Treatment of congenital abnormalities is specific to each individual. People with severe or multiple abnormalities usually require a multidisciplinary treatment. Babies with birth defects need an operation or other medical treatments. Prenatal surgery has saved with urinary tract blockages and rare tumors of the lung babies. Other prevention is not smoking and avoid secondhand smoke, avoid alcohol, eat a healthy diet and take prenatal vitamins (make sure you have enough folic acid), avoiding all illicit drugs, exercise and plenty of rest and get early and regular prenatal care. Couples who had or have a family history of birth defects of a child with a birth defect, you should consult a genetic counselor. Obstetrics Rroutine also useful.

Science articles non-smoking and avoid secondhand smoke.

1. Avoid alcohol.

2. Avoid all illegal drugs.

3. A healthy diet and take prenatal vitamins.

4. First movement and plenty of rest.

5. Getting early and regular checkups.

Atrial Septal Defect- Definition, Causes, Symptoms and Treatment

Atrial septal defect is an abnormality of the heart's upper chambers (atria) where the wall between the right and left atria does not close completely. In general, the defect is a hole in the wall (septum) between the heart's two upper chambers (atria). As a group, atrial septal defects are detected in 1 child per 1500 live births. Septal defects smaller headphones can close only in infancy or early childhood. The health effects of holes that remain open often not until recent years - usually at the age of 40. Many people do not realize that so far an atrial septal defect. Sometimes a doctor detects an atrial septal defect for a newborn screening or during a routine examination in the future. Septal defects large and longstanding headphones can damage the heart and lungs. One that has an atrial septal unrecognized for decades may have a shortened life of heart failure or high blood pressure in the lungs. For children with disorders very small ASD, the ASD closes itself has more than 90% of the time. However, most ASDs must be closed. People with certain types of heart defects, including certain rarer forms of the CIA, are at greater risk of developing bacterial endocarditis, an infection of the inner surface of the heart.

The term "atrial septal defect" generally refers to provide holes in the atria to lack of atrial septal tissue, rather than a so-called patent foramen ovale in (PFO). Symptoms usually were children 30 years septal defects may manifest with larger headphones have loss of appetite and not as they should grow. Toddlers can signs of heart failure or arrhythmias. Congenital heart disease seems to run in families and sometimes occur with other genetic problems such as Down syndrome. A genetic counselor can predict the approximate probability that their children will have a future. An atrial septal defect allows oxygen-rich (red) blood from the left atrium through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right atrium. Complete closure occurs in most individuals. In 25-30% of the normal heart, however, a catheter from the right atrium to the left atrium through the patent foramen ovale and secundum is passed.

The person may also develop heart or vascular damage and an increased risk of suffering a stroke or heart infection itself. Congenital heart defects of significance occur in approximately 8 out of every 1,000 live births. Surgical closure of the defect is recommended if the ASD is large or if symptoms occur. Anticoagulants, often called blood thinners, can help reduce the chances of developing a blood clot and a stroke. Anticoagulants include warfarin (Coumadin) and antiplatelet agents such as aspirin. Maintain regular heartbeat. Examples include beta blockers (Lopressor, Inderal) and digoxin (Lanoxin). Prophylactic (preventive) antibiotics should be given prior to dental procedures to reduce the risk of developing infective endocarditis. Embolization (displacement of thrombi) normally enters the lungs and cause a pulmonary embolism. In a person with ASD, these emboli can potentially enter the arterial system. In most cases, atrial septal defects can not be prevented. Consider talking with a genetic counselor before becoming pregnant.

The treatment of atrial septal tips

1. Surgical closure of an ASD involves opening up at least one atrium and closing the defect with a patch under direct vision.

2. Embolization (displacement of thrombi) normally enters the lungs and cause a pulmonary embolism.

3. Maintain regular heartbeat. Examples include beta blockers (Lopressor, Inderal) and digoxin (Lanoxin).

4. Increase the strength of heart contractions. Examples include digoxin (Lanoxin).

5. Reduce the amount of fluid in circulation. This reduces the volume of blood that must be pumped. These drugs, called diureticsFree Web content, include furosemide (Lasix).

6.Prophylactic antibiotics (preventive) given before dental procedures to reduce the risk of developing infectious endocarditis.