Congenital Heart Disease (CHD)

Congenital Heart Disease

According to the American Heart Association, about eight of every 1,000 babies born in the United States has a congenital (present at birth) heart defect--a problem that occurred as the baby's heart was developing during pregnancy, before the baby is born. Congenital heart defects are the most common birth defects.

A baby's heart begins to develop at conception, but is completely formed by eight weeks into the pregnancy. Congenital heart defects happen during this crucial first eight weeks of the baby's development. Specific steps must take place in order for the heart to form correctly. Often, congenital heart defects are a result of one of these crucial steps not happening at the right time, leaving a hole where a dividing wall should have formed, or a single blood vessel where two ought to be, for example.

Rarely, defects include those in which:

What causes congenital heart disease?

The vast majority of congenital heart defects have no known cause. Mothers will often wonder if something they did during the pregnancy caused the heart problem. In most cases, nothing can be attributed to the heart defect. Some heart problems do occur more often in families, so there may be a genetic link to some heart defects. Some heart problems are likely to occur if the mother had a disease while pregnant and was taking medications, such as anti-seizure medicines or the acne medication isotretinoin. However, most of the time, there is no identifiable reason as to why the heart defect occurred.

Congenital heart problems range from simple to complex. Some heart problems can be watched by the baby's doctor and managed with medicines, while others will require surgery, sometimes as soon as in the first few hours after birth. A baby may even "grow out" of some of the simpler heart problems, such as patent ductus arteriosus (PDA) or atrial septal defect (ASD), since these defects may simply close up on their own with growth. Other babies will have a combination of defects and require several operations throughout their lives.

What are the different types of congenital heart defects?

We can classify congenital heart defects into several categories in order to better understand the problems the baby will experience. They include:

Again, in some cases there will be a combination of several heart defects, making for a more complex problem that can fall into several of these categories.

Septal congenital heart defects

Some congenital heart defects allow blood to flow between the right and left chambers of the heart because an infant is born with an opening in the septal wall that separates the right and left sides of the heart.

Atrial Septal Defect

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Cyanotic congenital heart defects

Cyanotic defects are defects in which blood pumped to the body contains less-than-normal amounts of oxygen, resulting in a condition called cyanosis. It causes a blue discoloration of the skin. Infants with cyanosis are often called "blue babies."

Some of the problems that cause too little blood to pass through the lungs include the following:

Tricuspid Artesia

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A surgical shunting procedure is often necessary to increase the blood flow to the lungs.

Transposition of the great arteries

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Immediate medical intervention is necessary to correct this condition.

Tetralogy of Fallot

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Obstructive congenital heart defects:

Coarctation of the Aorta

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Although aortic stenosis may not cause symptoms, it may worsen over time, and surgery may be needed to correct the blockage - or the valve may need to be replaced with an artificial one.

Other congenital heart defects:

Patent Ductus Arteriosus

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Who treats congenital heart defects?

Pediatric cardiologists diagnose heart defects and help manage the health of children before and after surgical repair of the heart problem.

A new subspecialty within cardiology is emerging as the number of adults with congenital heart disease (CHD) is now greater than the number of babies born with CHD, as a result of the advances in diagnostic procedures and treatment interventions that have been made since 1945.

In order to achieve and maintain the highest possible level of wellness, it is imperative that those individuals born with CHD who have reached adulthood transition to the appropriate type of cardiac care. The type of care required is based on the type of CHD a person has. Those persons with simple CHD can generally be cared for by an adult cardiologist. Those with more complex types of CHD will need to be cared for at a center that specializes in adult CHD.

For adults with CHD, guidance is necessary for planning key life issues such as college, career, employment, insurance, activity, lifestyle, inheritance, family planning, pregnancy, chronic care, disability, and end of life. Knowledge about specific congenital heart conditions and expectations for long-term outcomes and potential complications, and risks must be reviewed as part of the successful transition from pediatric care to adult care. Parents should help pass on the responsibility for this knowledge and accountability for ongoing care to their young adult children to help ensure the transition to adult specialty care and optimize the health status of the young adult with CHD.

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