Local guest column: Congenital heart disease can be treated
By Dr. Veronica Schmer
About one out of every 100 infants — about 36,000 — are born each year in the U.S. with a congenital heart defect, or CHD.
A CHD is a defect in the structure of the heart and the great vessels that is present at birth. Many children outgrow certain CHDs without even requiring medications, but others need surgery to correct the problem.
Simply, the heart’s function in the body is to pump oxygen-rich blood to organs, together with nutrients, and to separate the nonoxygenated (blue) blood from the oxygenated (red) blood.
Some congenital heart problems are structural — a problem with mechanical function such as valve leakage or narrowing.
Others involve a persistent opening between the right- and left-sided heart chambers, leading to a mixing of the blue and red blood and either overloading the lungs, causing extra work for the heart, or allowing blue (deoxygenated) blood to show up in the body’s circulatory system, in which case the baby is “blue.”
Most heart problems are random events and not related to anything that the mother did during pregnancy. There are several common heart problems in babies.
■ A baby can be born with a ventricular septal defect, or VSD, which is a hole between the bottom-pumping chambers of the heart. The baby often outgrows this problem. Sometimes with VSD, there are other problems such as an obstruction to flow on the right side (pumping to the lungs), making the child “blue.”
If there is a VSD with an obstruction of blood flow to the body, often it is too much for the heart to pump and it fails, causing heart failure.
■ Another common problem is an opening between the heart’s top collecting chambers, called atrial septal defect, or ASD, which is often not noticed until adolescence or even adult life.
Before birth, since the circulation inside the mother is different — the baby gets everything through the umbilical cord — it bypasses the lungs. Two communications, or openings, between the lung and body circulation have to be present in the fetus; they usually close over within weeks after birth.
During this closing process, symptoms of heart failure may not show up until the baby is 2 to 3 months old, even if he or she was born with the problem.
■ Some babies with genetic birth defects such as Down syndrome or other chromosomal abnormalities frequently have heart problems at birth.
Some medications (lithium or seizure medications), drugs, alcohol and some infections (German measles) and poorly controlled blood-sugar levels in the mother can increase the risk of heart defects in the baby.
During pregnancy, it’s a good idea to try to avoid any medications, since even ibuprofen (Advil, Motrin) may cause harm to the fetus. Also, screening can be done with an ultrasound to find out if the fetus’ heart has a problem.
Babies with heart problems can have symptoms of poor oxygenation _ causing dusky, blue lips _ poor growth or trouble breathing around feeding time or with exercise.
If a heart murmur (an extra or unusual sound heard during a heartbeat) is detected in your baby, your pediatrician will refer you to a pediatric cardiologist who can do an ultrasound.
A cardiac catheterization may be done in order to plan the best way to correct a murmur surgically, but sometimes the problem can be corrected with catheters without having to operate.
The outlook for babies born with CHD in 2009 is greatly improved since the first open-heart surgery in 1952 for such a defect. Today, children with complex heart problems can survive and lead normal lives.
There are support groups and online references and education available. Every year, there have been great strides in improving the quality of life of children born with congenital heart defects. Good record-keeping by the parents of tests and surgeries is essential in following children with CHD.
For more information on CHD, speak with your primary care provider, who may suggest a visit to a pediatric cardiologist.
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Dr. Veronica Schmer is a board-certified pediatric cardiologist at Bassett Healthcare.