Congenital Heart Defects

Type of Congenital Heart Defects

There are many types of congenital heart defects. They range from simple to complex and critical. Simple defects, such as atrial septal defect and ventricular septal defects, may have no symptoms and may not require surgery. Complex or critical defects such as hypoplastic left heart syndrome may have severe, life-threatening symptoms. Babies born with a critical congenital heart defect typically have low levels of oxygen soon after birth and need surgery within the first year of life.

An atrial septal defect is a hole in the wall between the atria, which are the two upper chambers of the heart. The hole causes blood to flow from the left atrium and mix with the right atrium, instead of going to the rest of the body. Atrial septal defect is considerered a simple congenital heart defect because the hole may close on its own as the heart grows during childhood, and repair may not be necessary.

Patent ductus arteriosus is a common type of simple congenital heart defect that occurs when a connection between the heart’s two major arteries does not close properly after birth. This leaves an opening through which blood can flow when it should not. Small openings may close on their own.

Pulmonary stenosis is a narrowing of the valve through which blood leaves the heart on its way to the lungs. Many children with pulmonary stenosis do not need treatment.

A ventricular septal defect is a hole in the wall between the ventricles, which are the two lower chambers of the heart. Blood may flow from the left ventricle and mix with blood in the right ventricle, instead of going to the rest of the body. If the hole is large, this may make the heart and lungs work harder and may cause fluid to build up in the lungs.

Tetralogy of Fallot is the most common complex congenital heart defect. It is a combination of four defects:

• Pulmonary stenosis.
• A large ventricular septal defect.
• An overriding aorta. With this defect, the aorta is located between the left and right ventricles, directly over the ventricular septal defect. As a result, oxygen-poor blood from the right ventricle can flow directly into the aorta instead of into the pulmonary artery.
• Right ventricular hypertrophy. In this case, the muscle of the right ventricle is thicker than usual because it has to work harder than normal.

Other critical, common congenital heart defects include:

• Coarctation of the aorta
• Double-outlet right ventricle
• D-transposition of the great arteries
• Ebstein’s anomaly
• Hypoplastic left heart syndrome
• Interrupted aortic arch
• Pulmonary atresia with intact ventricular septum
• Single ventricle
• Total anomalous pulmonary venous return
• Tricuspid atresia
• Truncus arteriosus

Risk Factors

Exposure to certain substances during pregnancy may increase the risk of having a baby with a congenital heart defect.

• Smoking during pregnancy or exposure to secondhand smoke.
• Taking some medicines—such as angiotensin-converting enzyme (ACE) inhibitors for high blood pressure and retinoic acids for acne treatment—in the first trimester.

Some medical conditions increase the risk of having a baby with a congenital heart defect, such as:

• Diabetes. Your risk is higher if you have diabetes before pregnancy, or if you are diagnosed with diabetes while you are in your first trimester. However, a diagnosis of gestational diabetes, which occurs later in the pregnancy, is not a major risk factor.
• Phenylketonuria. This rare, inherited disorder affects how your body processes a protein called phenylalanine, which is found in many foods. Getting phenylketonuria under control before getting pregnant can reduce your risk of having a baby with a congenital heart defect.
• Rubella. Infection with the rubella virus, also known as German measles, during pregnancy increases your risk.

Signs, Symptoms, and Complications

Some congenital heart defects cause few or no signs and symptoms. Since more children with congenital heart defects are living longer, we now know that complications can develop later in life. Signs, symptoms, and complications will vary based on the type of congenital heart defect that you or your child have.

Signs and symptoms may be different for newborns and adults. They also depend on the number, type, and severity of the heart defect. Some common signs and symptoms include:

• Cyanosis
• Fatigue
• Heart murmurs
• Poor blood circulation
• Rapid breathing

Congenital heart defects do not cause chest pain or other painful symptoms. Older children or adults may get tired easily or short of breath during physical activity.

Complications depend on the type of congenital heart defect you have. Some of the possible complications include:

• Arrhythmia  
• Blood clots  
• Developmental disorders and delays. Children with congenital heart defects are more likely to have problems with behavior. They are also more likely to have speech and attention-deficit/hyperactivity disorders.
• Emotional health issues. Depression, anxiety, and post-traumatic stress disorder are common among people with congenital heart defects.
• Endocarditis, a type of heart inflammation
• Endocrine disorders, including thyroid problems, bone health issues, and diabetes. Problems with the hormones that deal with calcium can cause bone problems.
• Heart failure. Heart failure is the leading cause of death in adults with congenital heart defects. Some children with congenital heart defects develop heart failure.
• Kidney disease
• Liver disease
• Pneumonia. Pneumonia is a leading cause of death in adults with congenital heart disease.
• Pregnancy complications. Women with congenital heart defects have an increased risk of complications during pregnancy and childbirth. 
• Pulmonary hypertension
• Stroke

Diagnosis of Congenital Heart Disease

Some congenital heart defects are diagnosed during pregnancy or soon after birth. Others may not be diagnosed until adulthood. Your or your child’s doctor will perform a physical exam and order diagnostic tests and procedures based on what he or she finds in the physical exam.

To diagnose a congenital heart defect, your doctor may have you or your baby undergo some of the following tests and procedures:

• Echocardiography to diagnose a heart defect or follow your or your child’s progress over time. Fetal echocardiography can sometimes diagnose a congenital heart defect before a baby is born.
• Electrocardiogram (EKG or ECG) to evaluate the rhythm of the heartbeat.
• Cardiac catheterization to measure the pressure and oxygen level inside the heart chambers and blood vessels. This can help the doctor figure out whether blood is flowing from the left side of the heart into the right side of the heart, instead of going to the rest of the body.
• Chest X-ray to show whether the heart is enlarged. It can also show whether the lungs have extra blood flow or extra fluid, a sign of heart failure.
• Genetic testing to determine if particular genes or genetic syndromes such as Down syndrome are causing the congenital heart defect. Your doctor may refer you or your child to a specialist in genetic testing.
• Cardiac MRI to diagnose a heart defect or follow your or your child’s progress over time.
• Pulse oximetry to estimate how much oxygen is in the blood. A small sensor is attached to an infant’s hand or foot or an older person’s finger or toe.

Treatment for Congenital Heart Disease

Treatment will depend on which type of congenital heart defect you have. Treatments for congenital heart defects include medicines, surgery, and cardiac catheterization procedures. Many congenital heart defects do not require treatment at all. However, children with critical congenital heart defects will need surgery in the first year of life. Some people with congenital heart defects may need treatment, including repeated surgery, throughout their lives. All people with congenital heart defects should be followed by a cardiologist, a doctor who specializes in the heart, throughout their whole life.

Medication

Your child's doctor may prescribe medicines to help close patent ductus arteriosus in premature infants.

• Indomethacin or ibuprofen triggers the patent ductus arteriosus to constrict or tighten, which closes the opening.
• Acetaminophen is sometimes used to close patent ductus arteriosus.

Procedures

Cardiac catheterization is a common procedure that is sometimes used to repair simple heart defects, such as atrial septal defect and patent ductus arteriosus, if they do not repair themselves. It may also be used to open up valves or blood vessels that are narrowed or have stenosis.

In this procedure, a thin, flexible tube called a catheter is put into a vein in the groin or neck. The tube is threaded to the heart. Possible complications include bleeding, infection, and pain at the catheter insertion site and damage to blood vessels.

Surgery

In heart surgery, a cardiac surgeon opens the chest to work directly on the heart.

Surgery may be done for these reasons:

• To repair a hole in the heart, such as a ventricular septal defect or an atrial septal defect.
• To repair a patent ductus arteriosus.
• To repair complex defects, such as problems with the location of blood vessels near the heart or how they are formed.
• To repair or replace a valve.
• To widen narrowed blood vessels.

Surgeries that are sometimes needed to treat congenital heart defects include:

• Heart transplant. Children may receive a heart transplant if they have a complex congenital heart defect that cannot be repaired surgically or if the heart fails after surgery. Children may also receive a heart transplant if they are dependent on a ventilator or have severe symptoms of heart failure. Some adults with congenital heart defects may eventually need a heart transplant.
• Palliative surgery. Some babies with only one ventricle are too weak or too small to have heart surgery. They must have palliative surgery, or temporary surgery, first to improve oxygen levels in the blood. In this surgery, the surgeon installs a shunt, a tube that creates an additional pathway for blood to travel to the lungs to get oxygen. The surgeon removes the shunt when the baby’s heart defects are fixed during the full repair.
• Ventricular assist device. For people with heart failure from a congenital heart defect, this device supports the heart until a transplant occurs. These devices can be difficult to use in people who have congenital heart defects because of the heart’s abnormal structure.
• Total artificial heart. For some people with complex congenital heart defects, a total artificial heart may be needed instead of a ventricular assist device.

Living With Congenital Heart Disease

The outlook for children who have congenital heart defects is much better today than it was in the past. Advances in diagnosis and treatment allow most of these children to survive to adulthood, which means that more and more adults are living with congenital heart disease. Even if your congenital heart defect was repaired in childhood, you need regular medical follow-up to maintain good health.

Find a Cooper Doctor to Help Manage Congenital Heart Disease

Whether you need a pediatric cardiologist for your child or an adult cardiologist for yourself, the Cooper Heart Institute can help. Call 800.8.COOPER (800.826.6737) today!