Congenital heart disease – children

Congenital heart disease is the name for heart defects people are born with. As many as one baby in 100 is born with a heart defect. Many of the defects do not cause problems, but others are more serious and may need surgical correction. A few cannot be corrected.

Causes

Congenital heart defects are usually a chance occurrence due to a slight fault in the complex development of the heart. It is rare for a heart defect to be inherited, that is, to occur because of faulty genes from either parent. Some known causes of congenital heart disease include:

Rubella (German measles) virus

Rubella can damage the developing heart. A mother who comes in contact with rubella in the first three months of a pregnancy should consult her doctor.

Medications

Some medications may cause heart defects. Do not take medication in early pregnancy except on a doctor's recommendation.

Things such as getting a bad fright, having an accident or a threatened miscarriage do not cause congenital heart defects. Babies are well-protected in the womb from most outside influences.

How the heart works

The heart is a pump and its main function is to pump blood around the body. It is separated into left and right sides by a muscular partition (septum). The left side of the heart pumps red blood containing oxygen and other fuels through the main artery, or aorta, to the arteries of all parts of the body.

Tissues in the body, such as muscle, brain and kidneys, use some of the oxygen in the blood, leaving it with a blue tinge. The 'blue' (deoxygenated) blood returns in the veins to the right side of the heart which pumps it through the pulmonary arteries to the lungs. Here, the blood receives oxygen again, restoring its red colour, and returns to the heart ready to be pumped once more through the body.

Valves are important in directing flow

Each side of the heart has a receiving chamber (the atrium) and a pumping chamber (the ventricle). As with any pump, valves are necessary to keep flow in the proper direction and each side of the heart has two valves, one at either end of the ventricle. The right-sided valves are called the tricuspid and pulmonary valves, and the left-sided valves are called the mitral and aortic valves.

What does it mean if my child has a heart murmur?

Sometimes the heart may produce an unusual sound due to noisy blood flow. These so-called murmurs can be heard with a stethoscope. Most murmurs are quite innocent and do not indicate a major problem. But occasionally, murmurs are a sign of a serious heart problem and so should be checked out.

A heart murmur in someone experiencing symptoms such as intermittent blueness, breathlessness on exercise, or fainting, is more likely to be significant.

Diagnosis

In most cases a medical examination with an x-ray of the heart, an electrocardiogram (ECG) and an echocardiogram will be enough to decide if a heart defect requires treatment. Sometimes cardiac catheterisation is necessary. In this test, carried out under anaesthetic, special tubes are passed through an artery and/or vein to take recordings and x-rays of the heart. This will provide the cardiologist and heart surgeon with detailed knowledge of the structure of the heart so they can decide on the best form of treatment.

Treatment

With serious defects, surgery can now be carried out, if necessary, in the first week of life. Where possible, however, operations are usually postponed until the child is older. With some of the simpler defects, surgery can be carried out while the heart is still beating. For any operation inside the heart, however, the heart must be stopped and emptied of blood to enable the surgeon to repair the defect.

A heart-lung machine is used during the operation to carry out the work of the heart and lungs. The heart may take some time to recover from the effects of surgery but many children can go home within one to two weeks of the operation. Some patients (such as those with a hole in the heart) may require medication to help the heart while they are awaiting or recovering from surgery.

Self care

Physical activity

Young children with heart troubles do not usually overtax themselves. It is, therefore, rarely necessary to try to restrict them. With older children, overstrenuous exertion is best avoided. Competitive athletics or sports such as rugby are generally unwise, but the child can usually play socially in the playground and can often enjoy non-competitive tennis, physical education and swimming.  Your doctor will advise what sports and activities are safe for your child. The aim is for the child to live as full and normal a life as possible.

For children with innocent murmurs, no restrictions are needed.

Special care for infections

If your child has a heart defect such as a leaky valve, or other congenital heart problem, you do need to be extra careful about infections such as bronchitis, pneumonia, tonsillitis, infected sores or boils. Bacteria can spread to the heart, causing bacterial endocarditis. A doctor should be consulted to decide if treatment with antibiotics is indicated. Bad teeth and untreated skin infections are common sources of trouble.

Looking after children's teeth is also very important. Regular six-monthly dental checks are essential and the dentist must know that your child has a heart defect. An antibiotic must always be given when extractions and other major dental procedures are being carried out.

Childhood illnesses

Common illnesses such as measles and chickenpox present no particular risk to a child with a heart defect, although a check from your doctor is a wise precaution whenever your child is ill.

Children with heart defects are not at higher risk of cot death.

Immunisation

Immunisation is always advised and is even more important for a baby or child with a heart defect. They should be given at the usual times and will only be postponed if the child is very ill.

Other complications

Physical development may be slower in a child who has been ill because of his/her heart but this will usually improve once the heart defect is corrected. Sometimes a heart defect may be associated with other congenital problems, but this possibility will be checked by your doctor. Parents often worry that a heart problem may slow mental development. Fortunately, this is rarely a problem.

Telling your child about their condition

Explain the condition to your child in simple, clear terms and the doctors and nurses will also help you do this.

Encourage them to tell you if they are feeling any changes or if they have any questions or worries about their condition, or any treatment they are having. With good support, children readily accept these things.

If they are going into hospital, explain why, tell them who they will meet there, and reassure them that you will be with them. A couple of days' warning is enough for a young child.

Credits: Editorial team.