The most common birth defect seen in infants and newborns are related to the heart. The abnormality is seen in almost one in 100 pregnancies.
The diagnosis may be made during pregnancy or sometime after the birth of the baby. The diagnosis usually involves a paediatric doctor hearing a heart murmur. A heart murmur happens to be an abnormal heart sound. Once this is suspected, a cardiologist performs an echocardiogram, and a confirmation of whether the murmur is from an abnormality in the heart or is an innocent murmur can be made.
An innocent murmur is a murmur, which though present is not associated with a heart abnormality i.e. the heart is innocent and normal though there is a murmur. This is a fairly common situation. If an abnormality is noted, often it is a condition of the heart that does not require immediate treatment or surgery. Occasionally, the abnormality may warrant intervention or surgery.
Types of heart disease
There are two main types of heart disease: ones in which the baby turns blue and the ones in which the baby does not turn blue. Almost all conditions in which the baby turns blue require surgical treatment. For others, surgery may not be required at times, or it may be treatable by balloon angioplasty or device closure. Both these methods are non-surgical methods. All major defects require surgery to be done.
The most common defect of the heart is a ‘hole in the heart’. An isolated hole in the heart (which could be a ventricular or atrial defect) will require treatment. The hole is between chambers carrying red and blue blood (red signifying ‘with oxygen’ and blue signifying ‘without oxygen’). The condition of an isolated hole in the heart should not be confused with conditions where hole is present, associated with many other abnormalities in the heart, which have varying treatment and outlook.
The outlook of children with a hole in the heart is very good, irrespective of whether it is closed by surgery or intervention. Many conditions now can be treated without surgery. The closure of such defects can be done by an angioplasty technique similar to the one in adults to place stents.
Common problems in children include a hole between the lower chambers (called VSD). The wall between upper (ASD) or lower (VSD) chambers separates red from the blue blood. A hole would result in extra blood flow to lungs. This makes the child have more chest infections; the child gains weight with difficulty and feeding also becomes a problem.
On the other hand, the child could be blue when in addition to a hole in the heart there is a blockage of blood flow to the lungs (ToF). This is the most common condition in which the baby becomes blue. Such conditions always require surgery to be done. Other defects in which the child becomes blue include conditions where red blood from lung (with oxygen) drains abnormally into blue blood; or, the tubes coming out of the heart carrying red and blue blood get switched whereby the body receives blue blood wrongly and the lungs get red blood. These conditions usually require a single operation and the child becomes normal. Finally, it is in a condition when one of the valves of the pump is not normal that the child requires more than one operation in his/her lifetime, and may affect the quality of life or the life span.
Symptoms of congenital heart disease
Children may show symptoms in many ways when they have a birth heart defect. The most common are seen in infancy:
- In infancy, children may have several symptoms that parents may recognise as not being normal. For example, a child may take too long to feed. A child may sweat while feeding, or may not gain weight in spite of feeding. The child also may have a faster breathing rate, and rarely parents may complain that the child’s heart rate is faster.
- The child may appear blue. Sometimes they may gradually become bluer and reach a point where they may not be able to walk. The child may have to squat for some time before continuing to walk.
- A newborn baby may require oxygen and without that may not maintain a normal oxygen level.
- Occasionally, the child may show symptoms that require emergency treatment. This may happen more so in the newborn age group when the symptoms may vary between:
- A very blue baby
- A baby with low blood pressure or in shock
- A baby with very rapid breathing or breathing difficulty
- Older children may have fainting episodes, which may be the only indicator of a major underlying heart problem. These conditions can occasionally be fatal. This is referred to as an acute life threatening heart problem. These are electrical problems of the heart. A small child may not be able to verbalise what the problem is.
Sometimes, the heart disease may not be picked up till late in life and such symptoms are called adult symptoms of congenital heart disease.