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Congenital heart disease

What is Congenital heart disease?

Congenital heart disease refers to heart defects that you are born with. The severity of the disease ranges from mild defects to severe and life-threatening conditions. In Singapore, according to the birth defect registry, congenital heart disease was a factor in 0.81% of total live births from 1994 − 2000.

There are numerous types of congenital heart disease such as:

  • Atrial septal defect (hole in the wall separating the two upper, right and left, atriums of the heart)
  • Coarctation of the aorta
  • Tetralogy of Fallot
  • Hole in the heart
  • Mitral valve prolapse
  • Patent ductus arteriosus
  • Pulmonary atresia
  • Pulmonary/aortic stenosis
  • Transposition of the great vessels
  • Ventricular septal defect (hole in the wall separating the right and left ventricles)

Complications

  • Complications related to pregnancies, use of contraception and risk to offspring
  • Inflammation of the inner layers of the heart (endocarditis)
  • Managing of resulting non-cardiac medical problems
  • Social, emotional, financial, employment and education issues
  • Life-long follow-up

Causes

The causes of congenital heart disease are not very well known, though they may include:

–  Chromosomal or genetic conditions, which can be inherited or might occur (rarely) in early pregnancy:

  • Down syndrome, DiGeorge syndrome, Marfan’s syndrome and Turner syndrome

–  Environmental factors can lead to congenital heart disease:

  • Excessive drug or alcohol consumption during pregnancy, acne medications, exposure to chemicals, viral infections (eg. rubella), and other diseases including diabetes

Symptoms

Depending on the type and severity, many congenital heart defects may present with no symptoms. When the heart defects are severe or if multiple heart defects are present, especially in newborns, the following symptoms may occur:

  • Blue skin, lips and fingernails
  • Chest pain
  • Fainting
  • Heart murmur
  • Palpitation
  • Poor blood circulation
  • Rapid breathing
  • Tiredness

Treatment

Transcatheter procedures may be used to treat congenital heart defects. These are minimally invasive procedures performed using a catheter (small tube). This includes the delivery of an intravascular device such as a balloon, a coil or a stent to help dilate or close existing cardiovascular defects.

Transcatheter procedures include:

  • Balloon angioplasty or balloon dilation is a procedure that expands narrowed blood vessels to improve blood flow to the heart
  • Balloon atrial septostomy is used to treat some congenital heart defects and can be performed on fetuses or infants. This technique expands the hole between the right and left upper chamber of the heart.
  • Balloon valvuloplasty is recommended for patients whose valves are narrowed. A tiny balloon catheter is directed to the target valve, then inflated until the valve opening is widened sufficiently.
  • Device closure of a condition called patent ductus arteriosus (PDA) is performed when a baby’s ductus arteriosus (blood vessel normally present and closed a few days after birth) is not completely closed after birth. A device is inserted through the blood vessels in the groin to close this gap.
  • Device closure of atrial septal defect (ASD), a congenital heart defect between the upper two chambers of the heart. An occluder (separator) can be inserted to divide the two chambers of the heart when atrial septic defect is present. This will help the heart resume its normal function.

Surgery

  • Cavo-pulmonary shunt (CPS)
  • Fontan procedure
  • Ligation of patent ductus arteriosus
  • Modified blalock taussig shunt (BTS)
  • Norwood procedure
  • Pulmonary artery band (PAB)
  • Rastelli operation
  • Ross procedure

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