Infant Heart Defects - VSD and COA
Newborn with a Heart Defect
Like any other serious illness, it is always something that happens to someone else. During my daughter-in-law's pregnancy she told me the baby had a hole in it's heart. Our new baby had a hole in the heart and a narrowing of the aortic arch.
Apparently, one out of every one hundred and twenty-five babies born has some form of heart defect often referred to as Congenital Heart Disease. I was stunned to learn this but also comforted in some small way. Knowing that it is more common than I suspected provided some comfort in the procedures necessary to correct the problems.
A Congenital Heart Disease is simply a problem with the structure of the heart and covers any number of problems or abnormalities. The March of Dimes website tells us the defect may not manifest itself at birth or it may be so severe as to need surgery immediately. It seems these heart defects begin to form in the early weeks of pregnancy as the baby's heart develops. The baby's heart starts beating about twenty-two days after conception. Often the doctor is alerted to the defect or abnormality when there is a heart murmur present. A heart murmur is a sound the heart makes as it pumps blood. Not all heart murmurs mean a severe problem, but they allow the doctor to do further testing to determine exactly what the baby has or does not have.
A children's heart disease specialist can do a fetal echocardiography, a test that uses sound waves to take pictures of the heart. These pictures show the heart in detail and allow the doctor to determine if there is a problem to watch. Sadly scientists do not know what causes these heart problems in newborns. There is speculation and suspect conditions but nothing has been proven. One of the suspects is the mother having had the measles during pregnancy, another is a mother with diabetes. There are also medications that are said to increase the risk of heart defects and pregnant mothers are told not to take them.
Interestingly the placenta does the breathing for the fetus so heart defects only become a problem after birth.
Heart with VSD
A baby after VSD surgery
VSD - Ventricular Septal Defect
There are over thirty-five congenital heart defects in newborns. One of the heart problems newborns face is called Ventricular Septal Defect or VSD. Our baby had VSD. It is the most common heart defect among newborns. VSD is a hole in the wall of the heart between the right and left ventricles. The right and left pumping chambers are separated by the ventricular septum. This hole in the septum or wall, allows oxygen rich blood and oxygen poor blood to mix and then that blood goes back to the lungs.
Before birth, one of the signs of VSD is a heart murmur. If not caught before birth, after birth the baby's lips and finger tips will begin to turn blue. If not detected the VSD can cause heart failure within the first two months of the baby's life. Interestingly more than half of VSD's close by themselves. The other half need surgery. That is determined by the size, location, and severity of the hole. According to kidshealth.org, in surgery;
In this procedure, the surgeon makes an incision in the chest wall and a heart-lung machine will maintain circulation while the surgeon closes the hole. The surgeon can stitch the hole closed directly or, more commonly, sew a patch of manmade surgical material over it. Eventually, the tissue of the heart heals over the patch or stitches, and by 6 months after the surgery, the hole will be completely covered with tissue.
It sounds so easy but when you are talking about a newborn baby it is more than scary.
- Associated with other abnormalities of the heart
- Makes up 8% of congenital heart problems
- Occurs more commonly in boys
- Usually diagnosed in babies or young children
- Needs to be treated or it will cause other problems
- Symptoms may include cold hands and feet, shortness of breath, and chest pain
- Those diagnosed at birth are corrected by surgery
Narrowing of the Aortic Arch - COA
Narrowing of the aortic arch is also called COA because the narrowing is referred to as a coarctation. It is the fourth most common Congenital Heart Disease. Our baby had a narrowing of the aortic arch. The Children's Hospital of Pennsylvania's website notes that "Children with interruption of the aortic arch almost always also have a large ventricular septal defect (VSD), or a hole in the wall between the two lower, pumping chambers of the heart." It is also noted that blood pressure can be higher before the narrowing and lower after the narrowing.
An ultrasound can detect a COA in the womb. The most common COA is located right after the arch of the aorta. COA must be fixed by open heart surgery to open the narrowed vessel. It is either opened or surgically removed depending on the individual circumstance. If not corrected the overworking of the ventricles will eventually cause heart failure. It appears this heart failure is more rapid in newborns. If not corrected babies will experience poor appetite, trouble feeding or failure to gain weight and thrive. Surgical resection of the narrowed artery is the only cure.
As with other infant heart defects there is no known reason for the occurrence of COA. They just seem to be there by chance.
Though surgery corrects the immediate problem this is not to be dismissed. Yearly checkups with a cardiologist are necessary to ensure there are no further problems. These yearly checkups are necessary for life. It is very important to monitor blood pressure and make sure a narrowing does not reoccur.
After Infant Heart Surgery
After your infant has open hear surgery he/she is monitored much like an adult. The baby may still be hooked to a ventilator to help her breathe until the effects of the anesthesia have worn off. You will see IVs providing both medicine and IV fluids. Next, an arterial line will be present to monitor the baby's blood pressure. A nasogastric tube will help keep the baby's stomach free of any acid or gas that built up during the surgery. A chest tube is inserted to keep the chest cavity free of blood as the heart and incision heal. A heart monitor will be connected to allow staff to monitor the baby's heart throughout the recuperation period. Some hospitals also keep an Electroencepholograph hooked up to the baby to watch for any seizure action that would not otherwise be obvious.
What do you remember?
As previously mentioned, my granddaughter was born with a VSD and COA. She was born at CHOP, The Children's Hospital of Pennsylvania, the number one children's hospital in the United States. Both of her defects were corrected with open heart surgery three days after she was born. She is now two and a half weeks old and doing well. She still has a feeding tube as bottle feeding makes her tired. It is very important for "heart babies", as the nurses call them, to get proper nutrition. The formula that she is getting is higher in calories than a normal baby formula. She is first fed the bottle to encourage her to eat on her own but if she does not finish the bottle the remaining portion is fed to her through the feeding tube (also referred to as a nasogastric tube).
She is beautiful and seems to be getting stronger every day and eating a little more at each feeding. She amazes me! I look at her perfect features and dainty face as she sleeps and I cannot believe that she has gone through open heart surgery.
The most important lesson here is that babies are born with Congenital Heart Disease but can be helped. Open heart surgery is scary at any age but down right paralyzing for the families of newborns. Research, updated techniques and tests have all led to more accurate and advanced surgical procedures that will benefit your baby. My prayers are with anyone who has to go through this surgery with their newborn.
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