CHD - The Most Common Birth Defect in Babies
Congenital heart defects (CHD) are the most common birth defects. CHD affects 8 out of every 1,000 newborns. Each year, nearly 40,000 babies in the United States are born with congenital heart defects. Congenital heart defects are also responsible for more deaths in the first year of life than any other birth defect.
What are Congenital Heart Defects?
Congenital Heart Defects are when babies are born with something wrong with their hearts. When some part of the heart doesn't develop normally, the flow of blood is changed through the heart. Some CHDs, like mild pulmonary valve stenosis (narrowing of the pulmonary valve) are simple defects and usually do not require treatment. The only symptom may be a heart murmur.
Other defects, however, can be more complex, such as tetralogy of fallot, which is the most common complex CHD. Tetralogy of fallot (TOF) consists of four different types of defects which prevents an adequate amount of blood from reaching the lungs, resulting in oxygen-poor blood flow to the body. In the case of this type of defect, open heart surgery is needed either at birth or later in infancy. Symptoms of TOF usually include cyanosis or blueness of the skin and/or mouth and fingernails.
Whether mild or complex, there are 35 known types of defects. Heart defects may involve missing, unconnected or misplaced arteries; underdevloped or missing valves, and narrowed or blocked blood vessels.
Causes of CHD
To date, there is no known cause of CHD. Researches have speculated that heart defects are caused by a genetic abnormality or when the developing fetus is exposed to infections, toxic substances or drugs. Other factors may include:
- Hereditary - a parent with a congenital heart defect may be more likely to have a child with CHD.
- Genetic Disorders - Children with genetic disorders are more likely to have CHD. Half of all Down Syndrome babies have heart conditions.
- Smoking during pregnancy - smoking has been linked to several congenital heart defects
- Babies born prematurely have a higher chance of having a congenital heart defect.
- Babies born to women who have chronic conditions such as diabetes have a higher chance of having a congenital heart defect.
Symptoms of CHD
If a baby has a mild defect, there may be no symptoms at all. There may be a heart murmur which can be heard with a stethoscope but sometimes even healthy babies and children have heart murmurs and some of them even grow out of their murmur.
Some symptoms of CHD in babies and children include:
- Rapid or difficulty breathing
- Tires easily
- Poor circulation
- Poor weight gain
- Sudden weight gain or puffiness or swelling of the skin
There are some types of heart defects that cause the heart to work harder than it should. If the heart continues to work too hard it could result in heart failure. This is also known as Congestive Heart Failure or CHF.
Symptoms of heart failure include:
- Fatigue with physical activity
- Shortness of breath
- A buildup of blood and fluid in the lungs
- A buildup of fluid in the feet, ankles, and legs
Treatments for CHD
Treatments for CHD vary depending on the severity of the heart defect and also the general health of the heart patient. As discussed earlier, mild defects might not require any treatment. While this is true, it is important to be seen by a pediatric cardiologist as he or she deems necessary. Some defects can get worse over time so it is always best to take extra caution.
Sometimes medication is required. Some examples of medicines used to treat CHD include:
- Antiarrhythmics - controls irregular heartbeats
- Cardiac glycosides - increases strength of heartbeats
- Vasodilators - enlarges blood vessels
- Diuretics - reduces extra fluid (usually used in cases of heart failure)
- Prostaglandins and prostaglandin inhibitors - improves blood flow to the lungs or body
Some who have CHD need to undergo a cardiac catheterization. This is done in order to find out the details of the heart defect or to sometimes to repair it. With cardiac catherization, a catheter is threaded through a blood vessel, usually in the groin and into the heart. This procedure allows the doctor see how blood is flowing through the heart and heart arteries.
Sometimes treatment includes surgery. The type of surgery depends on the type of heart defect. There are many different kinds of surgeries to treat several different heart defects. If the defect is life-threatening, surgery might be done right away in a newborn. For other defects, surgery is usually done within the first two years of the child's life. Sometimes a child has two, three or more surgeries within the first years of the child's life.
There are cases where all three types of treatment - medicine, catherization and surgery - may be required. Also, it is important to know that just because a child has had corrective surgery does not mean they are cured. A congenital heart defect is something the child is going to receive ongoing care for, or at least be seen by a pediatric or a congenital adult cardiologist on a regular basis.
I will give you a new heart and put a new spirit in you; I will remove from you a heart of stone and give you a heart of flesh. And I will put my spirit in you and move you to follow my decrees. Ezekiel 36:26-27a
CHD and Me
I was born with a very complex congenital heart defect called Double Outlet Right Ventricle (DORV). As a baby, my mom noticed I tired easily and had cyanosis in my lips and fingernails. I had my first heart surgery called a Waterston shunt at six months of age. My parents took me by car from western North Dakota all the way to Minneapolis for the surgery. At the age of four, I had my second surgery called the BT shunt. We traveled by train to Minneapolis for that one and returned home just in time for Christmas. I had my Fontan when I was ten years old. Following surgery, I was excited to finally have pink fingernails.
The best way to describe my heart condition is that there are two main arteries attached to the ventricles. There is the pulmonary artery which carries oxygen-poor blood to the lungs and there is the aorta which carries oxygen-rich blood from the heart to the body. In a normal heart, the pulmonary artery rises from the right ventricle and the aorta rises from the left ventricle. In my heart, both the pulmonary artery and the aorta were attached to my right ventricle which caused my left ventricle to be non-functioning. I also had pulmonary stenosis, a ventral septal defect and leaky mitral valve.
I had a hard time being a kid with a heart defect. I couldn't do a lot of the normal physical activities that my siblings and other kids in my class were doing. I wasn't supposed to run or do anything that would increase my heart rate. When I did overextend myself, I came down with really bad headaches, sometimes migraines. I had scars on each side of my body and after my third surgery I had a scar down the middle of my chest. After my Fontan I actually felt 'normal' and healthy and could do more. It seemed I had been cured, until my bout with congestive heart failure at the age of 19 while a sophomore in college. You can read more about that ordeal in my Hub, Adults Living with Congenital Heart Defects.