Adults Living with Congenital Heart Defects

Currently, there are approximately one million adults in the United States living with congenital heart defects (CHD). Due to increased survival, this number increases by about 5% every year. These numbers are significant considering that at one time babies born with CHD had virtually no chance of becoming an adult. Thanks to surgical advances and research in pediatric cardiology in the past 50 years, most congenital heart defects have been able to be corrected. Today, babies born with heart defects have a much better outlook than they did 50, or even 15 years ago.

Some of the adults who are alive today are survivors of some of the first open heart surgeries done in babies born with defects. For instance, the Blalock-Tausigg procedure was developed in 1944 to help infants with cyanosis or blue-baby disease. This procedure was done primarily for those born with Tetralogy of Fallot (TOF), one of the most common congenital heart defects.

Another surgery, called the Fontan was first done in 1968. This type of surgery is done for patients born with a single ventricle or a single-functioning ventricle. Today, the Fontan operation is the most common procedure performed after the age of two years. Babies born with defects requiring this type of surgery often have to go through other procedures first.

Of course, even though surgeries like those mentioned above were first performed when they were, they have gone through several modifications. Today many of these open heart surgeries being performed offer babies born with CHD's a better quality of life which in turn helps them grow into adults with a higher quality of life than the first-time recipients of such procedures.

Many adults who received treatment for their heart defect as a child go into adulthood thinking that they have been cured and they no longer need to worry about their heart condition. For over half of the adults living with CHD, this couldn't be further from the truth. Depending on the complexity of the heart condition the patient was born with, sometimes they need to receive ongoing care for the rest of their lives.

Adults who need continual care often fall through the cracks because either they think they have been cured and they no longer need care, they can't afford ongoing care because they no longer qualify under their parents' insurance plan or other financial issues or they simply don't know where to go. As children, many adults with congenital heart defects saw a pediatric cardiologist and it then becomes difficult for them to make the transition from a child to an adult with CHD.

Every year, the American College of Cardiology (ACC) conducts a meeting in Bethesda, Maryland to address important issues in cardiology. In the year 2000 during the 32nd Bethesda conference, the ACC addressed the needs of adults living with congenital heart defects. The report produced from this conference outlines many unmet health care needs facing those adults with congenital heart defects (ACHD). The report also states that those adults born with complex heart defects should be seen at specialized ACHD care centers on a regular basis, in other words be seen by someone with experience in treating adults, not just children with CHD. The report also suggests that even those adults born with simple defects be evaluated at least once at an ACHD care center. A regular cardiologist has little training in the area of pediatric cardiology and virtually none when it comes to adults with CHD, which is why it is so important to see a more specialized cardiologist.

There are cases where the ACHD cardioglist travels from an ACHD center to surrounding towns to see patients. For example, my cardiologist is at the Mayo Clinic in Rochester, Minnesota but thankfully, he comes to Bismarck three times a year so I don't have to travel all the way to Rochester every year. I do however, go to Rochester for medical procedures such as getting my battery in my pacemaker replaced.

There are many challenges for some adults with complex CHD that healthy adults do not face.

Contraception and Pregnancy

Women born with a complex heart condition need to be careful about which kind of contraception is safe for them and also if pregnancy puts their life at risk. At one time it was not recommended for women with certain heart defects to have children. Now, however with the development of ACHD centers, some women can become pregnant but have to be followed closely by their ACHD cardiologist. It is advisible that before a women starts on any kind of birth control or before getting pregnant that she talk to a cardiologist who specializes in adults with CHD.

If pregnant, women with CHD should also begin to have their baby's hearts monitored between the 16th and 18th week of pregnancy. Some congenital heart defects are thought to be hereditary.

Exercise

Some adults with CHD have to be careful about how much they can tolerate when it comes to exercising. Some patients need to have weight restrictions while others are not recommended to walk or run long distances.

Psychological Issues

Being an adult with CHD can take it's toll emotionally. Some adults have a fear of dying while others may have trouble being active because of their health. Others face depression and unresolved fear and pain. There are also physical characteristics such as scarring or being cyanotic that can be hard to deal with. Sometimes talking about their heart defect is hard to do with friends of family members. If an adult with CHD is having emotional issues because of health reasons or any reason, it is recommended they see a counselor.

All adults living with CHD should be educated about their particular defect. To live as healthy as possible it is important to be educated in the following:

• Name and details of their heart condition;
• Surgeries that have been performed;
• Frequency of follow-up;
• Medications and side effects;
• Preventing heart infections (endocarditis);
• Exercise;
• Birth control and family planning;
• Career planning and resources;
• Insurance;
• Dental care;
• Symptoms to look for;
• When to contact their health care provider

They also need to know that minor or major surgery can present risks for the CHD patient. Special attention is needed with anesthesia and to prevent heart infections (endocarditis). Patients on blood thinners also require special care. Ideally all surgery on these patients should be done at ACHD centers.

The Adult Congenital Heart Association (ACHA) is a "nonprofit organization which seeks to improve the quality of life and extend the lives of congenital heart defect survivors." It was founded in 1998 by a group of adult congenital heart defect survivors and their families.

The ACHA website is a great place to go for support, education and to become an advocate of research. There is a message board which is a wonderful way to find other people with similar conditions as yours. There is also information on how to get an ACHA support group started in your area.

Recently, on my hub, CHD - The Most Common Birth Defect, I menioned what it was like for me as a child with a heart condition. When I was going to college, I was under the misconception that the surgery I had when I was ten years old had "fixed" me and that I no longer to worry about my heart. After all, it had been nine years and I was having no symptoms of there being anything wrong. That was until my sophomore year in college when I got really sick. The three doctors I had seen over a span of two months all thought I had an ulcer of some sort. Then one day I was having a hard time breathing so my college roommates rushed me to the emergency room.

I was in congestive heart failure. They put me on diuretics and I lost about twenty pounds of fluid I had been retaining. I hadn't been on any medication before this, and after my bout with CHF, I was on four different medications. For the next five years I did not feel well and finally in 1999 I knew something was very wrong. At my yearly appointment with a pediatric cardiologist (at this time I was going to Fargo, ND for my cardiology care, which did not have an ACHD center), I was told my right atrium was grossly enlarged and my doctor talked about putting me on a blood thinner since I was at risk for blood clots. It wasn't definite though and he wanted to review some of my tests before deciding. I never heard back from him for two weeks and when I called they told me to just take an aspirin a day.

I knew there was something else going on so I got a second opinion from one of the Mayo doctors who came to North Dakota and he shocked me when he said I needed open heart surgery. He explained to me that my adult body had outgrown my Fontan I had when I was ten years old so they needed to go in and make some modifications. Three weeks later at 25 years old, I had my fourth open heart surgery and three months after that I had my pacemaker implanted.

I can honestly say I've been well since then. I see my ACHD cardiologist once a year and everything continues to go well. The only thing I've had done since my last surgery is have two batteries replaced in my pacemaker. I was even able to have a baby when I was 29, which because she was born preterm, I had to be flown to Mayo Clinic - that's another hub!

I know there are adults with CHD who struggle with their health on a daily basis. Some are in constant congestive heart failure while others are on medications with severe side effects. There are those who are on oxygen 24/7 and even those who die at a young age. My heart goes out to them and their families who struggle along with them. Sometimes I wonder why I am doing so well, considering my heart condition is one of the more complex ones. I think prayer and knowing Jesus as my healer has played a big part and I can only pray that I continue to do well and Jesus continues to heal all who struggle with a congenital heart defect.