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, more than 35,000 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 exactly is CHD?

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.

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.

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
• Cyanosis
• Tires easily
• Poor circulation
• Sweating
• 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 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.

Medication

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

Catherization

Some who have CHD need to undergo a heart catherization. This is done in order to find out the details of the heart defect or to sometimes to repair it. With heart 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.

Surgery

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 myself was born with a congenital heart defect called Double Outlet Right Ventricle (DORV), which is considered a very complex defect. When I was a baby, symptoms my mom noticed were tiring easily and cyanosis. I had my first heart surgery called a Waterston shunt at six months of age. At the time, my parents and older brother lived in Montana and they needed to take me (by car) all the way to Minneapolis for the surgery. When I was four, I had my second surgery called the BT shunt. We got to travel by train to Minneapolis for that one. And when I was ten I had the fontan. Post fontan, I was so excited to have pink fingernails and I took my first plane ride from the Twin Cities to Minot, ND.

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. Along with this, I also had pulmonary stenosis and a ventral septal defect.

It was hard being a kid with a heart defect because it meant I couldn't do many of the normal physical activites that kids do. Running was a huge no-no. When I did overextend myself I got really bad headaches, sometimes migraines. I was pale and cyanotic with blue lips and blue fingernails. 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 when I was ten, I actually felt 'normal' and healthy and could do more things. It seemed I had been cured, until my bout with congestive heart failure when I was 19. That though, is another hub which I hope to write soon regarding adults living with congenital heart defects.