Matters of the Heart

It’s much more common than you may think. In fact, according to the Centers for Disease Control and Prevention, each year about 40,000 infants are born with a congenital heart defect. While you may have heard the term, you may not know what it is and how it’s treated. To better educate ourselves — and our readers — we spoke with pediatric cardiologist Dr. Renee Bornemeier with Arkansas Children’s Hospital.

BY ANGELA E. THOMAS

The word congenital means existing at birth, and while it’s sometimes referred to as congenital heart disease, defect is more accurate, per the American Heart Association.

“Ventricular septal defects are the most common,” Bornemeier said. Often referred to as VSD, “a ventricular septal defect means there is a hole in the muscular wall that divides the lower left and lower right chambers of the heart. And like many congenital heart defects, there is no way to prevent VSD prior to birth.”

“The majority of heart defects are caught during the child’s first year of life. Treatment of a VSD depends on the size of the defect. If it’s small, it may close on its own, and some holes are so small, we may not even know they exist,” she said.

The most common indicator of a VSD is a heart murmur. A murmur is an extra sound that’s usually heard when the valves of the heart close, and most often is heard by a doctor. Not all murmurs are cause for alarm.

“Functional murmurs are normal and may be heard as a child moves, is active or excited. Doctors are trained to hear murmurs and to differentiate them. Statistically, most murmurs are found within the first few hours of a newborn’s life,” Bornemeier said.

She explained, “While a baby is in utero, mom breathes for them with the help of the placenta. Very little blood is circulated through the lungs. After the baby is born, he transitions to breathing on his own. This process continues for weeks, up to three months and during this time a larger hole in the muscular wall may be detected.”

Because of the hole, his heart must work harder to move blood to the lungs, so he will breathe a bit faster than normal. This is one of the signs of a heart defect. Additionally, babies with heart defects must work hard to eat. They tire easily while drinking milk and may sleep through feeding times or only eat 1.5 to 2 ounces at a time.

Doctors generally use three tests to detect a VSD: an electrocardiogram (ECG or EKG), a chest X-ray and/or a fetal echocardiogram. Doctors use electrocardiograms to look at the heart’s activity through electrical patterns. The chest X-ray is used to look at the size and contour of the heart, to look at the lungs and to determine if the blood vessels are more prominent. The fetal echocardiogram, an ultrasound, is used to allow doctors to get a good look at the heart’s chambers, wallsand valves. Additionally, doctors will measure the speed at which the blood is moving.

“There are several variables that determine treatment: if the hole is very, very small, the recommendation may be to give it time to close naturally; if it’s ‘medium,’ we will base treatment on things such as the rate at which the child is breathing and growing,” Bornemeier said.

Other variables like the rate of breathing and weight gain are taken into consideration, and doctors may treat the VSD by advising an increase in caloric intake and prescribing medication to ensure the lungs don’t develop excessive fluid. Surgery may, Bornemeier stresses may, be advised as well. Again, doctors will look at several factors and it’s important to remember each case and each child is different.

The second most common congenital heart defect is the atrial septal defect (ASD), which is a hole between the upper chamber of the heart. It’s a bit more difficult to distinguish, the doctor added, as it’s not as loud. “A cardiologist would probably be the one to identify this,” Bornemeier said. “A child may be 3 or 4 years old or even a teen approaching adulthood before he’s diagnosed with an atrial septal defect.”

Some of the signs of an ASD include shortness of breath and irregular heartbeats. Again, a murmur that is the result of an ASD may be heard when a child has been active or sick with a fever. There are several treatments, including surgery. The most common type of ASD is a secundum ASD and these may be closed in a cath lab by adding a ASD closure device.

If you are concerned about your child, speak with your pediatrician or general practice doctor first. Additionally, if you are pregnant or are planning to become pregnant, be sure to disclose your medications to your physician. While there’s no way to prevent congenital heart defects, some medications taken during the time the heart is developing may be of concern.

“The heart is a very complex organ and its development is complicated,” Bornemeier said. She practices at Arkansas Children’s Hospital, where their pediatric cardiology services include: surgery; a transplant program; fetal cardiology treatments (offered prior to birth); interventional cardio treatments; advanced cardio imagery; an echocardiogram lab; and CT and MRI services which are often used for 3D modeling; and more.