Certain heart defects can cause congestive heart failure. In this condition, the heart can’t pump adequate blood to the lungs or other parts of the body. It can lead to fluid build-up in the heart, lungs and other parts of the body. An affected child may experience a rapid heartbeat and breathing difficulties, especially during exercise. Infants may experience these difficulties during feeding, sometimes resulting in poor weight gain. Affected infants and children also may have swelling of the legs or abdomen or around the eyes.
Some heart defects result in a pale grayish or bluish coloring of the skin called cyanosis. This usually appears soon after birth or during infancy and should be evaluated immediately by a health care provider. On occasion, cyanosis may be delayed until later in childhood. Cyanosis is a sign of defects that prevent the blood from getting enough oxygen. Children with cyanosis may tire easily. Symptoms, such as shortness of breath and fainting, often worsen when the child exerts himself. Some youngsters may squat frequently to ease their shortness of breath.
- Chest X-ray
- Electrocardiogram, a test that records heart rate patterns
- Echocardiogram, a special form of ultrasound that uses sound waves to take pictures of the heart
All of these tests are painless and noninvasive (nothing enters the child’s body). Some children with heart disease also may need to undergo a procedure called cardiac catheterization. In this procedure, a thin, flexible tube is inserted into the heart after the child is given medications to make him sleepy. This test provides detailed information about the heart and how it is working.
Scientists are making progress in understanding the genetics of heart defects. Since the 1990s, they have identified about 10 gene mutations (changes) that can cause isolated (not accompanied by other birth defects) heart defects (3). For example, a March of Dimes grantee identified a gene that can cause a heart defect called an atrial septal defect (a hole between the upper chambers of the heart), and one that may contribute to hypoplastic left heart syndrome (underdevelopment of the heart’s main pumping chamber) (4, 5).
Environmental factors can contribute to congenital heart defects. Women who contract rubella (German measles) during the first three months of pregnancy have a high risk of having a baby with a heart defect. Other viral infections, such as the flu, also may contribute, as may exposure to certain industrial chemicals (solvents) (2). Some studies suggest that drinking alcohol or using cocaine in pregnancy may increase the risk of heart defects (2). Certain medications increase the risk. These include (2):
- The acne medication isotretinoin (Accutane and other brand names)
- Thalidomide (approved only for a rare, severe skin disorder, but sometimes used for other conditions)
- Certain anti-seizure medications
Some studies suggest that first-trimester use of trimethoprim-sulfonamide (a combination of antibiotics sometimes used to treat urinary-tract infections) may increase the risk of heart defects (2).
Certain chronic illnesses in the mother, such as diabetes, may contribute to heart defects (2). However, women with diabetes can reduce their risk by making sure their blood sugar levels are well controlled before becoming pregnant.
Heart defects can be part of a wider pattern of birth defects. For example, at least 30 percent of children with chromosomal abnormalities, such as Down syndrome (mental retardation and physical birth defects) and Turner syndrome (short stature and lack of sexual development), have heart defects (3). Children with Down syndrome, Turner syndrome and certain other chromosomal abnormalities should be routinely evaluated for heart defects.
Heart defects also are common in children with a variety of inherited disorders, including Noonan syndrome (short stature, learning disabilities), velocardiofacial syndrome (craniofacial defects and immune deficiencies), Holt-Oram syndrome (limb defects) and Alagille syndrome (liver, skeletal and eye defects) (3).
- Septal defect: This is a hole in the wall (septum) that divides the right and left sides of the heart. A hole in the wall between the heart’s two upper chambers is called an atrial septal defect, while a hole between the lower chambers is called a ventricular septal defect. These defects can cause the blood to circulate improperly, so the heart has to work harder. Some atrial septal defects can be repaired without surgery by inserting a thin, flexible tube into the heart and then releasing a device that plugs the hole. A surgeon also can close an atrial or ventricular septal defect by sewing or patching the hole. Small holes may heal by themselves or not need repair at all.
- Coarctation of the aorta: Part of the aorta, the large artery that sends blood from the heart to the rest of the body, may be too narrow for the blood to flow evenly. A surgeon can cut away the narrow part and sew the open ends together, replace the constricted section with man-made material, or patch it with part of a blood vessel taken from elsewhere in the body. Sometimes, this narrowed area can be widened by inflating a balloon on the tip of a catheter (tube) inserted through an artery.
- Heart valve abnormalities: Some babies are born with heart valves that do not close normally or are narrowed or blocked, so blood can’t flow smoothly. Surgeons usually can repair the valves or replace them with man-made ones. Balloons on catheters also are frequently used to fix faulty valves.
- Tetralogy of Fallot: This combination of four heart defects keeps some blood from getting to the lungs. As a result, the blood that is pumped to the body may not have enough oxygen. Affected babies have episodes of cyanosis and may grow poorly. This defect is usually surgically repaired in the early months of life.
- Transposition of the great arteries: Transposition occurs when the positions of the two major arteries leaving the heart are reversed, so that each arises from the wrong pumping chamber. Affected newborns suffer from severe cyanosis due to a lack of oxygen in the blood. Recent surgical advances make it possible to correct this serious defect in the newborn period.
- Hypoplastic left heart syndrome: This combination of defects results in a left ventricle (the heart’s main pumping chamber) that is too small to support life. Without treatment, this defect is usually fatal in the first few weeks of life. However, over the last 25 years, survival rates have dramatically improved with new surgical procedures and, less frequently, heart transplants (6).
Following surgery, children should have periodic heart checkups with a cardiologist. Children and adults with certain heart defects, even after surgical repair, remain at increased risk of infection involving the heart and its valves. Parents of children with heart defects and adults with repaired heart defects should discuss with their provider whether they need to take antibiotics before dental visits and other procedures to prevent these infections. Antibiotic treatment is recommended only for those considered at highest risk for infection, including those with man-made heart valves (7).
- Take a multivitamin containing 400 micrograms of folic acid daily, starting before pregnancy. This helps to prevent serious birth defects of the brain and spinal cord and may also help prevent heart defects.
- Go for a preconception visit with her health care provider. At this visit, a woman should be tested for immunity to rubella and be vaccinated if she is not immune. Women with chronic health conditions, such as diabetes and phenylketonuria (PKU), should discuss adjusting their medications and/or eating habits to keep these conditions under control before and during pregnancy.
- Discuss all medications with their provider, even over-the-counter or herbal medicines.
- Avoid people who have the flu or other illnesses with fever.
- Avoid exposure to organic solvents, used in products such as paints, varnishes and degreasing/cleaning agents.
Parents who have had a child with a heart defect should consult their pediatric cardiologist and can consult a genetic counselor to find out the risks to any future children. Parents who themselves have a heart defect also are at increased risk of having an affected child and should consider consulting a genetic counselor.
In some cases, the mother’s heart disease or the medications she takes to treat it can affect the fetus, causing poor growth, premature delivery or other problems (9). Some women with heart disease may need careful monitoring by a high-risk obstetrician, as well as their cardiologist, throughout pregnancy.
- National Heart, Lung and Blood Institute. Congenital Heart Defects. December 2007.
- Congenital Cardiovascular Defects: Current Knowledge: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young. Circulation, volume 115, June 12, 2007, pages 2995-3014.
- Pierpont, M.E., et al. Genetic Basis for Congenital Heart Defects: Current Knowledge: A Scientific Statement From the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young. Circulation, volume 115, June 12, 2007, pages 3015-3038.
- Garg, V., et al. GATA4 Mutations Cause Human Congenital Heart Defects and Reveal an Interaction with TBX5. Nature, volume 424, July 24, 2003, pages 443-447.
- Garg, V., et al. Mutations in NOTCH1 Cause Aortic Valve Disease. Nature, volume 437, September 8, 2005, pages 270-274.
- Johnston, M.V. Congenital Heart Disease and Brain Injury. New England Journal of Medicine, volume 357, number 19, November 2, 2007, pages 1971-1973.
- American Heart Association. Congenital Heart Defects. Accessed 3/24/08.
- Gill, H.K., et al. Patterns of Recurrence of Congenital Heart Disease. Journal of the American College of Cardiology, volume 42, number 5, September 3, 2003, pages 923-929.
- Uebing, A., et al. Pregnancy and Congenital Heart Disease. British Medical Journal, volume 332, February 18, 2006, pages 401-406.