The term ‘congenital’ means the condition, disease or problem that is present from birth. Out of several birth defects, Congenital heart defects are the most common birth defects. Congenital heart defects occur during the first important 8 weeks of the baby’s development during pregnancy.

Congenital heart disease is not an ailment, it’s a defect or abnormality, which affects 8 out 1000 babies born in the UK. It can either be a hole in the heart, atrial septal defect or ventricular septal defect. CHD is an outcome of complications between genetic and nongenetic factors acting on the fetus.

Congenital Heart Defects

There are several types of congenital heart defects like inside walls of the heart, large blood vessels or inside walls of the heart. Some defects do not require treatment at all but some need instantaneous treatment just after birth.

So basically, congenital heart diseases can range from minor (small void in the heart)  to major (poorly formed part of the heart)  heart defects. 1 out of 4 babies is born with a critical congenital heart defect and requires instant surgery. 

As the health care systems have become more advanced, 9 in 10 children with congenital heart diseases live a long and healthy life. 

According to the centers for disease control and prevention, currently, one million adults and one million children in the United States are suffering from congenital heart defects. 

By definition, Congenital Heart Disease means a poor heart condition that develops in the womb before a baby is born. As per now, scientists and doctors aren’t able to find an exact cause behind the occurrence of heart congenital disease. But it has a relation with the early development of the fetus. Sometimes the reason behind congenital heart disease is due to faulty genes or chromosomes. Congenital Heart diseases can also occur if the mother has diabetes during pregnancy.

Impact of Maternal Diabetes on Congenital Heart Disease 

Those infants whose mothers have diabetes are more likely to have congenital anomalies and cardiac defects. According to Dr. Garg (Nationwide Children’s Hospital), “certain epidemiological studies show that

  1. Maternal diabetes has a strong influence on the increased risk of CHD in infants.” The risk of cardiovascular malfunctions is highest in those groups of infants whose mothers were on insulin because of diabetes during their pregnancy.
  2. There is a specific relation between type 1 diabetes or type 2 diabetes with CHD subtypes. Those infants whose mothers have diabetes type 1 are more likely to develop conotruncal malformations and atrioventricular septal defects. Those infants whose mothers have diabetes type 2 are more likely to have problems like heterotaxy and left ventricular outflow tract obstructive malformations.

    Consequently, both types of diabetes increase the risk of CHD in infants. Diabetes is a problematic disease that leads to overall metabolic syndrome. Maternal diabetes can ultimately affect the health of the baby by causing CHD.

Causes

The causes of Congenital Heart Diseases are still unknown to the doctors. However, there are some things that are termed responsible for CHD in infants. Some of those conditions which cause CHD includes : 

  • The mother having diabetes during pregnancy.
  • Infection in a pregnant woman.
  • Consumption of certain medicines (eg: acne medicine or insulin) during pregnancy
  • Smoking or consuming alcohol during pregnancy which can have a poisonous effect on the tissue of the fetus.
  • A genetic disorder called down’s syndrome influences normal physical development in a baby. This causes difficulty in learning. Half of the children with down syndrome suffer from congenital heart disease.
  •  Other chromosomes defects.

The exact cause of congenital heart disease is not identified yet but it’s estimated that most cases affect the heart development of the infant during the first six weeks of pregnancy. 

Types

  • Coarctation of the aorta

The coarctation of the defect is a congenital heart defect. In this defect, there is a constriction of the aorta which is the major artery that carries blood to the different parts of the body. Because of the narrowing, the blood flow gets implicated in the region from where the arteries branch out to deliver blood. 

The cause of the defect is unknown. Due to coarctation, the blood flow from the heart is hindered to the lower parts of the body. The blood pressure gets higher in the left ventricle and pumping blood through the constriction in the aorta becomes complicated. Because of too much pressure on the heart, it can cause damage to the overworked heart muscle. 

Surgery or catheterization is the best way to treat the coarctation of the aorta. 

  • Aortic Valve Stenosis

Aortic Valve Stenosis is one of the most common and serious heart defects. The heart has four valves, the aortic valve is one of them. It lets the blood flow into the aorta. 

In aortic valve stenosis, the valve does not open completely. Because of the narrowing of the valve, it becomes harder for the blood to reach out to different parts of the body. It can even go back into the lungs. It weakens the heart and in some cases, the proper amount of good does not surpass the brain and other parts of the body.

 One major cause behind the aortic valve stenosis is the buildup of calcium on the valve. It can occur in an infant as congenital heart disease or can also develop later in life. The condition also gets developed after rheumatic fever which forms scar tissues in the heart. It is a progressive disease that keeps getting worse with time. 

The treatment depends on the severity of the disease. The symptoms of aortic valve stenosis include chest pain, fainting, and shortness of breath.

  • Ebstein’s Anomaly

Ebstein’s anomaly is a rare congenital cardiac defect of the heart. In this, the heart valve does not properly close to maintain the blood flow moving in the right direction.

 Those who have atrial septal defects may have this syndrome as well. In this defect, the blood may leak back from the lower to upper chambers on the right side of the heart. It is characterized by the rotational deportation of the septal and inferior leaflets of the tricuspid valve in a way that they are pivoted within the right ventricle. 

Symptoms include fatigue, shortness of breath or abnormal heart rhythms. If the level of the defect is mild, it may require no treatment. But the need for surgery depends on the moderate or severe level of the disease. 

There are very rare cases of Ebstein’s Anomaly where a newborn is operated.

  • Patent Ductus Arteriosus

Patent Ductus Arteriosus is a rare birth defect in which there exists a relentless connection between the pulmonary artery and the aorta. Because of which, the blood mixes between the two arteries. Thus, creates more pressure on the heart and lungs to work harder.

 In babies with patent ductus, the ductus stays open mixing the oxygen-rich blood with the blood that lacks oxygen and enforces the lungs and heart to work harder. This defect can potentially damage the lungs and the heart. 

Babies suffering from patent ductus arteriosus show symptoms of sweating with crying or eating, breathlessness, rapid heart rate, and easy tiring. 

There is no clear cause behind the occurrence of patent ductus arteriosus but in some cases genetic factors. 

  • Ventricular Septal Defects

The ventricular septal defect occurs when there is a hole in between the lower chambers or ventricles of the heart, it can be anywhere in the muscle that divides two sides of the heart. 

VSDs are one of the most common congenital birth defects as per the National Institute of Health. The symptoms of Ventricular Septal Defect consist of rapid breathing, difficulty in breathing, frequent respiratory infections or pale skin. 

A VSD is a defect that exists from birth, it may take years for the disease to show it’s symptoms and get diagnosed. But one notable factor behind VSD is severe blunt trauma to the chest. Depending on the severity of the condition, VSD is treated in the same way as some of the heart defects are treated as.

Surgery is done to repair the damage caused to the heart, in case of severe VSD. If the defect is small with no symptoms in your baby, the doctor may wait for the disease to get recovered by itself.

  • Hypoplastic Left Heart Syndrome

Hypoplastic left heart syndrome is a defect where a child is born with a defective structure of the heart. It affects the flow of blood in the heart. The baby needs immediate surgery just after birth because of the critical level of the disease. In most of cases, babies with hypoplastic left heart syndrome also have atrial septal defects in which there is a hole between the left and right upper chambers of the heart. 

According to the Centre for Disease Control and Prevention(CDC) that each year about 1024 babies suffer from HLHS in the United States. The cause of this syndrome is not yet identified. 

Treatment for HLHS differs in babies according to the level of the disease. Some babies may need medication only and some may need surgeries. The disease is diagnosed right after the birth of a baby or sometimes during pregnancy.

  • Tetralogy of Fallot

It is a rare disease which is a combination of the following diseases :

  • Ventricular Septal Defect is a defect where there is a hole between the left and right ventricles.
  • Overriding Aorta is a defect where the aorta isn’t in its normal position.
  • Right ventricular hypertrophy is a defect where the right ventricle’s muscle becomes thick.
  • Pulmonary Valve Stenosis is a defect of obstruction in the pulmonary valve.

Thus, the tetralogy of Fallot is a combination of several diseases. Sometimes it often causes the many to appear blue, that condition is called cyanosis. In this disease, the overall amount of oxygen in the blood becomes exceptionally low.

Treatment 

The treatment of congenital heart disease is done on the basis of the type and level of the disease. Some babies may have a mild level of the heart defect that can just be treated with the help of medicines or even without it. And some infants may have a serious type of heart defect which requires extensive treatment like surgeries. Treatments for congenital heart diseases involve Implantable cardioverter defibrillators (ICD), catheter procedures or open-heart surgery.

There are very few cases of congenital heart diseases in which the defect can not be fixed by treatment so, a heart transplant may be needed.

Prevention

To prevent the occurrence of congenital heart defects in babies, the best way is to take some precautions during the time of pregnancy. To lower the risk of congenital heart defect, the following steps can be taken :

  • If you are planning to become a mother, consult your doctor about the counter medications that you are taking.
  • If you have diabetes and you are on insulin, then you must talk to your doctor about it. Diabetes increases the risk of congenital heart diseases to a great extent.
  • Ask your doctor about genetic screening, in case you have a family history of congenital heart defects.
  • Avoid alcohol and smoking 

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