Congenital heart disease

Congenital heart disease differs from other heart defects in that it is present from birth. At least eight in every 1,000 babies are born with a heart or circulatory condition and only about a quarter of these are detected by ultrasound scans. Sometimes, a congenital heart condition will not be found out until later in the child's life.

Some types of congenital heart defects cause no problems to the child, while the rest can often be treated successfully. Before the 1960s, when open-heart surgery wasn't carried out on children, many who had congenital heart disease died in infancy.

Common examples of congenital heart diseases are:

• openings in the internal wall of the heart,
• narrowing of the main heart valves (pulmonary valve stenosis),
• failure by a blood channel, used only before the baby is born, to close at the right time (patent ductus arteriosus),
• narrowing of the main artery of the body (actric stenosis),
• blockages in the pathways between the heart and the lungs, and
• abnormal connections between the chambers and vessels of the heart.

Babies and children who are affected by congenital heart disease may show a bluish skin colour. In black children, it is especially prominent around the lips, inside the mouth, on the tongue and under the fingernails. 

Babies may breathe very quickly. They will probably get tired easily when breastfeeding and put on weight slowly. Older children may be regularly short of breath, even when resting and take up a squatting position after exercise to recover. They may become dizzy and may even faint.

Children with congenital heart disease often have a heart murmur, which is usually diagnosed by your GP between 6 weeks and 1 year of age, depending on the kind of heart condition. Usually, a heart murmur by itself is harmless.

In most cases of congenital heart disease, the cause is unknown. Some heart conditions in babies are due to faulty genes. This means that a heart condition could be passed down from the mother or father through the genes.

Sometimes congenital heart disease is the result of the mother's health during pregnancy.  If she has diabetes, for example, there is a small chance it could affect the baby's heart.

Illegal drugs and some prescribed drugs taken during pregnancy, as well as alcohol and smoking, can also have an affect.

Other causes include viral infections early in pregnancy, such as German Measles (Rubella) and chromosomal problems affecting the child such as Down's Syndrome.

It is possible for heart defects in children to be diagnosed before birth. Around 1 in 4 are detected during routine ultrasound scans, often at 18 to 20 weeks. However, most heart conditions are diagnosed after birth.

If your GP suspects a heart condition they will check your child's height and weight, as well as the colour of their lips, tongue and fingers. They will also check for heart murmurs and arrange further tests to diagnose the exact condition, if necessary.

The tests, called cardiac investigations, are carried out by a paediatrician (a doctor who specialises in children's illnesses), or a paediatric cardiologist (a children's heart specialist).

The tests could include:

• an electrocardiogram - this is painless procedure where sticky patches are put on the child's arms and legs and then connected a machine that records heart rhythm for any irregularities,
• a chest X-ray - this shows the size and position of the heart and how air expands in the lungs,· an echocardiogram - a painless probe is placed on the chest, abdomen and neck and shows the structure of the heart and how it is working,
• MRI (magnetic resonance imaging) scanning - this is a type of scan that is carried out while the child is lying in a short tunnel. It gives a detailed picture of the internal organs of the body,
• cardiac catheterisation - for this a tube is inserted through the groin and guided through to the heart. A special dye that shows up under X-ray is injected through the tube, and an X-ray is taken to see how the blood runs through the heart. This test can involve a few days in hospital.

Congenital heart diseases that affects a child's health and lifestyle will usually require surgery, depending on the exact nature of the disease. Most children make a straightforward recovery.

Advances in the surgical treatment of congenital heart disease mean that nowadays most children can be cured. At the very least, treatment can greatly improve quality of life.

In some cases, further surgery will be required in later life. Precautions may also be necessary when taking certain medications, depending on the type of heart defect and the type of surgery carried out.

If not treated, congenital heart defects will cause poor growth, thickening of the tips of the fingers and toes and recurrent chest infections. They will also get tired easily when exercising. There is also the possibility of the heart itself being infected.