Expert answers common questions about congenital heart defect

Congenital heart disease or defect is a common type of birth defect that needs medical attention. The exact cause is unclear, but it may be connected to genetic factors or the mother’s health condition. If you are a mother, who gave birth to a baby with a heart defect, you would have a lot of doubts about it. Apart from knowing what it is, you may have questions about its treatment, or ways you can avoid the complications that come with it, and how it will affect your child’s life. To take care of your child in the best possible way, it is good to know all about congenital heart defect.

On Congenital Heart Defect Awareness Day, which is observed on February 14, we got cardiologist Dr Abhijit Borse to answer frequently asked questions about this health issue.

Question 1: What is a congenital heart defect?

Dr Abhijit Borse: A congenital heart defect (CHD) is a structural abnormality in the heart that develops before birth. It affects the way blood flows through the heart. Defect in the heart is the most common type of birth defect. It affects almost 1 percent of births each year, according to the US Centers for Disease Control and Prevention. The exact cause of CHD is often unknown, but genetic factors, and maternal health conditions such as diabetes or infections during pregnancy may contribute to their development.

Question 2: What are the 7 critical congenital heart defects?

Dr Abhijit Borse: Critical congenital heart defects are severe conditions that require medical attention soon after birth. The seven most critical congenital heart defects include:

1. Hypoplastic Left Heart Syndrome (HLHS)

HLHS is a severe congenital heart defect where the left side of the heart is underdeveloped, making it difficult to pump oxygen-rich blood to the body. Babies with HLHS require multiple surgeries or a heart transplant for survival.

2. Pulmonary Atresia (PA)

In this condition, the pulmonary valve does not form properly, blocking blood flow from the heart to the lungs. Without treatment, babies cannot get enough oxygen.

3. Tetralogy of Fallot (TOF)

TOF consists of four heart defects, including a hole in the heart, a narrowed pulmonary valve, a thickened right ventricle, and a misaligned aorta. This condition results in reduced oxygen levels in the blood, causing cyanosis (bluish skin). Surgery is required for treatment.

4. Transposition of the Great Arteries (TGA)

TGA occurs when the two main arteries (the aorta and pulmonary artery) are switched in position, leading to improper blood circulation. Immediate surgery is needed to correct this congenital heart defect.

5. Truncus Arteriosus

This congenital heart defect occurs when a single blood vessel comes out of the heart instead of two separate ones, causing oxygen-rich and oxygen-poor blood to mix. Surgery is necessary to separate the vessels.

6. Total Anomalous Pulmonary Venous Return (TAPVR)

In TAPVR, the veins that carry oxygenated blood from the lungs connect to the wrong part of the heart, leading to poor oxygen circulation. Surgery is required to take care of this congenital heart defect.

7. Coarctation of the Aorta (CoA)

CoA is a narrowing of the aorta, the main artery that carries blood from the heart to the body. This condition forces the heart to work harder, leading to high blood pressure and potential heart failure if untreated.

Question 3: Can you live a normal life with a congenital heart defect?

Dr Abhijit Borse: The outlook for people with a congenital heart defect has improved significantly due to advancements in medical care, surgeries, and medications. While some CHDs can be managed with minimal lifestyle adjustments, critical CHDs often require lifelong monitoring and medical intervention. With proper treatment, many people with congenital heart disease can lead active and fulfilling lives. Regular check-ups with a cardiologist, a heart-healthy diet, exercise (as recommended by a doctor), and avoiding smoking or excessive alcohol consumption can help manage the condition effectively.

Question 4. Does congenital heart defect go away?

Dr Abhijit Borse: The outcome of a congenital heart defect depends on the type and severity of the condition. Some mild defects, such as small ventricular septal defects (VSDs) or atrial septal defects (ASDs), may close on their own as the child grows. However, more complex conditions like Tetralogy of Fallot (TOF) or hypoplastic left heart syndrome (HLHS) often require surgery. In cases where CHD cannot be completely cured, lifelong monitoring and medical care may be necessary.

Question 5: Can congenital heart disease cause death?

Dr Abhijit Borse: Yes, congenital heart disease can be life-threatening, especially if it is severe and left untreated. Congenital heart disease caused 2, 61,247 deaths across the globe in 2017, according to research published in The Lancet Child & Adolescent Health in 2020.

Question 6: What are CHD blood tests?

Dr Abhijit Borse: Blood tests alone cannot diagnose congenital heart disease, but they help assess heart function and detect complications. Some commonly used tests include:

• Pulse Oximetry to measure oxygen levels in the blood, often used as a screening tool for newborns.
• B-type Natriuretic Peptide (BNP) test helps to assess heart failure risk in people with CHD.
• Genetic testing identifies inherited conditions linked to heart defects.
• Complete Blood Count (CBC) checks for anemia, infections, or other conditions that may affect heart health.
  These tests, combined with imaging studies, provide a clearer picture of a child’s heart health.

Question 7: How do you know if a baby has a heart problem?

Dr Abhijit Borse: Signs of CHD can appear at birth or shortly after, while some defects may not be detected until later in life. Parents should watch for:

• Bluish skin (cyanosis) due to low oxygen levels.
• Rapid or laboured breathing.
• Poor feeding and slow weight gain.
• Swelling in the legs, abdomen, or around the eyes.
• Heart murmurs (abnormal heart sounds) detected during a check-up.
  If any of these symptoms of congenital heart defect appear, further testing will be needed.

Question 8: How to prevent heart defects in babies?

Dr Abhijit Borse: While not all congenital heart defects can be prevented, certain lifestyle and medical precautions can reduce the risk:

• Regular check-ups and ultrasounds can help to detect potential problems early.
• Taking 500 mcg of folic acid daily before and during pregnancy reduces the risk of birth defects.
• Pregnant women should avoid alcohol, smoking, as they can affect fetal heart development.
• Conditions like diabetes, obesity, and high blood pressure should be well-controlled before and during pregnancy.
• Some viral infections, such as rubella, can cause CHD. Getting vaccinated before pregnancy can lower this risk.

Question 9: How do you treat a hole in a baby’s heart?

Dr Abhijit Borse: A hole in the heart is one of the most common congenital heart defects. The treatment depends on the size and location of the defect:

• Small holes (e.g. small ventricular septal defect or atrial septal defect): Many of these close on their own within the first few years of life, requiring only regular monitoring by a cardiologist.
• Medium to large holes: These may need intervention if they cause symptoms like poor growth, difficulty breathing, or recurrent infections. Treatment options include:
• Medications: Drugs such as diuretics help reduce fluid buildup, easing symptoms.
• Catheter-based procedures: A minimally invasive approach where a device is inserted through a blood vessel to close the hole.
• Surgery: In severe cases, open-heart surgery is needed to patch the hole and restore normal blood flow.

Question 10: Can you cure congenital heart disease?

Dr Abhijit Borse: There is no universal “cure” for congenital heart disease, but many treatments effectively manage or correct the defect. The approach depends on the specific condition:

• Mild CHD: Some small defects heal naturally without intervention.
• Moderate to severe CHD: These require medical treatment, surgery, or catheter-based interventions. Some complex heart defects need multiple surgeries or lifelong management.
• Heart transplant: Children may get a heart transplant if they have a critical congenital heart defect that cannot be fixed via surgery or if the heart fails after the procedure, according to the US National Heart, Lung, and Blood Institute.

Question 11. Would an ultrasound help detect fetal heart defects?

Dr Abhijit Borse: Yes, many congenital heart defects can be detected before birth using a fetal echocardiogram (a specialised ultrasound of the baby’s heart). This test is typically performed between 18-24 weeks of pregnancy, especially if there is a high risk due to:

• A family history of CHD.
• Maternal health conditions like diabetes or lupus.
• Abnormalities detected in routine prenatal ultrasounds.
• Genetic syndromes like Down syndrome.

Question 12. What is the best medicine for congenital heart defect?

Dr Abhijit Borse: There is no single “best” medicine for CHD, but several medications help manage symptoms and prevent complications:

• Diuretics (e.g. Furosemide) helps to reduce fluid buildup, easing symptoms of heart failure.
• Beta-blockers (e.g. Propranolol) are used in some CHD cases to control abnormal heart rhythms.
• ACE Inhibitors (e.g. Enalapril) helps to relax blood vessels and improve heart function.
• Prostaglandins are given in newborns with certain critical heart defects to keep ducts open for blood flow before surgery.
• Anticoagulants (e.g. Aspirin, Warfarin) are used for CHD patients with artificial valves or an increased risk of blood clots.

Medication alone cannot cure CHD, but plays an essential role in managing symptoms, improving heart function, and preparing for surgical interventions if needed. Also, you must always check with a doctor for the right course of treatment for the condition.

Question 13: What to avoid when you have congenital heart disease?

Dr Abhijit Borse: People with CHD, especially those with moderate to severe defects, should avoid certain activities and lifestyle choices that may strain the heart or worsen their condition:

• Strenuous activities and high-intensity sports: While some people with congenital heart defect can exercise safely, high-intensity sports like weightlifting, marathon running, or competitive contact sports may be too strenuous for the heart.
• Smoking and alcohol: Smoking damages blood vessels, increasing the risk of heart failure and complications. Excessive alcohol can lead to heart rhythm problems, especially in those with repaired heart defects.
• Unregulated medications and supplements: Some over-the-counter medications (like decongestants) contain stimulants that can increase blood pressure and heart rate. Certain supplements, such as those containing high doses of caffeine or herbal stimulants, should be avoided.
• Uncontrolled stress: Chronic stress can put extra strain on the heart. Practicing relaxation techniques, such as meditation and deep breathing, can help to maintain heart health.
• Poor diet choices: People with congenital heart defect should limit high-sodium, high-fat, and ultra-processed foods to prevent heart complications.

Question 14: How to care for a child with congenital heart disease?

Dr Abhijit Borse: Caring for a child with CHD requires medical monitoring, lifestyle adjustments, and emotional support. Here are key steps:

• Follow up with a pediatric cardiologist to monitor your child’s heart health. Ensure all necessary medications, treatments, or surgeries are followed as prescribed.
• Encourage a heart-healthy diet with nutrient-rich foods. Monitor sodium and sugar intake to prevent additional heart strain.
• While some sports may be restricted, many CHD children benefit from light to moderate exercise such as walking, and swimming. But check with a doctor before letting your child start any physical activity.
• CHD children are at a higher risk of infections like endocarditis (a heart infection). Good hygiene, vaccinations for flu, and pneumonia, and regular dental care help reduce this risk.
• Children with CHD may feel different from their peers. Encourage emotional well-being by providing support, connecting with CHD support groups, and fostering confidence.