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HAVE HEART Facts:

HAVE HEART Fact #1
Six out of every 1,000 children born have a serious heart problem. In the United States, more than 32,000 infants are born with heart defects each year.

Approximately 6 out of every 1,000 children are born with congenital heart disease, with a range of 4 to 12 out of every 1,000 live births in recent studies. Congenital heart diseases are defects of the heart that are present at birth. These defects are also known as congenital heart defects or cardiovascular malformations . The incidence, or rate, of congenital heart disease in developed countries has remained stable over the past several decades (1).

One study from New England showed that, excluding premature infants, 3 infants of every 1,000 live births required heart catheterization or surgery. Approximately 5 out of 1,000 live births will require care at specialized facilities at some time during their lives because of congenital heart disease. Other children may develop heart problems later during childhood, including early lipid disorders. All together, approximately 10 children out of 1,000 live births, or 1% of children born each year, require attention from a pediatric cardiologist (2).

More sophisticated means of detecting birth defects have been developed over the years. With the use of routine echocardiography , an ultrasound study of the heart, many small defects may be detected in the walls between the upper and lower chambers that would otherwise go undetected. These clinically silent defects are not counted as "serious" heart problems in population-based studies (3).

References:

1. Hoffman JIE. Incidence of congenital heart disease: I. postnatal incidence. Pediatric Cardiology 1995;16:103-113

2. Fyler DC. Trends. In: Fyler DC (ed). Nadas' Pediatric Cardiology , Philadelphia: Hanley & Belfus, Inc., 1992:273-280

3. Lai WW, Lipshultz SE, Easley KA, Starc TJ, Drant SE, Bricker JT, Colan SD, Moodie DS, Sopko G, Kaplan S for the P 2 C 2 HIV Study Group. Prevalence of congenital cardiovascular malformations in children of human immunodeficiency virus-infected women. Journal of the American College of Cardiology 1998;32:1749-1755

HAVE HEART Fact #2
In the normal heart there are 4 chambers and 4 valves. The heart is divided into a right and left side. There are two major arteries, one dedicated to each side.

The normal heart has 4 chambers, 4 valves, and 2 major arteries. The 2 upper chambers are called atria (pleural for atrium); there is a right atrium and a left atrium separated by a thin wall called the atrial septum . The upper chambers act as receiving chambers, which collect the blood returning to the heart from the veins . The 2 lower chambers are called ventricles; there is a right ventricle and a left ventricle . The 2 ventricles are separated by a muscular wall called the ventricular septum . The ventricles are the pumping chambers of the heart which pump blood out the arteries.

The opening and closing of the valves allows blood to be pumped by the heart in one direction: from the veins to the atria to the ventricles and out the arteries. The tricuspid valve connects the right atrium to the right ventricle. The right ventricle pumps blood out across the pulmonary valve into a major blood vessel called the main pulmonary artery . The mitral valve connects the left atrium to the left ventricle. The left ventricle pumps blood out across the aortic valve into a major blood vessel called the aorta.

HAVE HEART Fact #3
The right side of the heart pumps "blue" blood to the lungs to pick up oxygen. The left side of the heart pumps "red" blood, loaded with oxygen, to the rest of the body. The blue and red colors of our wristband represent the circulation in a normal heart.

Blood returns from the body via the systemic veins to the right side of the heart. The blood returning in the systemic veins is low in oxygen, or "blue," because the body has consumed much of the oxygen to produce energy. When exposed to air, blood with low oxygen content is actually a dark red color, but it appears blue within the blood vessels in the skin. The "blue," or poorly oxygenated, blood is pumped from the right side of the heart to the lungs .

The "blue" blood from the right side of the heart courses through the lungs to pick up oxygen. Within the lungs, the blood picks up oxygen and becomes a bright red color. The "red" blood returns from the lungs to the left side of the heart via the pulmonary veins . The left side of the heart pumps blood high in oxygen content to the whole body, except for the lungs.

In a normal heart, the right and left sides are completely separated. That way, the "blue" blood goes only to the lungs to pick up oxygen. The "red" blood goes only to the rest of the body, which utilizes the oxygen for energy.

HAVE HEART Fact #4
The simplest forms of heart defects are holes in the heart that allow blood to mix from one side to the other. In more complex heart defects, a chamber of the heart and one or more valves may be missing.

Children frequently have minor congenital heart defects consisting of a hole between the right and left sides of the heart. A hole in the wall between the 2 upper chambers is called an atrial septal defect . A hole in the wall between the 2 lower chambers is called a ventricular septal defect . In children with normal pressures within the heart, blood usually flows from the left side of the heart to the right side, resulting in increased blood flow to the lungs. A small hole does not usually cause a noticeable problem in the circulation; and a small hole may close without treatment. When a hole is large, the amount of extra blood flow to the lungs becomes excessive, and a child may develop congestive heart failure . Children with large atrial or ventricular septal defects often require treatment in the form of medication, catheterization, or surgery.

Many forms of more complex heart defects exist. Occasionally, one of the heart valves may open poorly, known as valve stenosis. Alternatively, a valve may leak when closed, known as valve regurgitation . In more severe cases, a heart valve may not form at all, leading to poor development of the chamber that it enters or exits. For example, when the tricuspid valve does not open, known as tricuspid atresia , blood does not flow properly into the right ventricle, and the right ventricle may not develop normally. Another example is the case when the aortic valve does not develop and blocks blood from exiting the left ventricle normally, resulting in severe underdevelopment of the left ventricle; such cases are labeled as hypoplastic left heart syndrome .

HAVE HEART Fact #5
Heart murmurs are sounds produced by the heart pumping blood through the circulation. Many heart murmurs are "innocent," or normal sounds that are not a sign of heart disease. Children are sometimes referred to a pediatric cardiologist to have their heart murmur evaluated.

The heart pumps blood through the circulation. As with any mechanical pump, the heart is not perfectly silent. The noise made by the blood flowing through the heart chambers, the heart valves, and the large blood vessels may be heard through a stethoscope placed on the chest or back. These sounds are called murmurs . Normal sounds made by the blood circulating through the heart are called i nnocent murmurs . Heart defects may cause abnormal blood flow patterns within the heart and large blood vessels, resulting in abnormal sounds, or pathologic murmurs .

Innocent murmurs are soft, have a characteristic sound, and occur as the heart is pumping blood out. Pathologic murmurs are generally louder and may occur as the heart is filling. Your primary care physician is trained to detect and recognize innocent murmurs, but children are sometime referred to a pediatric cardiologist to determine whether a murmur is likely innocent or not. The pediatric cardiologist may rely on additional tests, such as an electrocardiogram (ECG) or an echocardiogram , to help exclude the presence of a congenital heart defect.

HAVE HEART Fact #6
Congenital heart defects may present with an abnormal murmur, a big heart, or an irregular heartbeat. More serious heart defects may present with less oxygen than normal in the blood, known as "cyanosis," or with poor circulation.

Congenital heart defects almost always result in abnormal blood flow patterns within the heart and major blood vessels. These abnormal flow jets often result in an abnormal, or pathologic, murmur being present on examination. Certain defects may result in enlargement of one or more chambers of the heart. For example, an atrial septal defect allows additional blood to flow to the lungs via the right ventricle , resulting in enlargement of the right ventricle. Enlargement of the heart may be detected on an examination, chest x-ray , electrocardiogram, or echocardiogram. Enlargement of the heart may also occur because of a primary abnormality of the heart muscle, known as a cardiomyopathy .

Some congenital heart defects present with an irregular heartbeat. An irregular heartbeat may be a sign of an abnormal conduction system , which is assessed with an electrocardiogram . Irregular heartbeats are also seen in many children without a serious heart problem. In some cases, an evaluation by a pediatric cardiologist may be helpful in determining the severity of an irregular heartbeat.

Children with a serious congenital heart defect may present with cyanosis . Significant cyanosis is characterized by a bluish color of the skin around the face, which is known as central cyanosis . The bluish discoloration occurs when blood with low oxygen content is pumped through the arteries of the body. Cyanosis may occur when "blue" blood mixes in the heart with "red" blood (see Heart Fact #3) or when too little blood is pumped to the lungs. Cyanosis may also occur in children with breathing problems or, less frequently, in children with too many red blood cells. Children with central cyanosis require the prompt attention of a physician. Cyanosis of just the hands or feet, known as acrocyanosis , is usually not a sign of severe heart disease, but still should be brought to the attention of a primary care physican.

HAVE HEART Fact #7
The cause of most heart defects is unknown. Doctors and scientists are trying to learn more about the genes and environmental factors that may play a role in congenital heart disease.

Most of the time we do not know why a child is born with a heart defect. Sometimes the use of certain drugs and medications or exposure to specific infections during pregnancy can cause heart defects. It is also thought that the cause of heart defects is genetic. A few genes have been discovered that are linked to heart defects, but there is continuous research to discover more genes and learn more about the causes of heart defects.

HAVE HEART Fact #8
Most families have only one member with a congenital heart defect, but first-degree family members (parents, children, and siblings) are more likely to be affected than the general population.

Anyone can have a child born with a heart defect. If someone has already had a child or family member born with a heart defect, their risk to have a child born with a heart defect may be higher. For individuals at a higher risk, genetic counseling may be helpful to learn more about testing and screening available for congenital heart defects.

HAVE HEART Fact #9
Most heart defects may be seen clearly by an ultrasound of the heart, or an "echocardiogram." Many serious heart defects can now be detected before birth by a fetal echocardiogram.

An ultrasound examination allows one to "see" inside the body with high-frequency sound waves. An ultrasound examination of the heart is known as an echocardiogram . Echocardiograms are performed by specially trained sonographers or physicians. An echocardiogram shows the heart muscle, valves, and blood vessels. In addition, the blood flowing through the heart may be detected, and flow patterns are assessed by Doppler echocardiography . Echocardiograms may safely be performed on adults, children, and even fetuses. For more information on echocardiograms, you may wish to visit www.seemyheart.org.

HAVE HEART Fact #10
Most forms of congenital heart disease may be treated successfully with medication, by catheterization, or with surgery. Minor defects may not require any treatment at all. More complex heart defects may require several procedures to improve the circulation.

After a congenital heart defect has been detected, a pediatric cardiologist may recommend treatment in the form of medication, catheterization, or surgery. Each treatment option should be explained in detail and in terms that are easy to understand. Recommendations for treatment are based on the needs of each individual patient.

Smaller holes in the heart may close without treatment, and many minor congenital heart defects may require only periodic check-ups. A physician or dentist may recommend that an antibiotic be given before certain procedures, such as dental cleanings.

A catheterization is a procedure performed in a room with specialized x-ray equipment and pressure monitors. A catheter is a thin and hollow tube that is designed to travel through a blood vessel into the heart. An interventional pediatric cardiologist may use specially designed catheters to treat certain congenital heart defects. For example, a valve that does not open properly may be dilated, or a small hole in the heart may be closed with a device delivered through a catheter.

Surgery may be recommended for some children as the most effective treatment option. A surgeon may repair more serious abnormalities of the valves or close larger holes in the heart. More complex heart defects may require several procedures, performed in stages. In the more severe cases, the heart defect is not "cured," but a nearly normal circulation may be provided through surgery. In the rare instances when standard treatments or surgeries are unlikely to help, a heart transplant may be considered.

All decisions regarding treatment must be made in close consultation with a physician. The treatment of children with congenital heart disease often requires the involvement of a team of specialists, including, but not limited, to pediatric cardiologists and congenital heart surgeons.