The Most Prevalent Congenital Heart Diseases and How They Are Treated
The term "congenital heart disease" covers a wide range of birth defects that affect the normal way the heart works. Up to 40,000 children are born with a birth defect concerning their heart every year in America. The number of mild congenital heart defects is increasing, while the prevalence of severe types has been stable for the past decades.
Unfortunately, congenital heart disease is often impossible to prevent. Some preventive measures the mother can take to avoid these heart defects in their children are staying away from exposure to toxic agents, drinking alcohol, smoking tobacco, and infections such as rubella, which they can shield themselves from by immunization.
Bicuspid Aortic Valve, The Most Common Congenital Heart Defect
Without a doubt, the most common congenital heart defect is the bicuspid aortic valve. The aortic valve opens and closes to allow blood to pass from the heart to the aorta, a major blood vessel carrying blood with oxygen to the body. A bicuspid aortic valve occurs when only two leaflets are within the valve instead of three. Having this congenital heart defect can make it difficult for the heart to pump blood into the aorta, the body's primary artery.
Between 1% and 2% of the world's population has this congenital heart defect. Left untreated, this heart defect can lead to the person experiencing the symptoms of heart failure, which include fatigue, shortness of breath, chest pain, and fainting. Furthermore, an aortic aneurysm might develop downstream from the valve and result in bleeding or rupture. Other complications a person with a bicuspid aortic valve might develop are:
- the narrowing of the aortic valve (aortic valve stenosis), due to which the valve might not open fully, and blood flow from the heart to the body will be reduced
- backward blood flow (aortic valve regurgitation), occurring when the bicuspid aortic valve fails to close tightly, causing blood to flow backward
- enlarged aorta (aortopathy), which increases the risk of a tear in the lining of the aorta, also known as aortic dissection
Although many people can live with a bicuspid aortic valve for their entire life, some need to have their valve surgically replaced or repaired. Most people with a bicuspid aortic valve will have to undergo regular medical checkups and echocardiograms to see whether there is leaking, stiffening, or enlargement. The most common treatment for a bicuspid aortic valve is surgery, which can be of multiple types, more specifically:
- Aortic valve replacement: The surgeon will remove the damaged valve and replace it with a mechanical one or a valve taken from a cow, pig, or human heart. Another type of tissue for valve replacement that can be used is your pulmonary valve. However, biological tissue valves tend to break down over the years, and you may eventually need another replacement. Consequently, mechanical valves are superior. The only drawback is that people who have mechanical valves have to take blood-thinning medication for life to avoid blood clots.
- Aortic root and ascending aorta surgery: The surgeon removes the enlarged section of your aorta near the heart. It is subsequently replaced with a synthetic tube, known as a graft, which is sewn into place. Sometimes, just the enlarged section of the aorta is removed, and the aortic valve is left where it is.
- Balloon valvoplasty: If your bicuspid valve has caused aortic stenosis, your doctor may suggest you undergo this procedure. The surgeon will insert a catheter with a balloon on its tip into one of the arteries in your groin and move it until it reaches the aortic valve. Subsequently, the balloon is inflated, which expands the opening of the valve. The air is let out of the balloon, and the catheter and balloon are removed. Eventually, the valve tends to narrow again in adults who undergo the procedure.
Following bicuspid aortic valve surgery, you might feel tired and sore for the first couple of weeks. You might have a brief, sharp pain on either side of your chest, and your chest and shoulders may ache. The incisions in your chest may be sore or swollen, but these symptoms usually improve after 4 to 6 weeks.
You will be able to resume most of your usual activities following 4 to 6 weeks. But for at least one month and a half, you will not be allowed to lift heavy objects or do activities that can strain your chest or upper arm muscles. Initially, you might notice that you get tired easily and need to rest often. This is completely normal, as it may take 1 to 2 months to get your energy back.
Other Usual Congenital Heart Defects
There are numerous different types of congenital heart defects. They can be broken down into several categories: cyanotic congenital heart disease, critical congenital heart disease, ductal dependent congenital heart disease, and other acyanotic or less acute congenital heart defects. The following are other common congenital heart defects and how they are treated:
- Cyanotic congenital heart disease: These kinds of congenital heart defects cause a baby to appear blue at birth, hence the term "cyanosis". The bluish color occurs because deoxygenated blood flows out into the body. Some typical cyanotic heart defects include tetralogy of Fallot, transposition of great arteries, tricuspid atresia, total anomalous pulmonary venous return, truncus arteriosus, and hypoplastic left heart syndrome. All children born with these heart defects require surgery within their first year of life. They may even require more than one procedure to get their heart to function normally.
- Ductal dependent congenital heart disease: While every baby is born with a small hole in the heart medically known as ductus arteriosus, it usually closes during the first few days of life. Nevertheless, in some babies, it fails to close. Children with a ductal dependent congenital heart disease usually experience cardiovascular collapse when the patent ductus arteriosus closes. To keep it open until the child can undergo surgery or catheterization, they will be given prostaglandins, a type of medicine that helps keep the ductus arteriosus open.
- Critical congenital heart disease: Roughly 25% of all congenital heart defects are deemed critical, which means they require surgery or a procedure within a baby's first year of life. The most serious and complex congenital heart disease is hypoplastic left heart syndrome. It is rare and occurs when the left side of the heart is extremely underdeveloped. If the baby is born with hypoplastic left heart syndrome, the left side of the heart cannot effectively pump blood to the body.
- Acyanotic or less acute congenital heart defects: These heart defects are generally less dangerous and not life-threatening, even though they can still affect a child's health. They include ventricular septal defects, atrial septal defects, and minor valve defects such as a bicuspid aortic valve. These kinds of defects may heal on their own or with limited interventions and require no surgery within a baby's first year of life.
As the most common type of birth defect, congenital heart defects occur in 1 out of 100 children. If you know you have a history of congenital heart disease, we strongly advise you and your family members to regularly undergo screening, as this is the only way to make sure everything is alright with your heart and how it functions.