Heart Problems
While most people think of heart disease as an adult problem, more than 40,000 American children are born with a heart defect each year, and others develop heart disease in childhood. Congenital heart defects are the most common birth defect and are the number one cause of death from birth defects during the first year of life. Nearly twice as many children die from congenital heart disease in the United States each year as die from all forms of childhood cancers combined. At present at least 35 different heart defects in children have now been identified.
Still, the outlook for children born with heart disease is slowly improving. The risk of dying after congenital heart surgery has declined from 30 percent in the 1970s to 5 percent today.
Congenital Heart Disease
Most heart disease in children is congenital, which means that a structural problem with the heart was present at birth. Eight out of 1,000 infants will be born with a congenital heart defect—about 35,000 babies each year. Defects range in severity from simple problems—holes between heart chambers, abnormal valves or connections of heart vessels, abnormally narrow heart vessels—to very severe malformations, such as the complete absence of one or more chambers or valves.
Defects appear when a mishap occurs during heart development soon after conception—often before the mother realizes she is pregnant. These defects are usually but not always diagnosed early in life.
Severe heart disease generally becomes evident during the first few months after birth. Some problems trigger very low blood pressure shortly after birth; others cause breathing difficulties, feeding problems, or poor weight gain. Minor defects are most often diagnosed on a routine medical checkup, since these defects rarely cause symptoms. While most heart murmurs in children are normal, some may be due to defects.
Cause The cause of congenital heart problems is often unknown. Although the reason most defects occur is presumed to be genetic, only a few genes have been discovered that have been linked to the presence of heart defects. Rarely the ingestion of some drugs and the occurrence of some infections during pregnancy can cause defects. A maternal viral infection may also produce serious problems. For example, if a pregnant mother gets GERMAN MEASLES (rubella), the infection may interfere with the baby’s heart as it develops or may lead to other malformations. Other viral diseases also may cause defects before birth. Certain conditions that affect multiple organs, such as DOWN SYNDROME, also can involve the heart.
Acquired Heart Disease
Acquired heart disease develops at some point during childhood as a result of infection—a much more unusual type of heart disease. This includes conditions such as KAWASAKI DISEASE, RHEUMATIC FEVER, and infective endocarditis. Children also can develop heart rate problems such as slow, fast, or irregular heart beats, known as “arrhythmias.”
Diagnosis
The echocardiogram is a noninvasive procedure that uses ultrasound to image the structures of the heart. Doctors can obtain much more echocardiographic information in children than in adults. The structure of these hearts is often extremely different from the normal adult heart. Heart surgery texts often devote five times as many chapters to congenital heart problems as they do to adult heart diseases.
Catheterization, a common procedure for evaluating adult heart conditions, is used less often in children because inserting a catheter into a child’s tiny artery carries a much higher risk. Only about one in four children must have the procedure for diagnosis.
Treatment
Because most childhood heart problems require sophisticated care, it is important that these children be treated in a center that specializes in pediatric cardiology. These centers can provide the highly skilled technical expertise needed, specialized diagnostic equipment designed for children, and the social and emotional support needed by the families.
Surgery itself involves much more sophisticated techniques than for adults, because the structure of a child’s heart is so small. Of equal significance is the degree of care necessary to support the child under anesthesia, where medications must be administered precisely matched to the child’s weight.
In the past repairs to a child’s heart were often delayed because the risks were so significant, but today doctors realize delay can interfere with growth and cause FAILURE TO THRIVE. Modern doctors believe that preserving heart function as soon as possible permanently improves the quality of life. Half of all heart repairs in children are now done less than one month following birth.
Prognosis
Virtually all children with simple defects survive into adulthood. Although exercise capacity may be limited, most lead normal or nearly normal lives.
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