Congenital Heart Defects (CHDs) occur in approximately 8 out of 1,000 newborns and are the most common kind of birth defect, according to the National Institutes of Health. This equals more than 35,000 babies each year in the U.S.
Congenital heart defects occur when the heart does not develop normally before the baby is born. Some congenital heart defects are simple and do not need treatment or can be easily fixed. Others are more complex, but due to improvements in diagnosis and treatment, most children who have complex congenital heart defects survive into adulthood and are able to lead active lives.
Many adults with ACHD need continued special heart care throughout their lives, and also need to learn how ACHD can affect employment, pregnancy and family planning.
According to the American Heart Association, there are 18 major types of congenital heart defects. The most common types are:
Aortic Valve Stenosis (AVS):
- AVS occurs when a valve from the heart to the body does not properly open and close. This causes the left ventricle to pump harder (stenosis), or can leak blood backwards (regurgitation).
- This increased pressure in the left ventricle may cause the heart muscle to thicken, get larger and be damaged.
- If severe, it can cause chest pain, weakness, dizziness and fainting.
Aortic Valve Stenosis can be treated to reduce the pressure, or surgery may be needed. If the aortic valve has become too weak, then it may need to be replaced.
Atrial Septal Defect (ASD):
- This is similar to VSD, but is an opening between the upper chambers of the heart
- If it is small, it may not cause any problems and may not need treatment.
- If it is larger, it may cause a murmur, or can cause permanent damage to the blood vessels in the lungs.
- It can be fixed via open-heart surgery or cardiac catheterization (using a device to plug the hole)
Coarctation of the Aorta (CoA)
- CoA is caused by the narrowing of the aorta (a major artery) and can reduce blood flow to the upper and lower parts of the body.
- This causes increased blood pressure in the left ventricle and an overworked heart that is trying to pump past the blockage. This causes a thickening of the muscles and long-term damage.
- A serious obstruction may be treated with a balloon and catheter, or by surgery to repair the narrowing.
Complete Atrioventricular Canal Defect (CAVC):
- CAVC is when a large hole in the center of the heart affects all the four chambers. The blood mixes together and is not properly directed to each stage of circulation.
- It is common among children with Down Syndrome.
- Extra blood is pumped into the lung arteries and causes both the heart and lungs to work harder, causing the lung to be congested.
- This can cause children to breathe faster and harder than normal. They can have issues feeding and growing at a normal rate. Permanent damage can occur to the lung vessels.
- Open-heart surgery is needed to fix the defect since it cannot close on its own. Additional surgeries or medication may be needed.
Patent Ductus Arteriosis (PDA)
- This describes an unclosed hole in the aorta
- The ductus arteriosus is an artery found in the fetus that moves the blood away from the lungs. It is no longer needed after birth, and usually closes up in the first few days.
- If it is small, it will not cause any symptoms or cause the heart and lungs to work harder. It may close up in the first few months.
- If the PDA is large, it can cause the infant to breathe faster than normal and can prevent them from feeding or growing normally. It can also cause permanent damage to the lung’s blood vessels. This may require a plug to be inserted, surgery, or medication to help it close up.
Pulmonary Valve Stenosis
- This is when a thick or fused heart valve doesn’t open fully. This increases the pressure in the right pumping chamber (ventricle) and can cause damage due to the overworked heart muscle in that area.
- If it is serious, it can cause cyanosis (blueness). Otherwise there may be no symptoms.
- It can be treated to relieve pressure in the right ventricle, but the valve cannot be made normal.
Tetralogy of Fallot (fa-loh)
- This defect includes four problems:
- A hole between the lower chambers of the heart
- An obstruction between the heart and lungs
- Overly thickened muscle around the lower right chamber of the heart
- The aorta rests over the hole in the lower chambers
- This is commonly found in children with Down Syndrome or DiGeorge Syndrome.
- Blood travels across the hole from the bottom right chamber to the left (VSD) and out into the artery that is for the body. The block in the pulmonary valve can cause less blood to be pumped to the lungs.
- Children who do not have a repaired tetralogy of Fallot are blue.
- This is treated surgically, usually with a temporary operation coming first, before complete repair.
Transposition of Great Arteries
- This can occur when either the arteries carrying blood away from the body are reversed (d-transposition) or when the bottom chambers are reversed along with the arteries (I-transposition).]
- The d-transposition is more serious because the arteries are connected to the wrong chambers of the heart. This requires surgery early in life that enlarges a connection between the right and left upper chambers so that some oxygen-rich and oxygen-poor blood can go to the correct side of the heart.
- Depending on the surgical procedure, more surgery may be needed in the future to help the heart pump better, repair valves or correct heart rhythms.
- The I-transposition may cause long-term damage to the right ventricle, though surgery may not be needed.
Ventricular Septal Defect (VSD)
- VSDs are one of the most common types of congenital heart defects
- VSD is a hole in the wall separating the two lower chambers of the heart
- Usually, the wall closes up before the fetus is born, but if it doesn’t, it can cause higher pressure inside the heart or reduced oxygen to the body
- If it is a small hole, it won’t cause symptoms apart from a loud murmur through a stethoscope. It may even close on its own.
- If it is a large hole, open-heart surgery may be needed to close it so that severe symptoms and permanent damage do not occur.
Though most of these conditions may not affect the types of activities you or your child may be able to do, it is important to schedule regular check ups with your physician. The doctor may then suggest which exercises and activities should be avoided.
If you are one of the more than one million adults with a CHD and are not in the care of a physician trained specifically to deal with congenital heart disease, we highly recommend you schedule a visit with one of the Emory Adult Congenital heart specialists for follow up care.
- Congenital Heart Center of Georgia
- Emory Congenital Heart Center
- Congenital Heart Defects in Children: Is Surgery a Cure?
- Balancing Life with Congenital Heart Disease
- News from Emory’s Adult Congenital Heart Center
About Michael McConnell, M.D.
Dr. McConnell specializes in Pediatric Cardiology and general Pediatrics. His area of clinical interest is in cyanotic congenital heart disease management, syncope, and single ventricle patient management. Dr. McConnell completed his residency at the Children’s Hospital of Alabama, and his fellowship was held at the Children’s Hospital Medical Center in Cincinnati, OH. He’s been practicing at Emory since 2000.
About the Congenital Heart Center of Georgia
The Congenital Heart Center of Georgia is collaboration between Children’s Healthcare of Atlanta and Emory Healthcare. The Congenital Heart Center of Georgia is a comprehensive program for children and adults with congenital heart disease (CHD) that provides a continuum of lifesaving care from before birth through adulthood. It is the first comprehensive CHD program in the South and one of the largest in the country. The program is led by Emory Healthcare cardiologist Wendy Book, MD, along with Robert Campbell, MD, chief of cardiac services and director of cardiology at Children’s Sibley Heart Center.