Congenital Heart Diseases

CHDs are present at birth and can affect the structure of a baby’s heart and the way it works. They can affect how blood flows through the heart and out to the rest of the body.

BEFORE IS BETTER

Prenatal diagnosis
of congenital heart disease

Prenatal diagnosis of congenital heart disease (CHD) allowed to reduce significantly perinatal morbidity and mortality. The development of new ultrasound technologies and above all the greater experience of the operator, permitted to achieve excellent levels of accuracy in prenatal echocardiography diagnosis and to plan the best therapeutic strategy as well as the delivery in a third-level hospital equipped with cardiac surgery and neonatal intensive care.


The great interest surrounding the prenatal diagnosis of cardiac defects is justified by the epidemiological relevance of the problem, since the incidence is 1% on all live births [1], a potentially even greater percentage if we consider spontaneous abortions and stillbirths.

In Europe, a prevalence of CHD is estimated at 7.2 children per 1,000 live births and 8 per 1,000 considering TOP and fetal deaths [2]. Among premature births, excluding the patency of the ductus arteriosous and atrial septal defects, it reaches 12.5 per 1000 live births [3]. CHD are the major cause of infant mortality, about 3% of all infant deaths and 46% of deaths due to congenital malformations.

CHD represent the main cause of infant death in the western world [4].

About 18-25% of affected children in natural history die within the first year of life, while 4% of survived do not exceed 16 years [5, 6]. Overall, the CHD are distributed homogeneously in the two gender (males 48.7%, females 51.3%) [7], while there is a different incidence of some specific heart diseases between various ethnic groups. Furthermore, it has been shown that CHD are more frequent in fetuses of twin pregnancies than in single pregnancies [8].

In the context of CHD, someone are decidedly more frequent than others, such as ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosous (PDA), pulmonary stenosis (PS), tetralogy of Fallot (TOF) and transposition of great arteries (TGA) [9].

The trend of CHD, without considering septal defects, shows a progressive increase over time with an almost doubled prevalence of obstructions in the right ventricular outflow tract (RVOT) and a reduction of about one third in obstructions in the left ventricular outflow tract (LVOT), probably related to increased TOP due to the diagnosis of CHD such as hypoplastic left ventricular syndrome (HLHS).

However, these data are influenced by multiple variables: method of assessment, method of diagnosis, population studied, subjects examined, verification of the diagnosis even after birth, assessment period, inclusion and exclusion criteria, type of classification [10,11].


What are Congenital Heart Defects (CHDs)?

CHDs are present at birth and can affect the structure of a baby’s heart and the way it works. They can affect how blood flows through the heart and out to the rest of the body. CHDs can vary from mild (such as a small hole in the heart) to severe (such as missing or poorly formed parts of the heart).

About 1 in 4 babies born with a heart defect has a critical CHD (also known as critical congenital heart defect) [12]. Babies with a critical CHD need surgery or other procedures in the first year of life.




Simple CHDs.

  • Atrial Septal Defect
  • Atrioventricular Septal Defect
  • Ventricular Septal Defect
  • Coarctation of the Aorta



Critical CHDs

  • Double-outlet Right Ventricle
  • d-Transposition of the Great Arteries
  • Ebstein Anomaly
  • Hypoplastic Left Heart Syndrome
  • Interrupted Aortic Arch
  • Pulmonary Atresia
  • Single Ventricle
  • Tetralogy of Fallot
  • Total Anomalous Pulmonary Venous Return
  • Tricuspid Atresia
  • Truncus Arteriosus


Signs and Symptoms

Signs and symptoms for CHDs depend on the type and severity of the particular defect. Some defects might have few or no signs or symptoms. Others might cause a baby to have the following symptoms:

  • Blue-tinted nails or lips
  • Fast or troubled breathing
  • Tiredness when feeding
  • Sleepiness



Diagnosis

Some CHDs may be diagnosed during pregnancy using a special type of ultrasound called a fetal echocardiogram, which creates ultrasound pictures of the heart of the developing baby. However, some CHDs are not detected until after birth or later in life, during childhood or adulthood. If a healthcare provider suspects a CHD may be present, the baby can get several tests (such as an echocardiogram) to confirm the diagnosis.



Treatment

Treatment for CHDs depends on the type and severity of the defect present. Some affected infants and children might need one or more surgeries to repair the heart or blood vessels. Some can be treated without surgery using a procedure called cardiac catheterization. A long tube, called a catheter, is threaded through the blood vessels into the heart, where a doctor can take measurements and pictures, do tests, or repair the problem. Sometimes the heart defect can’t be fully repaired, but these procedures can improve blood flow and the way the heart works. It is important to note that even if their heart defect has been repaired, many people with CHDs are not cured. See more information about living with a CHD below.




Causes

The causes of CHDs among most babies are unknown. Some babies have heart defects because of changes in their individual genes or chromosomes. CHDs also are thought to be caused by a combination of genes and other factors, such as things in the environment, the mother’s diet, the mother’s health conditions, or the mother’s medication use during pregnancy. For example, certain conditions a mother has, like pre-existing diabetes or obesity, have been linked to heart defects in the baby. Smoking during pregnancy as well as taking certain medications have also been linked to heart defects [13,14].



Living with a CHD

As medical care and treatment have advanced, infants with CHDs are living longer and healthier lives. Many children with CHDs are now living into adulthood. It is estimated that more than two million individuals in the United States are living with a CHD. Many people with a CHD lead independent lives with little or no difficulty. Others might develop disability over time. Some people with a CHD have genetic problems or other health conditions that increase their risk for disability.

Even with improved treatments, many people with a CHD are not cured, even if their heart defect has been repaired. People with a CHD can develop other health problems over time, depending on their specific heart defect, the number of heart defects they have, and the severity of their heart defect. For example, some other health problems that might develop include irregular heart beat (arrhythmias), increased risk of infection in the heart muscle (infective endocarditis), or weakness in the heart (cardiomyopathy). People with a CHD need routine checkups with a cardiologist (heart doctor) to stay as healthy as possible. They also might need further operations after initial childhood surgeries. It is important for people with a CHD to visit their doctor on a regular basis and discuss their health, including their specific heart condition, with their doctor.


References

1.Kruszka P, Beaton A. The state of congenital heart disease. Am J Med Genet Part C. 2020;1–2.

2.Dolk H, Loane M, Garne E; European Surveillance of Congenital Anomalies (EUROCAT) Working Group. Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005. Circulation. 2011;123(8):841–849.

3.Mazzera E., Brancaccio G., Marino B. Introduzione alle cardiopatie congenite. Tavole ed appunti di anatomia e fisiopatologia delle malformazioni cardiache. Dedalo librerie 2005; p 13-15.

  1. Rossier MC, Mivelaz Y, Addor MC, Sekarski N, Meijboom EJ, Vial Y. Evaluation of prenatal diagnosis of congenital heart disease in a regional controlled case study. Swiss Med Wkly. 2014;144:w14068. Published 2014 Dec 4.
  2. Bakker MK, Bergman JEH, Krikov S, et al. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ Open 2019;9:e028139.
  3. Knowles R, Griebsch I, Dezateux C, Brown J, Bull C, Wren C. Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2005 Nov; 9 (449: 1-152).
  4. Samanek M. Boy: girl ratio in children born with ferent forms of cardiac malformation: A population-based study. Pediatric Cardiology 1994;15.
  5. Berg KA, Astemborski JA, Boughman JA, Ferencz C. Congenital cardiovascular malformations in twins and triplets from a population-based study. Am J Dis Child 1989;143:1461-1463.
  6. (Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019;48(2):455–463.
  7. From Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019;48(2):455–463.
  8. Congenital Heart Defects in Europe Prevalence and Perinatal Mortality, 2000 to 2005 Helen Dolk, DrPh; Maria Loane, MA; Ester Garne, MD; and a European Surveillance of Congenital Anomalies (EUROCAT) Working Group Circulation. 2011;123:841-849.
  9. Oster M, Lee K, Honein M, Colarusso T, Shin M, Correa A. Temporal trends in survival for infants with critical congenital heart defects. Pediatrics. 2013;131(5):e1502-8.
  10. Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL. Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007;115(23):2995-3014.
  11. Patel SS, Burns TL. Nongenetic risk factors and congenital heart defects. Pediatr Cardiol. 2013;34(7):1535-55.

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