Congenital Heart Disease Treatment

What is congenital heart disease?

Congenital heart disease (CHD) is a defect that occurs when the heart or blood vessels near the heart do not develop normally before birth. This affects how blood flows within and throughout the heart. This type of defect can vary from very mild (e.g. a hole in the heart) to critical (e.g. missing a part of the heart).

Improvements in diagnosis and technology have made it possible for conditions that were once thought to be untreatable. Our cardiologists at Mount Elizabeth Medical Centre have treated many children who are now reaching adulthood, living full and active lives.

What are the symptoms of congenital heart disease?

Technology today has allowed severe congenital heart disease to be diagnosed during pregnancy. However there are times when such disease is only evident during the first few months after birth. Some babies turn blue due to low oxygen levels in their blood. Some babies might have breathing or feeding issues. Abnormal sounds (also known as “heart murmurs”) might be heard too. Minor defects in the heart or major vessels can be detected during routine checks.

What are the causes of and risk factors for congenital heart disease?

Often there is no known cause for a child who develops congenital heart disease.

There are certain environmental and genetic risk factors that may put you at a higher risk of having a baby with congenital heart disease if the following occurs during pregnancy.

● Infections such as Rubella (German measles)
● Consumption of certain medications such as statins, angiotensin-converting enzyme (ACE) inhibitors, and teratogens
● Consumption of alcohol
● Smoking

Congenital heart defects may be linked with a genetic syndrome. For instance, many children with Down’s syndrome (caused by the presence of an extra chromosome) have heart defects.

Did you know?

A paper published in 2013 indicated that ventricular septal defect (a hole in the wall separating the two lower chambers of the heart) is the most common congenital heart defect found in 588 patients born with Down’s syndrome between 1996-2010 in Singapore¹.

What are the possible complications of congenital heart disease?

Possible complications that people with congenital heart disease might develop include
● Irregular heartbeat (arrhythmia),
● Increased risk of infection in the heart muscle (infective endocarditis)
● Weakness in the heart muscle (cardiomyopathy)

When should I see a specialist for congenital heart disease?

People with congenital heart disease need routine check-ups with a cardiologist to monitor their condition. A young patient may need further operations after initial childhood surgeries.

How should I prepare for my appointment?

Adults and adults accompanying their children with congenital heart disease should be prepared with the following when they meet their cardiologist for the first time. At Mount Elizabeth Medical Centre, our cardiologist will ask for your medical history, particularly the following:

● Type(s) of heart defect(s) you have
● Procedures or surgeries undergone
● Medicines and doses of medicines that have been prescribed now and in the past
● Type(s) of medical care you have been receiving
● Any new symptoms

How do specialists diagnose congenital heart disease?

Congenital heart disease is usually diagnosed when a child is young. If your cardiologist suspects that your child has congenital heart disease, he or she may offer one or a combination of several tests listed below to help diagnose the specific type of congenital heart disease.

● Echocardiogram. This uses ultrasound to create an image of a baby or child’s heart to identify any abnormalities in the heart muscle and valves.
● Electrocardiogram. This records the electrical activity of the heart. Electrodes are placed on the chest to monitor how the child’s heart is beating.
● Chest X-ray. This helps the cardiologist see if the child’s heart is enlarged or if there is fluid within the lungs
● Pulse oximetry. A sensor is clipped on the child’s finger to measure the level of oxygen in the blood.
● Cardiac catheterization. A thin tube is inserted into a blood vessel via the groin while being X-rayed. A dye may also be injected to help visualise the heart and its vessels. This allows a more detailed view of the heart and sometimes allows for certain treatment procedures.
● Cardiovascular magnetic resonance imaging (MRI). This is used increasingly to diagnose and evaluate congenital heart disease in teenagers and adults. Recent technology improvements allow better quality MRI images compared to echocardiography.

What treatments are available for congenital heart disease?

Not all congenital heart defects need to be repaired. Some, such as small holes, resolve themselves as the child ages. Some however, are considered critical and require treatment upon diagnosis.

Depending on the type of heart defect, our cardiologists treat congenital heart defects with one or a combination of the following treatments:

● Catheterization
Catheterization allows repairs to be done without having to surgically open the chest and expose the heart. It can be used to repair holes and narrowed areas. In such procedures, the cardiologist inserts a thin tube into a leg vein. Using x-rays to visualise the tip of the catheter, the cardiologist will guide and position it in the heart. Small tools will be threaded through to help repair the defect.

● Open-heart surgery
Many congenital heart defects are corrected using open-heart surgery, where the chest is open and the heart is exposed to facilitate repair.

● Medication
Some mild congenital heart defects, especially those found later in childhood or adulthood can be treated with medications to help the heart work more efficiently. Some examples include angiotensin-converting enzyme (ACE) inhibitors, beta blockers, as well as diuretics (medications that helps remove excess fluids from the body) to help by reduce blood pressure, heart rate, and fluid build-up in the chest.

At Mount Elizabeth Medical Centre, we are able to provide innovation, expertise and unwavering support to our patients. Our cardiologists are trained in treatments that can either control or improve your condition with the goal of helping you live an active healthy life.

[1] Tan M, Xu C, Sim SK, Seow AL, Tan TH, Quek SC. Types and distribution of congenital heart defects associated with trisomy 21 in Singapore. J Paediatr Child Health. 2013;49(3):223-227. doi:10.1111/jpc.12129.