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Cardiac Conundrums

tttdocMichael Hines, M.D., Professor of Pediatric Cardiovascular Surgery

Children’s Memorial Hermann Hospital

 

It’s one of the biggest moments for a mother-to-be, one so highly anticipated and exciting that doctors turn up the volume, filling the room with every lub, dub, whisper and whoosh.

 

A baby’s heartbeat means life and means that everything is as it should be. But this is not always the case. According to the National Heart Lung and Blood Institute, approximately 40,000 babies in the United States are born with a congenital heart defect each year. Some defects are simple, and others are complex. Some are picked up via fetal ultrasound and others not until birth or even later.

 

A heart begins to form around the fourth week of pregnancy and is fully developed structurally by the sixth to eighth week. After that, it’s basically just growing.

 

Heart Health 101

The heart’s right side pumps blood to the lungs, where the blood picks up oxygen. The left side pumps oxygenated blood to the body. The two sides are separated by a wall called the septum. Arteries carry blood from the heart to the body; veins carry blood from the body to the heart.

 

The heart has four chambers—two upper chambers called atria and two lower chambers called ventricles. Valves, four of them, open and close to control blood flow. Imagine opening and closing a door, repeatedly and with rhythm. That’s how a heartbeat sounds through a stethoscope. An extra or unusual sound suggests a heart murmur, which can be completely harmless or indicative of a congenital heart defect. There are more than 40 different types of congenital heart defects.

 

Despite how it sounds, a “hole in the heart” can actually be quite simple. A hole in the septum between the heart’s upper chambers is an atrial septal defect (ASD) and a hole in the septum between the heart’s lower chambers is a ventricular septal defect (VSD). Holes can be patched over or sewn shut, while some don’t require intervention at all.

 

One common misconception is that children who have a hole in the heart require prophylactic antibiotic therapy before procedures as routine and simple as dental cleanings. The theory behind this was that introducing bacteria into the blood of a child with a hole in the heart would increase the risk of endocarditis, an infection in the lining of the heart. But, according to the American College of Cardiology, antibiotics do not lessen the risk of developing endocarditis in anybody, whether they have a heart defect or not.

 

One of the most common heart defects is a patent ductus arteriosus (PDA). Before birth, two major arteries connected to the heart are themselves connected by a blood vessel called the ductus arteriosus. When a baby is born, this blood vessel, no longer needed for fetal blood circulation, should close on its own. If it remains open, or patent, it can strain the heart or lead to pulmonary hypertension. That’s why surgery is often recommended.

 

Most cardiac defects are repaired via open-heart surgery, but when it comes to PDAs, pediatric surgeons are now turning to a technique called video-assisted thoracoscopic surgery (VATS).

Performed at only a handful of pediatric hospitals nationwide, including Children’s Memorial Hermann Hospital, the procedure is minimally invasive and done on an outpatient basis.

 

A child’s heart is about the size of his or her fist and is safely ensconced in the chest, while a parent’s heart seems to never stop growing and is often worn on the sleeve. That’s why the very words “heart surgery” tends to strike fear, but heart surgery in general is usually successful, with a mortality rate of less than  five percent.

 

Approximately one million adults in the United States are living with a congenital heart defect. Suffice it to say, most children with congenital heart defects go on to live full, unrestricted, healthy and active lives.

 

Michael Hines, M.D., is professor of pediatric cardiovascular surgery at The University of Texas Health Science Center at Houston (UTHealth) Medical School and is affiliated with Children’s Memorial Hermann Hospital.

 

SIDEBOX:

*Fast facts:

– Congenital heart defects are the most common type of birth defect.

– Some are found before birth, some right after birth,  and others several years later.

– Some can be prevented.

*Source: Centers for Disease Control

 

SIDEBOX:

*Prevention:

•Avoid alcohol and illegal drugs during pregnancy.

•Have a blood test early in pregnancy to verify immunity to rubella.

•Pregnant women who have diabetes should maintain good control of blood sugar levels.

*Source: U.S. National Library of Medicine/National Institutes of Health

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october, 2020

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