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  5. Congenital Heart Disease

Congenital Heart Disease

  • What is Congenital Heart Disease?

    Congenital Heart Disease refers to heart defects that you are born with. The severity of the disease ranges from mild defects to severe and life-threatening conditions. In Singapore, according to the birth defect registry, from 1994−2000, congenital heart disease was a factor in 0.81% of total live births.

    The incidence of this disease in Singapore is on the rise and the approximate numbers of adults living with Congenital Heart Disease is 12,000 adults. With around 37,000−40,000 newborns born per year, it is estimated that 300−320 adult cases will be added annually. There are numerous types of Congenital Heart Disease such as:

    • Atrial Septal Defect (hole in the wall separating the two upper, right and left, atriums of the heart)
    • Coarctation of the aorta
    • Fallot's Tetralogy
    • Hole in the heart
    • Mitral Valve Prolapse
    • Patent Ductus Arteriosus
    • Pulmonary Atresia
    • Pulmonary/Aortic Stenosis
    • Transposition of the great vessels
    • Ventricular Septal Defect (hole in the wall separating the right and left ventricles)

  • The causes for Congenital Heart Disease are not very well known, though they may include:

    • Chromosomal or genetic conditions, which can be inherited or might occur once in a while during early pregnancy:
      1. Down Syndrome, DiGeorge Syndrome, Marfan Syndrome and Turner Syndrome
    • Environmental factors can lead to congenital heart disease:
      1. Excessive drug or alcohol consumption during pregnancy, acne medications, exposure to chemicals, viral infections (e.g. rubella), and other diseases including diabetes

  • Many congenital heart defects result in no symptoms. When the heart defects are severe or if multiple heart defects are present, especially in newborns, the following symptoms occur:

    • Blue skin, lips and fingernails
    • Chest pain
    • Fainting
    • Heart murmur
    • Palpitation
    • Poor blood circulation
    • Rapid breathing
    • Tiredness

  • Transcatheter Procedures may be used. These are minimally invasive procedures that are commonly performed using a catheter (small tube). This includes the delivery of an intravascular device such as a balloon, a coil or a stent to help dilate or close (device closure) existing cardiovascular defects.

    Types of transcatheter procedures include:

    • Balloon Angioplasty or Balloon Dilation is a procedure that allows the expansion of narrowed blood vessels to improve blood flow within the heart.
    • Balloon Atrial Septostomy, which is used to treat some congenital heart defects and can be performed in foetuses or infants. It is usually a technique that expands the hole between the right and left side of the heart.
    • Balloon Valvuloplasty, which is recommended for patients whose valves are narrowed. A tiny balloon catheter is directed to the target valve, which is inflated and deflated several times, until the valve opening is widened sufficiently.
    • Device closure of a condition called Patent Ductus Arteriosus (PDA) is performed when a baby’s Ductus Arteriosus (artery normally present in all foetuses) is not completely closed after birth. A device is inserted through the blood vessels in the groin to close this gap.
    • Device closure of Atrial Septic Defect (ASD), a congenital heart defect between the upper two chambers of the heart. Device closure is done whereby an occluder (separator) is inserted to divide the two chambers so the heart can resume its normal function.

    Surgery

    • Cavo-pulmonary shunt (CPS)
    • Fontan procedure
    • Ligation of patent ductus arteriosus
    • Modified blalock taussig shunt (BTS)
    • Norwood procedure
    • Pulmonary artery band (PAB)
    • Rastelli operation
    • Ross procedure

    • Complications related to pregnancies, use of contraception and risk to offspring
    • Inflammation of the inner layers of the heart (Endocarditis)
    • Managing of resulting non-cardiac medical problems
    • Social, emotional, financial, employment and educational issues
    • Surgical procedure complication and life-long follow-up

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