Cogenital heart disease

Some babies are unfortunate enough to be born with a damaged heart.This is known as congenital heart disease.The defect apparently arises from infection or injury to the baby's heart during the first three months after conception.congenital heart disease is less common than other forms of heart disease,but when it occurs,it can cause plenty of trouble to all concerned.There are many varieties of the disease,no two cases being exactly alike.

Atrial septal defect

Atrial septal defect is an abnormal opening or shunt between the two upper chambers of the heart,the right and left atria or auricles.Instead of flowing in the normal direction,part of the blood from the left atrium flows across into the right atrium,and is then recirculated through the lungs without having passed out into the tissues to nourish the body.This forces the right side of the heart to work doubly hard for no good reason.This abnormal opening or defect raises the blood pressure on the right side of the heart.The child often suffers from frequent chest colds and may fail to gropw as rapidly as he should.Eventually,because of extra resistance building up in the vessels supplying the lungs,the blood flow may reverse itself,passing from the right to the left side.When this occurs the patient may turn blue,a condition known as cyanosis.

Surgery suitable anesthesia the patient is cooled to a low body temperature.The chest is then opened and the defect repaired.Most patients make a satisfactory recovery following this operation,provided the abnormal opening is not too large and does not involve the mitral valve.once the patient turns blue the risk of operation is the greater,but even at this stage something can usually be done to help.

Ventricular septal defect

Ventricular septal defect means an abnormal opening or shunt between the right and left ventricles or pumping chambers of the heart.Because of the higher pressure on the left,some of the bright red blood coming from the lungs is forced through the defect in the septum or dividing wall,where it floods the right side of the heart.This excess blood is recirculated through the lungs,another waste of energy similar to what occurs in an atrial defect described above.The pressure in the right side of the heart is increased and there is a loud murmur heard over the breastbone or sternum.Not only is there danger from overloading the lungs,but in this type of defect the patient may possibly develop a very serious condition known as sub acute bacterial endocarditis(SBE),or some other serious inflammation involving the heart muscles.

Whenever possible the defect should be closed y a surgical operation on the heart,using the heart-lung machine.In this operation the surgeon usually stops the heart and allows the machine to pump the blood while the defect is being repaired.

Patent ducuts arterious means that a certain vessels called the ductus which normally closes at birth,has remained open,allowing blood to pass fromm the aorta to the pulmonary artery.This produces an effect similar to the atrial and ventricular septal defects described above.The only difference is that the abnormal openning occurs between the great vessels just outside the heart.This produces a continuous"machinery" murmur which is heard mainly in the upper part of the chest on the left.Eventually extra strain upon the circulation may cause the heart to fail.Worse still,the abnormal opening may become the focus of infection for subacute bacterial endocarditis.Eventually the vessels of the lungs may become constricted adn refuse to carry the excess blood.This raises the pressure in the pulmonary artery,so that eventually the shunt may flow i the reverse direction.The patient may complain of shortness o fbreath and pains over the heart.However,a few people do manage to live for many years with this condition,provided the opening is not too large.


Surgery is the best treatment for this condition.The abnormal channel should be closed,preferably some time between the fourth and tenth years of life.Meanwhile,the child should be taking penicillin or some other suitable antibiotic to prevent serious complications.

Coarctation of the aorta means a localized constriction or narowing o the aorta near the point where that vessel crosses behind the pulmonary artery.This is the spot where the ductus arterious or cross-channel between the aorta and pulmonary artery existed before birth.(as we have just noted,in a few children ths vessel fails to close,producing a patent ductus arterisus.)

This narrowing of the aorta means that the lower part of the body has a lower blood pressure than that found in the head and neck.Blood flow is also much slower in the leg than in the arm,unless other vessels open up to supply the lower extremities with blood.The patient may complain of numbness and weakness in the legs,and also severe headaches due to the very high pressure of the blood stream going to the head.There is a loud murmur in the chest,chich may also be heard all over the abdomen.

X-ray films of the ribs show notching along the edges of the ribs because of the increased size and twisting of the intercostal arteried.The condition is serious and should be adequately treated early in life,otherwise three out of four patients with coarctation will die before they reach forty years of age.The best treatment is to remove the narrowed portion of the aorta by surgery,bringing the two ends together and perhaps using a small graft to repair the defect.such operations can be done only by qualified teams of surgeons and cardiologists working together at some large medical centre.

Tetralogy of fallot is a serious malformation in which there is a defect in the ventricular sepctum.This allows the aorta to receive blood from both the right and left ventricles.In addition,there is narrowing or stenosis of the pulmonary valve,and hypertrophy or enlargement of the right ventricle.The large defect in the septum allows the darker and lighter blood to intermingle,so that the patient is bluish may have to squat down to get his breath after attempting to pay like normal children.
Because of the narrowing of the pulmonary artery much of the blood passes from right to left,thus depriving the child of a normal supply of oxygen to meet his needs.There may be retareded.Most of these children die in their early teens unless given the benefit of good surgery.The red blood count tends to rise,the red cell count often going above ten million instead of the usual five million.The greatly thickened blood also slows down circulation.In severe cases the child may have spells of unconsciousness brought on by lack of oxygen in the brain.A rough,harsh murmur is usually hears all over the chest.

The standard treatment for this condition has been the construction of an artificial channel or ductus between the pulmonary artery and the aorta,or between the pulmonary artery and one of the subclavian srteries.This forms an artificial ductus arteriosus condition similar to that described above.But even this defect sill help the child