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Congenital Heart Disease

  • What is Congenital Heart Disease?

    Congenital heart disease refers to heart defects that a person is 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 rate of this disease in Singapore is on the rise and there are about 12,000 adults living with congenital heart disease. With around 37,000 − 40,000 babies born each year, it is estimated that 300 − 320 adult cases will be added each year. There are many types of congenital heart diseases including:

    • Atrial septal defect (hole in the wall separating the 2 upper, right and left, atriums of the heart)
    • Coarctation of the aorta (narrowing of the aorta)
    • Fallot's tetralogy
    • Hole in the heart
    • Mitral valve prolapse
    • Patent ductus arteriosus (opening between 2 major vessels)
    • Pulmonary atresia (pulmonary valve does not open)
    • Pulmonary / aortic stenosis (narrowed)
    • Transposition of the great vessels (great vessels are reversed)
    • 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 (eg. 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 (fast, strong or irregular heartbeats)
    • 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 like a balloon, a coil or a stent to help dilate (widen) or close (device closure) existing cardiovascular defects.

    Types of transcatheter procedures include:

    • Balloon angioplasty or balloon dilation is a procedure that allows the widening 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 widens the hole between the right and left side of the heart.
    • Balloon valvuloplasty, which is recommended for patients with narrowed valves. A tiny balloon catheter is directed to the target valve and 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 an atrial septic defect (ASD), a congenital heart defect between the upper 2 chambers of the heart. Device closure is done with an occluder (separator) inserted to divide the 2 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
    • Swelling 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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