General information

Our children are our future; we must take care of them as much as we can.

Heart, is the organ which pumps needed blood to the whole body .it begins pumping blood from the twentieth day of the fetus in the mother's womb, at a pumping rate of approximately 7,000 to 8,000 liters of blood per day in adult.

Incidence of congenital heart disease: 

The probability of any mother to give birth to a sick child with one of the heart diseases is nearly 8 out of 1,000 births. In case that the mother and father had a child with heart disease, the probability of heart disease in their children doubles.

Congenital heart disease may be treated successfully if the disease was discovered early by correct diagnosis,, so it is necessary for parents to pay attention to any symptoms that may affect the child, it may be the first key for the correct detection and diagnosis, which can be treated as soon as possible.

 The most common eight congenital heart diseases, representing 80 per cent of the total cases, are: a hole between the ventricles (VSD), patent ductus arteriosus, a hole between the atria (ASD), tetralogy of Fallot,  pulmonary valve stenosis, coarctation of aorta, aortic valve stenosis, and transposition of great vessels (TGA). As for the remaining 20 per cent, they include various cardiac abnormalities that are complex and relatively rare.

The causes of these diseases are not clear but it could be related to the mother, the child himself, and congenital factors. 

The factors related to the mother are many, for example:

1 – Mothers that have un- controlled diabetes or Lupus Erythematous disease, some of the diseases that affect the pregnant mother, especially during the first weeks of pregnancy, such as rubella, herpes, mumps, that are a direct cause for the birth of a child with disease heart. And here I emphasize the importance of vaccinating girls against rubella and mumps MMR, as a preventive measure for the future of their children, when they are in the age of reproductive activity.

2. Drugs and chemical compounds when given to pregnant mothers form a risk factor for heart deformity like phenytoin, lithium, alcohol, and the latter are usually in Europe and America countries.

3 - There are other factors related to the fetus directly , like chromosomal abnormality , where 30 per cent of babies born with chromosomal disorder have congenital heart disease , notably trisomy 21 (mongolism ) caused by the old age of the mother .

4-Genetics play an important role in the incidence of certain congenital heart diseases in children, like cardiomyopathy, supra valvular aortic stenosis, and the syndrome of Marfan, as well as mitral valve prolapse. 

Acquired causes that lead to heart disease:

 it occurs after months or years of birth, the rheumatic fever comes on top which is caused by inflammation of the throat and tonsils germ (Streptococcus), which is often neglected or treated partially, and thus the resulting in life-long valvular heart disease, so we emphasize the correct diagnosis and adequate treatment for tonsillitis in children (for least ten days), The viral inflammation of the heart muscle, and inflammation of the arteries (Kawasaki disease).

Symptoms: 

1-Clinical symptoms, which is in fact directly related to the child’s age, (age-specific). For example, feeding difficulties in infants is the most important sign , which is accompanied by rapid breathing, fast fatigue during lactation, improper weight gain and slow growth, and there are Important symptoms like  repeated lung infections, while the main reason for the respiratory symptoms is the increase fluid in the lung, older children’s complaints are highlighted  more quickly by getting tired during playing and their inability to keep up with their peers and their need for a long break after they return from school. 

2- Cyanosis (bluish discoloration of skin and mucous membrane).

Diagnosis: 

1.The first step in diagnosing the disease in children,  began by clinical examination, which varies depending on the child's age, for example, at the age of birth ,shortness of breath or even shock are the prominent symptoms regardless of the presence or absence of heart murmurs. It is important to look for bluish discoloration of skin and mucous membrane, as well as to examine the heart sounds.

We must not forget to emphasize the heart rate, measurement of arterial blood pressure and O2 saturation as part of routine examination of the children's clinic, regardless of the original complaint,

2. The second diagnostic step is to do ECG, with a simple radiograph of the chest, and sonar of the heart (Echo), which in fact gives an accurate and final diagnosis from the fetus to the adult age group.

Treatment:

Treatment of the most congenital heart disease is available and successful in most of the cases and it could be just follow up, surgical or transcatheter approach.  

The recent trends in treatment tend to move away from the surgery and try to close the holes through cardiac catheterization without any surgical approach, like closing ductus arteriosus and the hole between the atria. More recently there have been a lot of successful attempts to close the opening between the ventricles or opening stenosed arteries and valves by expanding balloon or inserting a stents, and recently implanting artificial valves by transcatheter approach, fortunately most of these procedures are conducted at the King Hussein Medical City.

Doctor Abdel Fatah Abu Haweleh

Consultant pediatric cardiologist, 

Chief of congenital cardiology department,

Queen Alia Center for heart diseases

King Hussein Medical City