American Medical Association Family Medical Guide - American Medical Association [170]
• Chest X-ray An X-ray of the chest can show abnormalities in the shape and size of the heart and its chambers and in blood flow to the lungs.
• Electrocardiogram An electrocardiogram (ECG) records the electrical impulses associated with the heartbeat and can detect enlargement of the chambers of the heart or abnormalities of rhythm.
• Echocardiogram An echocardiogram is an ultrasound examination of the heart that can produce images of all four valves, the walls between the chambers, and the function of the pumping chambers. An echocardiogram can often provide enough information to enable a doctor to make an accurate diagnosis of all aspects of a congenital heart defect.
• Cardiac catheterization In rare cases, cardiac catheterization is required to help make a diagnosis. For this procedure, the child is given anesthesia or sedated, and a thin, flexible tube called a catheter is passed into a blood vessel in a leg and threaded up to the heart. The pediatric cardiologist observes the catheter on an X-ray image as it moves through the child’s heart, and he or she can see if it passes through any abnormal openings. The catheter also enables the doctor to measure the blood pressure and the amount of oxygen in the blood in each chamber of the heart. An X-ray moving picture is taken while a liquid dye that shows up on X-rays is passed through the catheter into the heart. This film shows the anatomy of the chambers and valves of the heart. With this information, the pediatric cardiologist can diagnose the precise heart defect and recommend appropriate treatment.
Treating Congenital Heart Defects
Many kinds of congenital heart defects do not require treatment. Small holes in the walls between the chambers do not affect the functioning of the heart and do not need to be closed; many eventually close on their own. Minor valve abnormalities also do not require treatment. However, these minor defects can be areas where bacteria that have entered the bloodstream can settle and cause infection. For this reason, a child with one of these minor heart defects will need to take an antibiotic before having any type of dental work (including cleanings or surgery) to prevent bacteria from infecting the heart.
More serious problems can produce symptoms at birth or in early infancy. If the symptoms are severe, immediate treatment will be necessary with a catheterization procedure or surgery to open narrow valves or close abnormal holes. A baby or child with a serious heart defect will be referred to a pediatric cardiologist in a hospital that has the appropriate medical equipment and trained specialists who can perform these procedures. Hospitals that care for a large number of babies and children with congenital heart defects have high success rates for cardiac catheterization and heart surgery, even if the problem is very complex.
Heart transplants (see page 573) are being performed on infants who have major heart defects that cannot be corrected with other forms of treatment. However, there are not enough compatible donor organs available to meet the demand.
Aortic and Pulmonary Stenosis
Aortic stenosis is narrowing of the heart valve that normally allows blood to flow from the heart into the aorta (the main artery in the body) and out to the rest of the body. Pulmonary stenosis is narrowing of the heart valve (or the area around it) that normally allows blood to flow from the heart to the lungs. Both types of stenosis require the heart to work harder to provide normal blood flow to the body or lungs. A child can be born with either type of stenosis.
Symptoms
Mild cases of stenosis do not produce symptoms. Most children with mild or