American Medical Association Family Medical Guide - American Medical Association [171]
A baby born with severe pulmonary stenosis can have blue skin color (cyanosis) shortly after birth from lack of oxygen in the blood. A baby with severe aortic stenosis can develop heart failure with symptoms such as rapid breathing, difficulty feeding, and poor skin color. These symptoms require emergency treatment in a medical center that is equipped for treating children with heart problems.
Diagnosis
If a child has stenosis, with or without symptoms, the doctor can detect it during a physical examination by listening for a heart murmur through a stethoscope. To confirm the diagnosis, the doctor will refer the child to a pediatric cardiologist (a doctor who specializes in treating heart disorders in children), who will probably recommend a chest X-ray, an ultrasound examination of the heart (echocardiogram; see previous page), or a recording of the electrical activity of the heart (electrocardiogram ; see previous page).
Treatment
If a child has mild stenosis, no treatment is necessary, but the doctor will want to monitor the child’s condition with regular examinations because stenosis can worsen over time. If the child develops symptoms or if the stenosis is progressing, the doctor will refer him or her to a center that is experienced in caring for children with heart problems. A child with either aortic or pulmonary stenosis needs to take antibiotics before any dental work or surgery to avoid possible bacterial infection of the heart.
Aortic and pulmonary stenosis
A heart with aortic stenosis (left) has a narrowed valve in the aorta. The narrowing obstructs the flow of blood to the child’s body, causes the heart to work harder, and thickens the wall of the lower chamber of the heart. A heart with pulmonary stenosis (right) has a narrowed valve in the pulmonary artery (the large blood vessel that transports blood from the heart to the lungs). The narrowing obstructs the flow of blood into the lungs and makes the heart work harder.
To treat severe aortic stenosis, a doctor may recommend heart-valve surgery or balloon valvuloplasty to open the valve and improve blood flow out of the heart to the rest of the body. In balloon valvuloplasty, the doctor threads a small plastic tube with a balloon attached through a blood vessel into the child’s narrowed heart valve. He or she then inflates the balloon to open up the abnormal valve. In rare cases, this procedure is unsuccessful and surgery is necessary. Because narrowing at the aortic valve tends to be progressive, more than one balloon valvuloplasty or surgical procedure may be necessary to treat severe aortic stenosis. Balloon valvuloplasty is also recommended for treating severe cases of pulmonary stenosis.
Septal Defects
A septal defect is a hole in the wall, or septum, that separates the left and right sides of the heart. There are two types of septal defects: ventricular septal defects and atrial septal defects. A ventricular septal defect, the most common congenital heart defect, is a hole in the wall between the ventricles (the two lower chambers of the heart). An atrial septal defect is a hole in the wall between the atria (the two upper chambers of the heart).
Septal defects allow blood from the left side of the heart to flow back into the right side. If the hole is large enough, it forces the heart to work harder and can cause congestive heart failure (see page 570).
Symptoms
The symptoms of a ventricular septal defect depend on the size of the hole. Small defects do not cause any symptoms and often close on their own. If a baby has a large ventricular septal defect, he or she may develop signs of congestive heart failure, such as rapid breathing, shortness of breath, excessive sweating while feeding, a heart murmur, poor weight gain, and delayed growth.
Children with atrial septal defects usually have no symptoms, but these defects