American Medical Association Family Medical Guide - American Medical Association [172]
Septal defects
A ventricular septal defect (top) is a hole in the wall (septum) that separates the right and left ventricles. Blood flows abnormally through the hole from the left ventricle into the right ventricle, potentially allowing excess blood to flow to the lungs. An atrial septal defect (bottom) is a hole in the septum that separates the right atrium from the left atrium. This defect also causes the blood to flow abnormally from left to right; if the defect is large enough, too much blood can enter the lungs.
Diagnosis
If a child has a septal defect, the doctor may detect a heart murmur during a physical examination while listening to the child’s heart through a stethoscope. To confirm the diagnosis, the doctor will order additional tests, such as a chest X-ray, an ultrasound of the heart (echocardiogram; see page 561), or a recording of the electrical activity of the heart (electrocardiogram; see page 559). Doctors usually refer children with septal defects to pediatric cardiologists (doctors who specialize in treating heart disorders in children).
Treatment
Because children with any kind of heart defect have a slight risk of developing infections at the site of the defect if bacteria enter the bloodstream, the child’s doctor will recommend that the child take antibiotics before having any kind of dental work (including cleanings) or surgery.
If a baby has a small ventricular septal defect, no treatment is necessary. More than 80 percent of ventricular septal defects close on their own. If a child has a large ventricular septal defect and signs of congestive heart failure, the doctor will prescribe heart medication and a high-calorie diet (because heart failure uses up calories that are necessary for the child’s growth and development). If the baby’s condition does not improve or if he or she has pulmonary hypertension (high blood pressure in the lungs) or is not growing at the normal rate, the doctor will recommend open heart surgery to repair the defect in the child’s first year of life. Surgery is very effective in correcting these defects, enabling a child to grow and develop normally and lead a full, healthy life.
If an atrial septal defect persists beyond 2 years of age, closure is recommended to avoid future problems. Most defects can be closed using a procedure called catheter device closure. In this procedure a thin flexible tube (catheter) is used to place a metal device in the defect; the device is then locked onto the atrial walls surrounding the defect, closing the hole. Very large defects require open heart surgery. Children who have surgery to close an atrial septal defect can live a full, healthy life and have a normal life span.
Coarctation of the Aorta
Coarctation of the aorta is an abnormal narrowing of the aorta, the major artery leading out of the heart. The narrowing usually occurs just beyond the point where the aorta turns down to supply blood to the lower part of the body, causing blood pressure in the aorta to increase above the narrowing and decrease below the narrowing. As a result, the child develops high blood pressure in the upper portion of the body and low blood pressure in the lower part of the body, and his or her heart has to work harder to pump blood past the narrowing to the rest of the body.
Coarctation of the aorta
In a healthy heart (left), the aorta is wide enough to allow normal blood flow. Coarctation of the aorta (right) is a narrowing in the aorta, usual ly just past the point where the blood vessels that supply blood to the head, neck, and arms branch from the aorta. When the aorta is constricted, the heart must work harder to pump blood to the areas of the body that lie below the narrowed area.
Symptoms
If the narrowing of the aorta is severe, symptoms can develop shortly after birth. An infant may feed poorly, become inactive,