5 Congenital Heart Disease and Prevention

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5 Congenital Heart Disease and Prevention

Congenital heart disease is a heart defect that occurs in infants in the womb. Fetus in the womb have a good compensation for this disorder, so without a good birth control Congenital heart disease is often not diagnosed before birth.

Each type of congenital heart disease have a different treatment to each other, depending on the classification (cyanotic or non-cyanotic), structural abnormalities, and the severity of cardiac effects. The impact of mortality and morbidity were disturbing it is necessary to understand more about the signs of this disease, so that it can perform early detection of congenital heart disease in children.
Congenital heart disease is a disorder of cardiac structure and function were found after delivery. This disorder occurs when the fetus develops in the womb. Congenital heart disease most commonly found are abnormalities in the septum chambers of the heart known as ventricular septal defect (VSD) and followed by abnormalities in the cardiac septum porch or better known as Atrial Septal Defect (ASD).

Ordinary people often look at both these heart defects known as leaky heart. Other types of structural abnormalities may include patent ductus arteriosus, transposition of great arteries, and heart valve abnormalities. Congenital heart disease is often also arise in the form of a combination of several disorders, as happened in tetralogy of Fallot, which includes 4 abnormalities in the heart. Among the various existing congenital abnormalities, Congenital heart disease is a disorder most commonly found.

Prevalence of Congenital Heart Disease in Indonesia about 8-10 of 1,000 live births, with a third of them manifest in critical condition in the first year of life and 50% of the gravity of the first month of life ends in death. With a population of 200 million inhabitants and a live birth rate of 2%, it is estimated there are about 30,000 patients with congenital heart disease.

Research in the United States stated that every year at least 35,000 babies suffer from this disorder and 90% of them could die in the first year of life when the baby is not carried out adequate treatment. According to the Children's Heart Foundation, each year as many as one million babies worldwide are born with congenital heart disease. About 100,000 of them will not be able to pass the first year of life, and thousands of other babies will die before reaching adulthood. This situation is often not realized by the common people, so the number of deaths of children caused by heart disease is on the increase.

Congenital heart disease is a heart disease which is inborn, where abnormalities in cardiac structure or function of the heart caused by circulatory disorders or structural development of heart failure in the early phase of fetal development. Causes of Congenital Heart disease itself is largely unknown, but several genetic disorders such as Down syndrome and infection Rubella (German measles) during the first trimester of pregnancy the mother associated with the incidence of certain congenital heart diseases.

Generally, there are two major groups, namely Congenital heart disease Congenital heart disease is cyanotic and acyanotic congenital heart disease. Cyanotic congenital heart disease usually have structural abnormalities of the heart is more complex and can only be treated with surgery. While acyanotic congenital heart disease generally have a lesion (abnormality) is simple and singular, but still more than 90% of whom require open-heart surgery for treatment. At cyanotic congenital heart disease, the newborn looks blue because the blood of mixing clean and dirty blood through structural abnormalities of the heart. In this condition the baby's body tissues do not get enough oxygen is very dangerous and should be treated quickly. In contrast to non-cyanotic congenital heart disease no obvious symptoms so often not realized and not in a good diagnosis by physicians and parents. Initially symptoms such as fatigue lactation or breast-feeding intermittently and subsequent symptoms such as delays in growth and development.

Here's 5 of congenital heart disease in children

1. VSD (Ventracular Septal Defect) / Room Partitions heart Perforated
VSD is a hole in the heart abnormalities bulkhead between chambers of the heart that causes leakage of blood flow in the left and right chambers of the heart. This makes some of the leakage of oxygen-rich blood back to the lungs thereby blocking the blood low in oxygen from entering the lungs. If the hole is small, VSD does not provide any significant problems. When it is, the baby can suffer heart failure. VSD is a congenital heart defect is most common (30% of cases). The main symptom of this disorder is difficulty breastfeeding and growth disorders, shortness of breath and fatigue. Infants with large VSDs fast asleep after breastfeeding less, waking briefly with hunger, tried to suckle again but quickly exhausted, fell asleep again, and so on.

2. PDAs (Persistent Persistent ductus arteriosus)
The ductus arteriosus is a blood vessel that connects the pulmonary artery to the aorta distal of the artery, subclavian, which will be amended after the baby is born, namely: "Normal postnatal patency": Functionally, the ductus arteriosus is still open because of hypoxia or in preterm infants, and will closes itself when the underlying circumstances have improved. "Delayed, non surgical closure": The ductus arteriosus closes both functionally and anatomically, but these things happen more slowly though the underlying circumstances have improved. This closure occurs because normally closes itself, or abnormally which is due to infection or thrombosis in the ductus arteriosus. "Persistent patency of the ductus" (PDA): The ductus arteriosus remains open anatomically into adulthood. Elective surgery is done (before entering school). Surgery is done early in the event: Impaired growth, lower respiratory tract infections recur, enlargement of heart / heart failure and bacterial endocarditis 6 months after recovery.

3. PS (Pulmonary Stenosis) / Narrowing of the pulmonary valve.
PS is a narrowing of the pulmonary valve that controls the flow of low-oxygen blood from the right chamber of heart to the lungs. With this narrowing, the right ventricle must work harder to pump blood so that more and more enlarged (hypertrophy). PS occurs in 10% of cases. Many patients newly diagnosed as an adult. If so, the impact might have been very damaging form of lung disease, stroke risk is high and life expectancy is low.

4. ASD (Atrial Septal Defect) / Block Porch heart Perforated.
Atrial Septal Defect (ASD) is the presence of a hole between two heart porch or there is a relationship between the right atrium to the left atrium were not closed by the valve. ASD is a hole or defect in the septum that separates the left and right atrium. These holes cause the same problems with VSD, the flow of oxygen-rich blood back to the lungs. ASD occurs in 5-7% of cases and is more common in female infants than male babies.

5. TF (tetralogy of Fallot)
TOF is a complication of congenital heart abnormalities were typical, and involves four conditions: Bulkhead hollow chambers of the heart (VSD), a narrowing of the pulmonary valve (PS), the right ventricle enlarged heart (hypertrophy) and the root of the aorta just above the hole VSD. In this disease plays an important role is ventricular septal defect and pulmonary stenosis, the defect in the ventricular terms at least as large as the hole aorta. VSD usually large holes and blood flow from the right ventricle through the hole to the left ventricle. This happens because of the constraints on the pulmonary valve. Once entered into the left ventricle, blood low in oxygen was pumped into the aorta and flow throughout the body. That's why babies with TOF have skin that turn blue from lack of oxygen.

Symptom Congenital Heart Disease

Congenital heart disease is often found in childhood. However, not all congenital heart defects directly produce symptoms at birth. Some congenital heart defects are difficult to detect in childhood, so that the abnormality was discovered during adolescence and adulthood. In general, severe congenital heart defects can cause symptoms within the first few months after birth, so it can often be detected in childhood. But mild congenital heart defects often cause complaints, so it is often also not detected. Generally mild congenital heart defects will be detected when the child comes to see the doctor.

Congenital heart disease can be divided into two. Blue congenital heart disease and congenital heart disease without the blue. Blue congenital heart disease cause symptoms more quickly and most easily recognizable. The most common symptom is a baby turns blue when crying (lip, nail and tongue turn blue). Baby face is pale and blue, toe nails and hands also looks bluish due to lack of blood flow.
Blue and this tightness will appear more clearly when the baby cries during defecation, general physical looks limp, tired and lazy feeding, the baby is often fever, cough, runny nose. At the time of sucking the milk, babies often stop and wheezing bluish face. Other symptoms include, difficulty breathing, low appetite, babies often choking or coughing while feeding, sweating excessive when eating or drinking milk, growth and development stunted, weight loss is difficult to rise or decline, late walking, the child's activity is reduced, child looks weak, and children often have a fever of unknown cause.

Diagnosis congenital heart disease

Heart disease in the fetus in the womb most do not cause significant symptoms. Therefore Congenital heart disease is often not diagnosed until the baby is born. Congenital heart disorders can be diagnosed during pregnancy that is entering the age of 16 to 20 weeks of pregnancy with ultrasound womb. The earlier the diagnosis can be in the know then hope for the healing process will be even greater.

At cyanotic congenital heart disease, the diagnosis can be done directly (baby looks blue and tightness) and requires prompt treatment. In the non-cyanotic congenital heart disease, physical examination in infants born balls paramount role. If the physical examination by a doctor is suspected cardiac abnormality, then some additional checks must be carried out, among others, echocardiography, electrocardiography (ECG), x-ray (X-ray) of the chest, oximetry, through catheterization or angiography. However, with advances in techniques echocardiography, angiography is invasive procedure tends to decrease.

Causes congenital heart disease

Causes of congenital heart defects majority (90%) are unknown. Environmental factors such as maternal smoking, drinking outside prescription drugs, infections during pregnancy is said to play a role 3%. The remaining 7% because of derivatives. Because the cause is largely unknown and only 7% transcription factors, is likely to give birth to children with congenital heart defects are relatively small.

Most experts suspect the incidence of congenital heart disease in infants newborn caused by a combination of several factors, including viral infections TORCH during pregnancy, diabetes during pregnancy, smoking, consumption of certain drugs such as retinoic acid for acne treatment, alcohol, and genetic or hereditary factors.

TORCH infections (toxoplasmosis, rubella, cytomegalovirus / CMV and herpes simplex) is a group of infections that can be transmitted from a pregnant woman to her baby. TORCH-infected pregnant women at high risk of spread to her fetus that can cause birth defects or congenital heart disease. Allegations against TORCH infections can only be proven by a blood test or screening. If the result is positive, or there is an active infection, it is further recommended diagnostic examinations be taking a bit of amniotic fluid for laboratory analysis.

Hereditary factors can be seen if a sibling or parent of a baby suffering from congenital heart disease also have the same abnormality. Research shows that parents who have a higher risk of cardiac abnormalities have children with heart defects as well. The disorder can also be caused by disorders of cardiac development in the fetus from infections such as rubella and toxoplasmosis, drugs, alcohol and toxic substances consumed by his mother. Gene abnormalities such as Down syndrome and Turner also correlated with congenital heart defects.

Prevention congenital heart disease

• Antenatal examination or inspection routine during pregnancy is needed. With regular birth control, the congenital heart disease can be avoided or identified early. 
• Identify risk factors in pregnant women is diabetes, the blood sugar should be controlled within normal limits during pregnancy, maternal age over 40 years, there is a family history of the disease such as diabetes, a genetic disorder Down syndrome, heart disease in the family. Pregnant women need to be alert to the risk factors although less likely.
• Antenatal examination can also detect the presence of congenital heart disease in the fetus by ultrasound (USG). This examination depends on the time of the ultrasound, the severity of heart failure and also the ability of physicians who perform ultrasonography. Generally, congenital heart disease can be detected during an ultrasound done in the second half of pregnancy or pregnancy over 20 weeks. If there is suspicion of cardiac abnormalities in the fetus, it is important to do further investigation by fetal echocardiography. With this inspection, the image of the heart can be seen more closely.
• Prevention can be done also to prevent mothers from the risk of viral infections TORCH (Toxoplasmosis, Rubella, Cytomegalovirus and Herpes). Screening before planning a pregnancy. Screening is also known as TORCH screening is routinely performed on pregnant women in developed countries, but in Indonesia the screening is rarely done because of financial considerations. Get immunizations to prevent disease morbili MMR (measles) and rubella during pregnancy.
• Consumption of certain drugs during pregnancy should also be avoided because some medications are known to harm the fetus. The use of drugs and antibiotics can cause potential side effects for both mother and fetus. The use of drugs and antibiotics during pregnancy should be used if there is a clear indication. The main principle of treatment of pregnant women with the disease is to think about whether appropriate treatment if the woman is not in a state of pregnancy. Usually there are a variety of options, and for this reason the second principle is to evaluate the drug's safety for mother and fetus
• Avoid exposure to X-rays or X-ray radiation from recurring in future pregnancies
• Avoid exposure to cigarette smoke both actively and passively from their husbands or family members in the vicinity.
• Avoid using the vehicle smoke pollution that do not suck protective substances - toxic than carbon dioxide.

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