Congenital Heart Defects May Lead to PH, Other Complications Later in Life, Expert Says

Heart defects that develop before birth may lead to a variety of complications later in life, including pulmonary hypertension (PH), according to cardiologist Sanjay Gandhi, MD.

However, he says, it is still not possible to predict if or when these complications will arise.

Congenital heart defects (CHDs) occur when the heart or the blood vessels around it do not develop normally in the fetus. They are the most common type of birth defect, affecting approximately 1 percent of all newborns — which accounts for about 40,000 babies in the U.S. each year.

There are several types of CHDs: holes in different areas of the heart, blood vessels narrower than normal, leaky valves, or in more severe cases, parts of the heart that are incorrectly formed, misplaced, or even nonexistent. These can significantly undermine blood flow and cause several disorders including arrhythmia (abnormal heart rhythms), stroke, congestive heart failure, atherosclerosis (hardening or narrowing of the arteries), and PH.

Owing to better methods of detection, diagnosis and treatment, living with CHDs has become easier, and today these defects are not as life-threatening as they were a few years ago. Data from the Centers for Disease Control and Prevention indicate that current survival rates up to the age of 18 are about 95 percent for babies with mild CHDs and 70 percent for those with severe CHDs.

However, some people with a CHD won’t discover their problem until later in life. Heart defects may only present signs or symptoms at older ages, and because many variables can affect the onset of complications, there is no way to predict if or when these problems will appear.

“The heart is an amazing organ with any moving parts and there are a lot of possibilities as the heart is developing for something to not connect right, so there are a lot of different congenital defects, probably more than 30,” Gandhi, an interventional cardiologist at Wake Forest Baptist Medical Center, said in a press release.

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“Some of these are identifiable right away, or they manifest in early childhood or maybe in adolescence. But otherwise there are too many variables to predict when someone with CHD might experience symptoms or effects,” he added.

These variables include the type of defect, severity, location, the function it affects, and if it is simple or complex. Age, general health, and lifestyle habits, especially related to diet and exercise, can also have an impact.

Even CHDs that are identified and treated in childhood can reappear and lead to complications in adulthood.

Fortunately, most of these cases are preceded by warning signs, such as shortness of breath, fatigue, dizziness or fainting, and heart palpitations. According to Gandhi, if a person has any of these symptoms, and they are significantly affecting his or her normal daily life, “you should definitely inform your primary health care provider, and explore whether you need to see a heart specialist and have some cardiac testing.”

Although patients are often surprised when they receive a CHD diagnosis, some realize they had already been experiencing signs of the problem for a while.

“Sometimes they realize that things weren’t always right with their breathing or stamina, that they couldn’t keep up with their friends on the soccer field or in the swimming pool when they were younger, that maybe this problem with their heart did manifest earlier than they had thought,” Gandhi said.

Doctors can use different methods to detect a heart defect, the most common being an electrocardiogram (ECG or EKG) and an echocardiogram (ultrasound), which can be complemented with blood tests, chest X-rays, and computed tomography (CT) or magnetic resonance imaging (MRI) scans.

Treatments vary based on the type and severity of the defect. These can include medications to relieve symptoms and reduce the risk of complications, or one or more surgeries that can be either minimally invasive, such as percutaneous catheterization, or more complex, such as open-heart procedures.

As opposed to pediatric cardiologists, cardiologists and heart surgeons of adult patients are usually more familiar with acquired heart disorders than CHD, so it is important that both experts work together to offer the best possible treatment to a person with a CHD.