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The three types of congenital heart defects (CHDs) are abnormalities of the structure of the heart, abnormalities of blood flow, and abnormalities of the rate and/or rhythm of the heartbeat.
One relatively common abnormality of structure is an atrial septal defect – a hole in the wall between the chambers of the baby’s heart. In a healthy baby, blood that has already been circulated enters the heart through the right chamber and is passed on to the lungs where it receives oxygen. The oxygenated blood then re-enters the heart through the left chamber where it is sent out to the rest of the body. When there is a hole in the wall between the right and left chambers, this blood can bypass the lungs and go directly through to the left chamber where it is pumped out to the body without the oxygen it needs.
Another relatively common structural heart defect is a patent ductus arteriosus. During fetal development, the baby has an opening between the aorta and the pulmonary artery - this opening normally closes shortly after birth once the baby is breathing on its own. If the hole stays open, extra blood will flow to the lungs – this causes pulmonary issues similar to those caused by pneumonia.
Transposition of the Great Arteries, a condition where the two main arteries leaving the heart are reversed, is also a form of CHD. Because this defect severely disrupts the flow of oxygenated blood to the rest of the body, transposition of the great arteries requires surgery in order for the baby to survive.
Hypoplastic Left Heart Syndrome is another structural abnormality under the umbrella of CHDs. This birth defect, which develops during the pregnancy, occurs when the left side of the heart does not form correctly. It also requires surgical intervention for survival.
Coarctation of the aorta is where the aorta has a narrowing, which means that less blood can flow through it. While this defect may appear on its own, it is also commonly present alongside other CHDs including atrial septal defects. Assessing the pre and post-ductal oxygen saturations (via the aforementioned shoulder and foot oxygen test) can help with the identification of coarctation of the aorta.
While most CHD’s combine abnormalities of structure and flow, issues can arise due to abnormalities of flow alone.
For example, Persistent Pulmonary Hypertension (“PPHN”), can be the result of a congenital heart defect, or it can be caused by a difficult delivery and/or birth asphyxia. During fetal development, because the baby receives oxygen through the umbilical cord and not the lungs, the lungs maintain high blood pressure in order to redirect oxygen towards other vital organs. After delivery, when the baby begins breathing, the blood pressure in the lungs would normally fall and blood flow to the lung increases. In babies with PPHN, however, the pressure in the lungs stays high, causing blood to be directed away from the lungs.
The third type of congenital heart defect consists of abnormalities in heart rhythm. An abnormal heart rhythm is also known as a cardia arrhythmia. The most common arrhythmia in newborns is supra ventricular tachycardia (SVT). When a child has SVT, the ventricles of the heartbeat at an abnormally fast rate. Atrial flutter is another form of arrhythmia that can be present in a newborn. There are many other forms of neonatal arrhythmias. Some are treated by electrical cardioversion, others by medical cardioversion, and in some rare cases by surgery.
The suspicion of CHD should lead to an immediate consult with a neonatologist, pediatric cardiologist, or pediatric electrophysiologist. An “electrophysiologist” is a physician who specializes in abnormalities of heart rate and rhythm.
The law firm of Nurenberg, Paris, Heller & McCarthy has been successful in litigating multiple cases involving congenital heart defects in the newborn. In the pursuit of these cases, Nurenberg, Paris, Heller & McCarthy has retained and consulted with some of the nation’s top-ranked neonatologists, pediatric cardiologists, and pediatric electrophysiologists.
If you have any questions about whether a failure to promptly diagnose your child’s congenital heart defect has led to permanent damage in your child, please call us or complete a free initial consultation form.
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