Congenital Heart Disease (Children)
The NYU Approach to Congenital Heart Disease
Diagnosing & Evaluating Congenital Heart Disease
Treating Congenital Heart Disease
Congenital Heart Disease (Adults)
Our Congenital Heart Disease Specialists
Patient Stories
Congenital Heart Disease (Children)
A congenital heart defect is a heart abnormality that is present at birth. These abnormalities range from holes in the heart to malformed heart valves to narrowed, reversed, or missing blood vessels. Heart defects are the most common form of birth defect in the U.S., affecting one out of every 120 newborns. In all, there are more than two dozen types of heart defects. The most common ones are atrial and ventricular septal defects (holes in the walls separating the chambers of the heart).
The causes of heart defects are not well understood. Some cardiac abnormalities can be traced to genetic defects or to environmental factors, such as exposures to certain medications or industrial chemicals, uncontrolled diabetes, or alcohol or drug abuse during pregnancy. In most cases, the specific cause is not known.
Many heart defects are mild, and some do not produce symptoms until later in life, if at all. However, a number of heart abnormalities significantly affect how blood flows to the lungs and the rest of the body, producing severe symptoms at birth or during early childhood. Left untreated, these defects can retard growth and development, limit one’s ability to exercise, or cause difficulties with breathing or eating. Other, potentially fatal complications include blood clots (increasing the risk of stroke), arrhythmias, infections of the heart and its valves, and heart failure.
Fortunately, the prospects for a newborn diagnosed with a serious heart defect are not as grim as they may seem. In the right hands, most of these defects can be treated effectively with medical therapy, catheter-based interventions, or surgery. Thanks to treatment breakthroughs in recent decades, 90 percent of children today born with heart defects can expect to survive into adulthood and beyond.
The NYU Approach to Congenital Heart DiseaseAt NYU, we bring a team approach to the care of children with congenital heart disease, involving specialists in pediatric cardiology, pediatric cardiac surgery, and pediatric critical care.
We recognize that the prospect of heart surgery and a stay in the hospital may seem frightening, especially to young children, which is why we make every effort to provide a warm, caring, and comfortable environment for patients and families alike. Our children’s floors are bright and cheerful, and they are staffed by some of the nation’s finest pediatricians and pediatric nurses.
Fortunately, most children treated at NYU find that the hospital experience is not as scary as they had anticipated. In most instances, children are admitted the morning of surgery. After leaving the O.R., children are immediately brought back to the pediatrics unit — and back to their parents. Since nothing promotes healing like a loving mother or father, we invite parents to remain with their children as much as possible during their hospital stay.
We use minimally invasive surgical approaches whenever feasible, allowing for hospital stays as short as one or two days. In more complex cases, the stay may be longer, though usually not more than a week. However short or long the child’s stay, our staff pays special attention to pain management as well as to rehabilitation, which is particularly important for children who were debilitated before surgery.
Diagnosing & Evaluating Congenital Heart DiseaseCongenital heart defects are being diagnosed earlier and earlier, thanks to continuing improvements in imaging technology. In fact, it is now possible to detect many heart defects before birth, using a noninvasive test called fetal echocardiography, a type of ultrasound. Early diagnosis allows physicians to monitor malformations during pregnancy and facilitates prenatal care and early intervention.
Typically, the first indication of a heart defect appears after birth, in the form of a heart murmur (an abnormal sound made by turbulent blood flow) or of a sign and symptom such as shortness of breath or and cyanosis (a bluish tint to the skin or lips).
When a patient’s history or physical exam suggests the possibility of cardiac disease, the physician will first order an echocardiogram. This test usually provides all the necessary information for diagnosis and treatment. In selected cases, however, MRI or CT scans, as well as a diagnostic catheterization procedure, might be needed.
Treating Congenital Heart DiseaseOur goal in treating children with congenital heart disease is to use the least invasive therapy that offers the highest chance for success. Treatment decisions are made on a case-by-case basis, in collaboration with our colleagues in pediatrics and pediatric cardiology. As part of a world-class academic medical center, we are able to offer patients the full range of therapies and the latest technologies, including some treatments not available at other institutions.
Therapies for congenital heart disease vary widely, depending on the type and severity of the abnormality. Medical therapy and watchful waiting may be all that is required for certain conditions, such as small- or medium-sized septal defects, which often close or reduce in relative size as the child ages.
Because of technological advances, some serious heart defects can now be treated in the cardiac catheterization laboratory, rather than in the operating room. Certain septal defects (holes in the heart), for example, can be repaired with a tiny umbrella-like device, which is put into place with a catheter (a long, slender tube) that is inserted into an artery and then threaded into the heart. Once the device is correctly positioned, the “umbrella” is opened, sealing off the unwanted hole. Other catheter-based interventions employed at NYU include coil occlusion of patent ductus arteriosus, stenting and balloon dilation of obstructed pulmonary and venous pathways, and radiofrequency ablation of arrhythmias.
Patients who are not candidates for these less-invasive procedures will require surgical treatment. Fortunately, many abnormalities can be corrected with a single operation performed in early infancy. Complex abnormalities may require a series of operations, starting in the first months of life and ending at about age three.
In general, surgery for congenital heart disease in children is performed using a traditional incision through the breast bone. Open-heart surgery has been highly refined over the years, with great extreme reliability and safety even in very small babies.
Whenever possible, we use minimally invasive surgical techniques, similar to those that have been used for years in adult cardiac surgery. These techniques, many of which were pioneered here at NYU, avoid the traditional splitting of the breastbone characteristic of open-heart surgery. Instead, the operation is performed through a much smaller incision between the ribs, resulting in far less postoperative pain and a dramatically shorter recovery — with the same overall success rates as traditional approaches. Often, children can return to school and play within a week.
The vast majority of children with heart defects, even those with complex abnormalities, will spend most of the time at home under their parents’ care, requiring only periodic visits to the pediatrician and pediatric cardiologist.
Congenital Heart Disease (Adults)Congenital heart disease is not limited to infants and children. An estimated one million adults in America are living with heart defects. Most of these people have few physical limitations or symptoms. However, more and more of adults with heart defects are requiring medical attention, either for newly diagnosed conditions or for abnormalities that were treated years ago but are causing new problems.
Ironically, the growing incidence of adult congenital heart disease is due to progress in cardiology and cardiac surgery. Only a generation or two ago, doctors could do little to help newborns with serious heart defects, and few survived past childhood. That began to change in the 1960s, with advances in diagnosis, medical therapy, open-heart surgery, and critical care, allowing more and more these children to live well into adulthood. Many of this first wave of survivors, now in their thirties and forties, are beginning to experience problems related to their original heart defects or to their surgical repairs (over time, tissue grafts wear out, surgically constructed openings grow too large, or re-routed blood vessels calcify and harden or develop dangerous bulges, to cite a few examples).
Few hospitals are equipped to handle adults with serious congenital heart disease, however. Typically, these conditions are complex, involving several parts of the heart or its vessels. It’s not uncommon for adults with congenital heart disease to have undergone three, four, or five operations, drastically altering the heart’s anatomy. Repairing these hearts is rarely straightforward. Each case is different, requiring a surgeon not only with experience in handling oft-repaired hearts, but also with the skills needed to improvise surgical solutions.
NYU’s cardiac surgeons have extensive experience with these operations.
Our Congenital Heart Disease Specialists