Skin appears to be blue. The degree of blueness depends upon the narrowing - if it is mild the blueness may be hardly noticeable.Blue colouration is common in babies and young children. It is usually confined to the area around the mouth ("muzzle area") and the hands and feet. The colour change usually occurs for no apparent reason and the child is completely well. The technical term for these colour changes is acrocyanosis. It is probably caused by local variation in blood flow through the skin - as oxygen is extracted from the blood by the tissues it changes to a blue colour. It is of no consequence and usually goes away as the child gets older.Blue colour (cyanosis) can be a sign of heart disease - it occurs in some conditions babies are born with, in this case, Tetralogy of Fallot.In children over the age of 6 months mild swelling of the ends of the fingers can be seen called clubbing. This goes away when the cause is treated. Sudden changes of colour can occur in Tetralogy of Fallot and should be taken very seriouslyBlue colour can of course occur in many conditions including breathing problems when it is a medical emergency.These children have a heart murmur as the blood makes a noise as it passes through the narrowing.
People with DiGeorge Syndrome are usually rather small and may be slow developers. They may have a speech impediment and feeding difficulties. Some also have an immune deficiency and infections, vaccinations and blood transfusions can cause problems.People with DiGeorge Syndrome may suffer from heart problems; including Tetralogy of Fallot, pulmonary atresia - VSD, truncus arteriosus and sometimes simpler lesions like a ventricular septal defect. These are usually treatable with surgery.Half of all children with Down syndrome have a heart problem. These include patent ductus arteriosus, atrial septal defect, ventricular septal defect, tetralogy of Fallot and atrioventricular septal defects. Some of these may not require surgery as some may close by themselves (patent ductus arteriosus, atrial septal defect, ventricular septal defect). Tetralogy of Fallot and atrioventricular septal defects always require surgery and sometimes more than one operation is necessary.
Tetralogy of Fallot has been known about for centuries. M. Fallot described 4 features - hence the name.Only two are important - the narrowed artery and the Ventricular Septal Defect (VSD) (hole in heart).The more narrow the artery the easier blood returning from the body finds it to pass across the VSD and straight into the body artery (Ao) without going through the lungs.These patients do not have enough oxygen in their blood and thus are blue.The degree of blueness depends upon the narrowing - if it is mild the blueness may be hardly noticeable.These children have a heart murmur as the blood makes a noise as it passes through the narrowing.In the most severe form of the condition the valve is not narrowed but completely blocked. This is called Pulmonary Atresia - VSD.
Rastelli Procedure is carried out. In the Rastelli Procedure, the hole inside the heart (VSD) is closed and the pulmonary artery connected to the heart by a homograft (cadaver valve).It is most commonly used in Tetralogy of Fallot and Pulmonary Atresia-VSD but is also used in Truncus Arteriosus. In the animation on the right the operation is undertaken on Pulmonary Atresia-VSD and first the shunt needs to be removed before the hole is repaired and the homograft inserted.The homograft wears out eventually and so requires replacement
Small babies - especially those with hole in the heart have an increased food requirement and may need special milk.
Children and adults with congenital heart disease are at an increased risk of having a heart infection. Whilst this is rare the chances of it occurring can be reduced by taking precautions.Infections in the heart can occur for no apparent reason but are more common if the teeth are rotten - germs spread into the blood stream and infect the heart. Good dental hygiene is therefore important as are regular visits to the dentist.If dental treatment is required then some procedures can cause germs to spill into the blood and infect the heart.It is therefore important that the dentist is informed about the heart condition before treatment. The usual method of avoiding this problem is to give a single dose of antibiotics one hour prior to the treatment to kill any germs beforehand.
Children who have tetralogy of Fallot (if there are still residual problems) are restricted to light exercise (like golf, cricket).Exercise is important even in those with heart disease. It improves the heart function and general sense of well being. It is associated with increased life expectancy and a reduced risk of heart disease in later life. In addition physical activity helps with controlling weight and reducing blood pressure.There are different types of exercise. In static exercise the muscles contract but there is little joint movement eg weight lifting. In dynamic exercise the muscles contract and also move the joints eg running. Each places a different stress on the body and cardiovascular system. In general most types of sports are a mix of the two.Children usually take part in more rigorous exercise at school as they grow older. In Singapore physical education (PE) tends to teach games skills rather than competitive sports. However pupils may take sport for their co-curricular activities (CCA) when training is more intense and competitive. Training for the NAPFA test is also intensive and some pupils with heart problems may have difficulty with the 2.4k run as they often perform less well at endurance type activities.As always parents or patients must seek the advice of their own doctor when deciding how much exercise and to what level is safe - particularly as there are no published guidelines for activity levels in children.The Bottom Line
Most children with heart disease can have all the normal vaccinations at the appropriate time.However some children with an immune deficiency (DiGeorge syndrome or an isomerism) and those who are receiving immunosuppression - for example following transplantation require a different vaccination schedule.
Before travelling anywhere unusual or a long distance make sure that you:
Those with cyanotic heart disease ("blue" due to reduced oxygen in the blood) can still travel but aircraft at altitude have less oxygen in the air than at ground level and so the blueness may be more apparent. This does not usually cause symptoms but if necessary airlines can arrange for additional oxygen to be available on the aircraft.For long aircraft flights it is sensible to use the support stockings and take aspirin or an equivalent unless your doctor advises against it.
Special diets are not normally necessary for those with heart disease. As with everyone it is important to have a balanced diet and not to eat to excess. It is however important to maintain a normal weight - excess weight means more work for the heart.
Most children with heart disease are no more prone to infections than any other children. Some however are likely to get chest infections - particularly those with holes in the heart (ASD, VSD, PDA).In addition some heart diseases are also associated with an immune deficiency and infections therefore are more common. The majority of childhood infections are viruses and get better without antibiotics. In any case of doubt professional medical help should be sort and the doctor will decide if antibiotics are necessary.
Most children with heart disease do not require medication. Some however need them to:
The majority of these medicine have been used for many years and are very safe but like all drugs side effects may occur - especially if there is another illness or a change in other medication. If unusual symptoms or side-effects occur whilst on medication it is important to inform the doctor immediately.
Most women with heart disease are able to undergo a normal pregnancy and delivery.The exceptions are those with severe cyanosis when there is usually insufficient oxygen in the blood supply to the placenta to sustain the baby. Most of these pregnancies spontaneously abort.Women with pulmonary hypertension (high lung artery pressure) are not usually advised to get pregnant as there is a serious danger to their life.As with any medical problem it is essential that medical advise is taken - preferably before the event so that the pregnancy can be monitored and if treatment is necessary it can be undertaken early.If a women herself has a heart problem then there is an increased risk that her child will have a problem too. The risk is around 6%. If a man has a heart problem then the risk is 2%. If the couple have had a previously affected child then the risk is about 2%. The risks quoted above are averages - the actual risk varies considerably between the various heart conditions. There is also some evidence that taking vitamins for 3 months prior to and the first 3 months of the pregnancy can reduce the chance of heart disease occurring in the baby.