Pediatric cardiology aims to provide comprehensive care and treatment for children diagnosed with heart conditions and congenital defects. Pediatric cardiology also deals with diagnosing and treating fetuses in the womb. Children can be born with heart defects (congenital heart problems) where the heart does not work properly due to problems associated with the valves of the heart or the blood vessels surrounding the heart. Many children with heart defects may not have complications that require surgery and can live a high-quality life with mild or self-correcting defects. However, some complex defects require surgical interventions.

Symptoms associated with congenital heart problems

There may be no early symptoms associated with some heart defects. These problems are usually diagnosed only during a routine physical examination or check up, which is why routine check-ups for your child are vital. Some heart problems may have obvious symptoms that appear in early childhood/infancy, like:

• Bluish skin tone (cyanosis)
• Fatigue and tiredness
• Swelling around the eyes or in the abdomen and legs
• Shortness of breath during feedings, that leads to poor weight gain
• Rapid heartbeat

Major congenital heart conditions in children

There are numerous types of congenital heart defects that affect children worldwide; here are a few common ones:

1. Altered heart or blood vessel connections: Some defects develop due to altered connections in the heart that complicate blood flow to and from the heart. Holes in the walls between heart chambers are a common type of congenital heart defect. Common defects include atrial septal defect, ventricular septal defect and patent ductus arteriosus.
2. ‍Congenital heart valve problems: Heart valve problems include valves that are narrowed and do not open completely (stenosis) or valves that do not close completely (regurgitation).
3. ‍Complex heart rhythm problems: An arrhythmia can occur as a result of internal factors, such as a disease of the heart muscle itself or congenital heart disease. Supraventricular tachycardia (SVT) is an irregularly fast or erratic heartbeat (arrhythmia) that affects the heart's upper chambers. Long QT syndrome (LQTS) is a heart-signaling disorder that can cause fast, chaotic heartbeats (arrhythmias). Some children are born with altered DNA that causes long QT syndrome.

Causes of congenital heart conditions in kids

In many cases of congenital heart conditions in children, the underlying cause is unknown. Sometimes, causes may be:

• A viral infection in the mother
• Genetic
• A result of alcohol or drug use by the mother during pregnancy
• Triggered by certain medication use

Tests to diagnose congenital heart defects

• Pulse oximetry: A sensor placed on the fingertip records the amount of oxygen in the blood. Too little oxygen can signal a heart or lung problem.
• Electrocardiogram (ECG): This test records the electrical activity of the heart, helping in diagnosis of irregular heart rhythms (arrhythmias).
• Echocardiogram: An echocardiogram uses sound waves to create images of the heart in motion. It shows how blood moves through the heart and heart valves. An echocardiogram done on a baby before birth, it's called a fetal echocardiogram.
• Chest X-ray: A chest X-ray shows the condition of the heart and lungs. It can show if the heart is enlarged, or if the lungs contain extra blood or other fluid.
• Cardiac catheterization: In this test, a thin, flexible tube (catheter) is inserted into a blood vessel and guided to the heart. Catheterization can provide detailed information on blood flow and how the heart works.
• Heart magnetic resonance imaging (MRI): A heart MRI may be done to diagnose and evaluate congenital heart defects in adolescents and adults.

Treatment of cardiac conditions in children

Pediatric cardiologists inform parents of the child of the best treatment available to them, depending on the particular heart problem. Some mild defects can be managed through medication and with regular heart health monitoring and do not require surgery.

Medications can include:

• Blood pressure medications
• Diuretics or water pills: These help reduce the amount of fluid in the body, reducing strain on the child’s heart.
• Anti-arrhythmics (heart rhythm medications): These medications help control an irregular heartbeat.

Surgery or other procedures

If your child has a severe congenital heart defect, a heart procedure or surgery may be recommended. Some notable procedures are:  

• Cardiac catheterization: Some congenital heart defects can be repaired using thin, flexible tubes (catheters), which are inserted into a blood vessel (usually in the groin) and guided to the heart. Cardiac catheterization may be used to fix holes in the heart or areas of narrowing.
• Heart surgery: A child may need open-heart surgery or minimally invasive heart surgery to repair a congenital heart defect. The type of heart surgery depends on the specific defect.
• Heart transplant: If a serious heart defect cannot be treated surgically, a heart transplant may be needed.

Some children with congenital heart defects need many surgical or other medical procedures and surgeries throughout life. After congenital heart defect surgery, a child will need regular check-ups by his/her pediatric cardiologist.

Prevention of congenital heart problems

If you have heart problems in the family or other risk factors that increase the risk of your child being born with a heart condition, then you should opt for genetic testing and screening during the pregnancy itself. The following steps can help you, as parents, to reduce the risk for your child:

Good prenatal care: Regular checkups during the pregnancy can help spot early or hidden symptoms of heart disease that can allow early intervention.

Quit smoking and moderate drinking: Smoking and excess drinking can put the health (heart and otherwise) of a baby at a high risk. Secondhand smoke is also dangerous.

Get appropriate vaccines: Rubella (German measles) can affect a baby’s heart development. It is important to get vaccinated against rubella before getting pregnant. Ensure that you, as parents, are up to date with all necessary vaccines.

Get good quality nutrition: Taking around 400mg of folic acid has been linked to reduced birth defects in the brain and spinal cord and may help with heart health as well. Ensure that pregnant mothers get quality nutrition.

Manage chronic health conditions: If you have diabetes as an expecting mother, you should make sure that your blood sugar is well controlled, as high blood sugar can cause congenital heart defects.

Consult your doctor before taking any medications: Some medications can increase the risk of birth defects in babies. Talk to your doctor before taking any non-prescribed medications, and do not fail to inform your obstetrician or your child’s pediatrician about any medication that you are taking during pregnancy.

Pediatric Cardiology Department at Dr. Soliman Fakeeh Hospital, Jeddah provides family centered care, which prioritizes collaboration and communication between parents and the child’s medical team. The hospital has a multi-disciplinary approach that brings together a team of experts in pediatric cardiac surgery - heart rhythm specialists (electrophysiologists), anesthesiologists, nurses, therapists and other medical professionals, to help diagnose and treat your child’s specific condition.