Congenital heart disease in children: what signs, what tests and when is intervention needed?

What are we talking about?

Congenital heart defects are among the most frequent malformations at birth. They include very different abnormalities:

• abnormal openings between the chambers of the heart, such as a ventricular or atrial septal defect;
• a ductus arteriosus that has stayed open after birth;
• narrowing of valves or vessels;
• complex malformations, such as tetralogy of Fallot or transposition of the great arteries.

Some cause too much blood to flow to the lungs, others a lack of oxygen in the blood, which gives the skin and lips a bluish colour called cyanosis.

What signs should raise concern?

In infants, signs are often linked to feeding: the baby tires while feeding, becomes breathless, sweats, stops frequently and gains weight poorly. Repeated chest infections, fast breathing at rest, a bluish colour of the lips or nails, or fainting episodes call for a consultation. In older children, breathlessness on exertion, unusual tiredness or growth delay may reveal heart disease that has gone unrecognised. A murmur heard by the doctor is not always a sign of a malformation, but it often justifies an echocardiogram.

Very blue lips, very laboured breathing, or a child who stops feeding or becomes drowsy require emergency care.

How is the diagnosis made?

Echocardiography shows the anatomy of the heart, how the valves and chambers work and the direction of blood flow. It is often enough to make the diagnosis and propose treatment. Measuring oxygen saturation at the finger, the electrocardiogram and a chest X-ray complete the assessment. For some complex malformations, CT, MRI or cardiac catheterisation is needed. Some heart defects can be detected before birth, during a pregnancy ultrasound.

Why the timing of intervention matters

When a malformation sends too much blood to the lungs, the lung vessels are gradually damaged. Beyond a certain stage, this pulmonary hypertension can become irreversible and rule out repair. Other malformations, in newborns, do not allow enough oxygenation and require a procedure within the first few days. Conversely, some small openings close spontaneously and only need monitoring. Only a paediatric cardiology team can say, from the echocardiogram, whether intervention is urgent, can be planned or is unnecessary.

What treatments?

Medicines

They relieve the child and help them gain weight while waiting for an intervention, or treat heart failure. They do not repair the malformation.

Interventional catheterisation

Some abnormalities can be treated without opening the chest, using a catheter inserted into a blood vessel in the groin: closure of an atrial septal defect or a ductus arteriosus with a device, or widening of a narrowed valve. The indication depends on the size and location of the abnormality and the child’s weight.

Heart surgery

More complex malformations require surgery, usually open-heart surgery with cardiopulmonary bypass. The child is then monitored in intensive care, then on a ward. Some malformations require several successive operations during childhood.

Care in Morocco is checked case by case

Whether a given congenital heart defect can be treated depends on the precise diagnosis, the child’s age and weight, the urgency and the team available. This is checked from the file, before any travel: the echocardiogram, recorded on video if possible, and a detailed report are the most useful documents.

Follow-up: a lifelong matter

Even after a successful repair, regular cardiology follow-up is recommended, often into adulthood and beyond. Good dental hygiene, up-to-date vaccinations and, for some malformations, prevention of endocarditis during dental care are among the protective measures. Parents receive a report setting out the anatomy, the procedure performed and the schedule of check-ups.

Frequently asked questions