Description

Pediatric Cardiology

Overview

Frequently asked questions about department and answers:

Can children have heart diseases like adults?

On the contrary to the popular belief, heart disease is not specific for adults.
Children can also have heart diseases. Most of them are congenital heart
diseases. Children may also have acquired heart diseases following certain
conditions such as acute rheumatic fever or Kawasaki disease, although more
rarely.

What is congenital heart disease?

Development of fetal heart is completed in the first three months of intrauterine period.
The potential problems that may emerge in this period may hinder normal
development of heart, cause holes between cardiac chambers, stenoses and
failures in vessels or valves. Sometimes, more complex disorders can be seen in
formation of cardiac chambers and vascular communications. These diseases that
develop secondary to abnormal growth of heart in intrauterine life and persist
at the birth are called CONGENITAL HEART DISEASES. Most of these diseases show
symptoms within two years after birth. Sometimes, even if the disease is
congenital in nature, they can manifest symptoms in the following years.

What are the causes of heart diseases in children?

There are many factors in development of congenital heart diseases; however, the
underlying cause can be clearly identified in only 10% of them. In addition to
genetic disorders, there are also environmental factors that can adversely
affect development of the heart in intrauterine period. Acknowledged environmental
risks include diabetes mellitus or rheumatoid diseases in mother, infection
(e.g. rubella) and use of drug in pregnancy. While genetic disorders can be
inherited among family members, they can also be seen only in the baby due to
advanced age of mother in pregnancy

Are heart diseases common in children?

Almost one out of every one hundred newborn infants is at risk for a congenital heart
disease. This risk can alter depending on various genetic and environmental
factors. For example, if there is congenital heart disease in more than one
member of a family and the diseased members are closely related (for example,
if the sibling or a parent has disease), risk of recurrence is higher than 1%
in this family. However, coronary heart disease in adult members of family does
not pose risk regarding congenital heart diseases.

What are symptoms of a heart disease in a child?

Although all congenital heart diseases are present at birth, symptoms can emerge in
different periods depending on type and severity of disease. Most of them show
symptoms during infancy. Rapid breathing, shortness of breath, difficulty and
getting tired during breastfeeding, inability to gain weight, cyanosis around
mouth, in tongue and nails, and pulmonary infection at frequent intervals can
be signs of congenital heart disease. These sings are not necessarily seen at
the same time. If a part of these signs can be recognized by parents, they are
mostly noted by pediatrician who supervises the baby. For some babies, a heart
disease is investigated due to murmur heard by the doctor before recognition of
the signs. For elder children, the findings can be fainting, chest pain,
palpitation, and poor exercise capacity comparing to the peers.

What is murmur?

Closing sound of valves can be clearly heard in the auscultation of heart. A different
sound, somewhat like whooshing in heart, is called murmur. Severe murmurs can
be a sign of heart disease; however, not all murmurs caused by a heart disease
in children. Most of the mild murmurs are called INNOCENT MURMUR and they can
be heard in a healthy heart. Sometimes, whether the murmur is innocent or not
cannot be decided through auscultation and other examinations can be needed,
such as echocardiography.

Which methods are used for diagnosis of heart disease?

For children, accurate diagnosis and timely treatment are critical and life-saving
in heart diseases. Echocardiography is the most frequently used diagnostic
modality.

ECHOCARDIOGRAPHY (ECHO): This
method is used to evaluate structure and functions of heart using ultrasound
waves. The mode of operation is similar to other ultrasound devices; it does
not emit radiation. Patients are evaluated and regularly followed up with
echocardiography before and after surgery in Pediatric Cardiology. Echocardiography
is also used to provide the surgical team with detailed information in surgery
and cardiologist during invasive catheterization procedures. Called
transesophageal echocardiography, this procedure is performed by inserting the
probe into esophagus under anesthesia. Fetal echocardiography means cardiac
evaluation of babies in case of high-risk pregnancy. Thanks to this method,
congenital heart diseases can be investigated in fetus through an intrauterine
examination starting from 19 to 20 weeks of the pregnancy.

CHEST X-RAY: This
method gives broad information regarding the underlying heart disease by
imaging size and shape of the heart and pulmonary vessels.

STRESS TEST: This
test can be used to compare the exercise capacity of the patient with children
at the same age for investigating onset of complaints during exercise,
evaluating some rhythm disorders, and examining congenital heart diseases
before and after surgery.

HOLTER TEST: The simplest method for determining the changes in heart rhythm is
electrocardiography. If these short-term rhythm data is not diagnostic and
longer recordings are necessary, ECG parameters are continuously recorded for
24 hours by HOLTER devices without need to hospitalize patients and restrict
daily activities.

CARDIAC CATHETERIZATION / ANGIOGRAPHY (ANGIO): This diagnostic modality is
employed for patients who are planned to undergo surgery, when echocardiography
does not provide sufficient information. On the other hand, congenital heart
diseases are non-surgically treated in a catheterization session. It is an
option for all children and even for neonates.

What kind of treatments is used for children with congenital heart diseases?

Most of the congenital heart diseases are surgically treated. Some of the patients
may die unless the condition is managed early. In addition, some small holes in
heart close spontaneously, while some of them can be followed up without
surgery as they are too small, although they do not close spontaneously. Some
congenital heart diseases can be treated with catheterization. Stenoses in
valves and vessels can be dilated with balloon during catheterization (balloon
angioplasty), while certain holes in heart can also be closed with catheter.
Every disease requires a different approach. The method and timing of follow-up
and treatment should be decided by pediatric cardiologist who follows up the
child. In addition to echocardiography, catheter angiography is also performed
for most of the patients who will undergo a surgery. The findings are discussed
in the council of pediatric cardiology and cardiovascular surgery departments
and a council decision is made. Council decisions aim to determine the type and
time of the surgery.

Can heart diseases of children recover spontaneously?

Some congenital heart diseases can recover spontaneously. Those are small holes
between atria or ventricles. However, these patients should be regularly
followed up by pediatric cardiologist during closure of these holes.

Is there a certain age limit for treatment?

Most of the congenital heart diseases are surgically treated. There is a different
timing for every disease. On the contrary to popular belief, heart surgery can
be performed for children at any age. There is no certain age or body weight
limit. An urgent surgery in neonatal period saves life in some heart diseases.
On the other hand, a longer waiting period may be necessary due to potential of
spontaneous closure of holes. These patients should also visit pediatric
cardiologist for follow-up examinations at regular intervals. Patients who do
not present for follow-up visit regularly may lose their chance for surgery as
they wait too long.