Nathaniel and Lucas Anderson are remarkable Kid Captains featured at Iowa football games this season have undergone treatment for serious heart conditions at University of Iowa Children's Hospital.
Each year thousands of children are born with congenital heart disease, while others may develop acquired heart disease. Dianne Atkins, MD, pediatric cardiologist at UI Children's Hospital, talks about pediatric heart disease:
How common are heart defects and heart disease in children?
Congenital heart disease is the most common of all the birth defects that we deal with. Multiple studies have shown that the incidence is approximately six to nine per 100,000 live births. To make that a little bit easier, that means approximately one in every 1,000 newborns will have congenital heart disease.
What type of heart defect might a child have at birth?
Usually if it's a heart defect, it's an abnormality of the structure of the heart:
- Holes between the various chambers of the heart
- Abnormalities of the valves
- Abnormalities of the vessels that bring blood back to the heart or carry the blood away from the heart to the body.
Some of the most serious defects we deal with are where one or more chambers of the heart did not form completely during gestation.
Are all heart disorders in a newborn considered serious?
About 25 percent are defined as critical, where we have to do something immediately or within the first several weeks to months of life. But many can be diagnosed and watched over a period of time and there are even some that will resolve spontaneously—especially the holes between the upper and lower chambers of the heart.
How are congenital heart defects treated?
It's a variety of things. Probably the most common is surgical repair such as placing patches in the heart or moving blood vessels. We don't like to replace valves, but some times we need to.
In instances when we are dealing with a baby who does not have all four chambers of the heart, we have to do some major rerouting in the operating room to get the blood to the correct place.
Some children we can treat in the catheterization laboratory, so it doesn't require a large surgical incision. We can often open up many valves this way and sometimes even close some holes between the two chambers.
What causes a child to develop heart disease?
There are probably many, many causes and it's not one particular thing in an infant. Often we can't identify a particular cause in a specific infant, but there is very much a genetic component.
If a family has one member with congenital heart disease, it increases the risk of another child having congenital heart disease by about two to three times the overall rate.
There are also some environmental causes. We know that children who are exposed—especially to alcohol, and there's increasing evidence about tobacco—before birth, they will have an increased incidence of heart defects and birth defects in general.
One of the things we do know, but don't understand the mechanism, is that if mothers increase the folate in their diet, both in the several months before conception and the early months of gestation, that will actually reduce their risk of having an infant with congenital heart disease.
Do children have symptoms of heart disease similar to those an adult would have?
Not quite. One of the big things that adults have is chest pain because they are at risk for having a heart attack or a myocardial infarction. Chest pain is a very uncommon cause of heart disease in children. Some children may be totally asymptomatic and it can only be detected by a physical exam. Other children with more serious heart disease can have some problems with exercise for instance. They tire out before their peers, have some shortness of breath, and those kinds of things. But they don't have chest pain.
Are adult heart treatments, like pacemakers or heart catheterization, available treatment options for a child?
Absolutely. In fact, a heart catheterization has been done on children for many, many years and is one of our major tools used to diagnose and now treat children with congenital heart disease.
We put pacemakers in a fair number of children, and the pacemaker technology is such that we can do this even on newborn infants. The youngest baby that I've had with a pacemaker was one day, and the smallest was about three pounds.
What is the long-term impact for a child with a heart condition early in life?
It really depends on the kind of heart condition. For some, it really has very minimal impact on their life expectancy or their activity level. Other children—especially those who require a lot of surgery or who are missing vessels or chambers of their heart—they will require cardiology care for the duration of their life. They many require medication and catheterizations and more than one surgical procedure. But we have made some tremendous strides in the treatment of congenital heart disease over the last half century and many of these children live very, very productive and normal lives now.
What does UI Children's Hospital offer to diagnose and treat heart disease in children that may not be available elsewhere?
We are a full-service institution for the state of Iowa. We offer:
- ECHO
- Cardiac catheterization
- Interventional catheterization--we treat the defects with a catheterization
- Full range of therapies for heart rhythm disorders
- Transplantation
We treat all forms of congenital heart disease and acquired disease at The University of Iowa.
What research are you currently involved in for pediatric heart conditions? How does research benefit patients at UI Children's Hospital?
There's a tremendous amount of research. In the basic science areas, we have several people who are evaluating the development of the heart, especially the conduction system of the heart, evaluating how the physiology of the heart of the fetus and the newborn is different from a child and an adult.
We also have several clinical projects. My area of research is defibrillation and cardiac arrest or how to treat a child in cardiac arrest.
We also have:
- Projects with the new technique of interventional catheterization, about the
- Use of pacemakers and implantable cardioverter defibrillators; and
- New kinds of ECHO or ultrasound procedures.
So there's an immense amount of research going on. |
