Kevin Mulhern,* MD
Division of Cardiovascular Diseases
University of Iowa Hospitals and Clinics
*Currently Private Practice, Kansas City, KS
First Published: March 2000
Last Revised: January 2004
Peer Review Status: Internally Peer Reviewed
What exactly is congenital heart disease? Isn't it a condition you are born
That is correct. The word congenital means born with, and this is different
than the more common heart diseases that people acquire sometime after birth
either from infection, coronary artery disease, trauma, and other problems.
Does congenital heart disease last a lifetime?
Yes, it does. The congenital heart problem is always there although it can
often be made much better as a result of surgery or treatment with a catheter-based therapy. Many children born with heart problems live to be active, normally
functioning adults, and there are some heart conditions that people are born
with that are so well tolerated that sometimes they are not even discovered
until the person is a young adult or even elderly.
What are the treatment options for congenital heart disease for a child
and an adult?
That depends on the problem. Sometimes the treatment is nothing. Nothing needs
to be done. Sometimes the treatment is surgery. Sometimes this requires more
than one operation. Newer treatments have become available in recent years and
can be done without surgery. For example, some holes in the heart can be closed
with special devices placed while the patient is under local anesthesia using x-rays to guide the
placement. For example, placing a coil to plug the vessel without doing surgery
can close some abnormal blood vessels.
Is there a cause of congenital heart disease?
There is no single cause of congenital heart disease. Some conditions are inherited;
others result from a combination of factors probably including inheritance and
environment. The Rubella epidemic during the 1960s caused a large number of
congenital heart problems. Research is trying to learn the causes and work to
prevent the problems.
Is it possible for patients born with heart disease who watch their diet
and exercise to not develop heart disease that has to be controlled by medication
A healthy lifestyle is important for everyone. People with congenital heart
disease will not prevent problems with their congenital heart disease simply
by dieting and exercising. It will preserve their overall health. This is important
because people with congenital heart problems are also prone to the same problems
as people born without heart defects, such as hypertension and coronary artery
You mentioned children born of mothers who had rubella during pregnancy
has me wondering what happens to that child if it is female when she herself
becomes pregnant and already has stress on her heart from her disease?
Pregnancy and congenital heart disease is an important topic. How well a woman
and the fetus do during pregnancy depends upon the type of heart problem. Any
woman who has a heart problem and is planning pregnancy or has become pregnant
should see her doctor. Many women with congenital heart disease are able to
become pregnant and carry the pregnancy to term, delivering normal babies. For
other women, there are risks involved with pregnancy.
I had 5 bypass surgery. How long is it good for?
Bypass surgery is done for coronary artery disease, which is not a congenital
heart problem. Internal mammary artery grafts tend to stay open for a long time.
More than 90 percent are still open 10 years after surgery. Vein grafts from
the legs tend to close down as the years pass. It is impossible to predict how
long they will stay open. A healthy lifestyle helps keep them open. You should
not smoke, and should eat a low fat diet, exercise regularly, and take aspirin
if your doctor recommends it.
Can pregnancy be life threatening to a woman with congenital heart disease?
Yes, it can. There are some conditions that historically carry a higher risk
of complications and even death during pregnancy or after delivery. Again, it
is very important for any woman with a heart problem to speak to her doctor
before pregnancy or when she first learns that she is pregnant.
What happens if congenital heart disease goes untreated?
Some congenital heart defects cause no problems without treatment. Examples
are very small holes in the muscles that divide the two pumping chambers. Other
heart defects can cause high pressure in the lung, which cannot be reversed
with medication or surgery. Other problems can cause weakening of the pump function
of the heart, such as leaky valves.
If the congenital heart disease is severe enough, does a patient graduate
to the heart failure clinic and possible heart transplant list?
Some severe congenital heart defects can be repaired with one or more operations.
Others cannot. Heart transplantation or heart/lung transplantation are sometimes
needed even after a successful repair of the heart performed during childhood.
What role does high blood pressure play in congenital heart disease?
High blood pressure does not cause congenital heart disease. People are born
with congenital heart disease. High blood pressure carries the same risks in
these patients that it does in other patients. It increases the thickness of
the left ventricle and can cause reduced function. It increases the risk of
heart attack and stroke.
What has happened to the lungs in congenital heart disease that requires
a heart/lung transplant?
Some conditions cause high blood pressure in the lungs and permanent changes
in the walls of the lung blood vessels. These changes would not improve after
heart transplantation. The transplanted heart would fail. The lungs must be
transplanted with the heart.
Can a child with this disease expect to live a normal healthy life as an
That depends on the particular type of heart defect and how fully it can be
repaired. It may also depend on how early the problem is repaired. Surgery has
been performed on children with congenital heart problems since the 1940s and
is improving all the time. Despite all that modern medicine has to offer, many
problems cannot be fully corrected. Some adults with congenital heart problems
are limited with their heart problem.
Can you go into adulthood without realizing that you have a congenital heart
Yes. Many problems are discovered in old age or never discovered at all. It
is not uncommon for some atrial septal defects, which are holes between the
two receiving chambers of the heart, to be detected in young adults. This does
not necessarily cause a problem for these people. Sometimes the problem is not
easily repaired. Often it can be repaired once discovered.
I am 31 years old and have mitral heart value prolapse. I am so tired all
the time. Could this be because of the prolapse? How do you know when it is
right to request another echocardiogram? Am I in any danger?
Mitral valve prolapse is not a congenital heart problem. It is a heritable
heart problem. It can cause problems with the heart rhythm. It can also lead
to leaky heart valves. This can cause problems with the heart. Many symptoms
attributed to mitral valve prolapse in the past have been found to be due to
something else. There is no absolute recommendation as to how often to do echocardiograms.
This should be decided by you and your doctor based upon your history and physical
Can a person who has a heart murmur feel any symptoms?
The heart murmur itself is simply a sound that blood flow makes in the heart.
Symptoms would depend on the cause of the murmur. Some murmurs are normal innocent
murmurs in normal hearts. Others indicate a narrowed valve, a leaky valve or
a hole in the heart.
I have a child that went through the Fontan procedure (three years ago). He is 7 now.
He is doing great. Do adults have success with a Fontan?
I am pleased to learn that your child is doing well. The Fontan procedure has
been a great operation for children with some complex heart problems. There are a number of adults
who are now living with a Fontan circulation. We are learning more about long-term
function and care all the time. The short answer to your question is that there
are adults living successfully after the Fontan procedure and living well.
If there are no further questions I will ask Dr. Mulhern for a closing statement...
Congenital heart disease is not as common as high blood pressure, coronary
artery disease, or some of the other problems discussed today. It does affect
1 percent of all newborns, sometimes in a very mild form. Many of these children
are surviving to adulthood and living satisfying, productive lives. Regular
follow up is necessary for most adults born with heart problems.