Post by Daniella on May 26, 2006 10:31:04 GMT
Heart problems
About one in three children born with Down’s syndrome has a heart defect. Some heart defects are quite minor, such as heart murmurs; some defects are severe, requiring medication and/or surgery.
Your baby’s heart will be one of the things that a paediatrician will check at her first neonatal examination, and, if there is any doubt about a heart defect being present, then further tests will be made to make sure everything is as it should be. However, heart defects are not always picked up by these tests when a baby is very small so your paediatrician will continue to make regular checks in the first year or so for any signs of a defect. If you are ever worried about anything - ask your doctor! (For a detailed explanation of the more common heart defects that can affect babies with Down’s syndrome, please see Appendix I).
If you are told that your baby has a heart defect, and you would like to talk to someone whose child has a similar problem or has heart surgery, the Down's Syndrome Association can put you in touch with parents who will understand what you are going through.
Congenital heart defects
The normal heart is divided in to four chambers. Blueish blood, low in oxygen, reaches the heart through veins and enters the right collecting chamber - the right atrium. Blood them flows into the right pumping chamber the right ventricle through the tricuspid valve.
The right ventricle pumps the blood through the pulmonary artery to the lungs where the blood receives oxygen. After the blood is oxygenated, it is bright red. This blood returns to the heart through the left collecting chamber - the left ventricle. From there it is pumped into a large blood vessel called the aorta which feeds it into smaller blood vessels which carry it around the body to supply essential oxygen to the tissues. When the oxygen has been removed the blood becomes blue again and returns to the right side of the heart.
Usually it is a heart murmur that first alerts a doctor to the possibility of congenital heart defect. However, not all children have a murmur so various other clues such as colour (pale, grey, blue), respiratory rate and effort, contours of the chest swelling of the eyelids are all looked at. On X-ray and enlarged heart and congested lungs might indicate a congenital heart defect.
A electrocardiogram (using high-frequency sound waves) helps provide additional information which may indicate the need for a cardiac catheterisation. This procedure requires a stay in hospital and can define precisely the extent and the location of the defect.
It is common for a congenital heart defect to give rise to a delay in growth and weight gain, and in children with Down’s syndrome there is often also decreased muscle tone and motor delay (i.e. they are delayed in learning skills such as crawling, standing, walking etc.). These symptoms usually improve after surgical correction of the heart defect.
The most common heart defects among children with Down’s syndrome are:
Atrio Ventricular (Septal) Defects (AV(S)D)These involve a malformation of the walls and the valves between the atria and the ventricles. The condition amounts to a ‘hole in the centre of the heart, which can gravely affect the direction and the pressure of the blood flow and impose a strain on the heart and lungs. Nowadays this can often be corrected by major heart surgery in infancy, but for a few babies this operation is not medically advisable.
Ventricular Septal Defects (VSD)
These defects involve an opening in the septum or wall, which separates the two ventricles. If a small opening exists, this will not cause strain on the heart and, in some cases, the opening may close itself. For large defects surgical correction may be necessary - again this is usually carried out in the first years of life.
Tetralogy of Fallot
This is a combination of four defects:
1. A large hole between the two ventricles (ventricular septal defect);
2. A narrowing in or near the pulmonary valve;
3. An unusually muscular right ventricle
4. The aorta receives blood from both the right and left ventricles.
This condition results in cyanosis or blueness of the lips and fingernails. Total correction is difficult in infants but an operation can be carried out to provide temporary relief.
Persistent Ductus Arteriosus (PDA)
All children are born with a ductus arteriosus - an opening between the pulmonary artery and the aorta. Normally, the passageway closes up within a few weeks of birth. When this fails to happen, some of the blood that should go through the aorta and on to the body is sent back to the lungs and the heart so imposing extra strain on the heart. If this occurs the duct can be closed by a simple operation, which does not involve operating on the heart, itself.
Atrial Septal Defect (ASD)
These are holes in the wall, which separates the two atria. They are often quite small. If large enough to allow a significant amount of blood to flow through they may need to be close by a surgical operation. So-called secundum defects (openings in the upper part of the atrial septum) often close on their own. Ostium primum defects (openings in the lower part of the atrial septum) are very near the valves and often need surgery.
About one in three children born with Down’s syndrome has a heart defect. Some heart defects are quite minor, such as heart murmurs; some defects are severe, requiring medication and/or surgery.
Your baby’s heart will be one of the things that a paediatrician will check at her first neonatal examination, and, if there is any doubt about a heart defect being present, then further tests will be made to make sure everything is as it should be. However, heart defects are not always picked up by these tests when a baby is very small so your paediatrician will continue to make regular checks in the first year or so for any signs of a defect. If you are ever worried about anything - ask your doctor! (For a detailed explanation of the more common heart defects that can affect babies with Down’s syndrome, please see Appendix I).
If you are told that your baby has a heart defect, and you would like to talk to someone whose child has a similar problem or has heart surgery, the Down's Syndrome Association can put you in touch with parents who will understand what you are going through.
Congenital heart defects
The normal heart is divided in to four chambers. Blueish blood, low in oxygen, reaches the heart through veins and enters the right collecting chamber - the right atrium. Blood them flows into the right pumping chamber the right ventricle through the tricuspid valve.
The right ventricle pumps the blood through the pulmonary artery to the lungs where the blood receives oxygen. After the blood is oxygenated, it is bright red. This blood returns to the heart through the left collecting chamber - the left ventricle. From there it is pumped into a large blood vessel called the aorta which feeds it into smaller blood vessels which carry it around the body to supply essential oxygen to the tissues. When the oxygen has been removed the blood becomes blue again and returns to the right side of the heart.
Usually it is a heart murmur that first alerts a doctor to the possibility of congenital heart defect. However, not all children have a murmur so various other clues such as colour (pale, grey, blue), respiratory rate and effort, contours of the chest swelling of the eyelids are all looked at. On X-ray and enlarged heart and congested lungs might indicate a congenital heart defect.
A electrocardiogram (using high-frequency sound waves) helps provide additional information which may indicate the need for a cardiac catheterisation. This procedure requires a stay in hospital and can define precisely the extent and the location of the defect.
It is common for a congenital heart defect to give rise to a delay in growth and weight gain, and in children with Down’s syndrome there is often also decreased muscle tone and motor delay (i.e. they are delayed in learning skills such as crawling, standing, walking etc.). These symptoms usually improve after surgical correction of the heart defect.
The most common heart defects among children with Down’s syndrome are:
Atrio Ventricular (Septal) Defects (AV(S)D)These involve a malformation of the walls and the valves between the atria and the ventricles. The condition amounts to a ‘hole in the centre of the heart, which can gravely affect the direction and the pressure of the blood flow and impose a strain on the heart and lungs. Nowadays this can often be corrected by major heart surgery in infancy, but for a few babies this operation is not medically advisable.
Ventricular Septal Defects (VSD)
These defects involve an opening in the septum or wall, which separates the two ventricles. If a small opening exists, this will not cause strain on the heart and, in some cases, the opening may close itself. For large defects surgical correction may be necessary - again this is usually carried out in the first years of life.
Tetralogy of Fallot
This is a combination of four defects:
1. A large hole between the two ventricles (ventricular septal defect);
2. A narrowing in or near the pulmonary valve;
3. An unusually muscular right ventricle
4. The aorta receives blood from both the right and left ventricles.
This condition results in cyanosis or blueness of the lips and fingernails. Total correction is difficult in infants but an operation can be carried out to provide temporary relief.
Persistent Ductus Arteriosus (PDA)
All children are born with a ductus arteriosus - an opening between the pulmonary artery and the aorta. Normally, the passageway closes up within a few weeks of birth. When this fails to happen, some of the blood that should go through the aorta and on to the body is sent back to the lungs and the heart so imposing extra strain on the heart. If this occurs the duct can be closed by a simple operation, which does not involve operating on the heart, itself.
Atrial Septal Defect (ASD)
These are holes in the wall, which separates the two atria. They are often quite small. If large enough to allow a significant amount of blood to flow through they may need to be close by a surgical operation. So-called secundum defects (openings in the upper part of the atrial septum) often close on their own. Ostium primum defects (openings in the lower part of the atrial septum) are very near the valves and often need surgery.