Adult Congenital Heart Disease

Overview

Congenital is a word meaning a “birth defect”. Babies born with birth defects of the heart are reaching adulthood in record numbers. While some patients are first diagnosed with simple birth defects as adults, many others, with more complex cardiac abnormalities, have undergone surgical and catheter-based interventions as children but continue to require specialized care as adults. Cardiac catheterization is an important tool not only in the evaluation of these patients, but it also presents numerous options for treatment, previously the exclusive domain of the cardiac surgeons.

The most common types of congenital heart disease diagnosed for the first time in adults include holes in the walls separating the right and left sides of the heart, heart valves which are abnormal and not working properly, and narrowing of blood vessels which may interfere with the normal flow of blood. Patients who have undergone previous surgery will often require revisions of previous repairs, including repair/replacement of valves, or artificial tubes placed by the surgeons to bypass congenital obstructions in the normal pathways exiting the heart.

Symptoms of Adult Congenital Heart Disease

Many patients with simple congenital heart disease will be completely free of symptoms as children and young adults. As they age, issues can develop. The signs of congenital heart disease are varied, but most often involve shortness of breath during exertion/exercise and heart palpitations or other rhythm changes. Neurologic symptoms, such as stroke or migraine headache, can also be related to an undiagnosed congenital heart defect. Low oxygen levels in the blood, from abnormal flows through holes in the heart can also be seen. Non-surgical repairs are available for many of this simpler heart defects, and are discussed below.

Selected Treatments for Adult Congenital Heart Disease

Atrial Septal Defect (ASD) / Patent Foramen Ovale (PFO)

Both ASD and PFO are holes in the wall (the septum) which separates the top two chambers of the heart. Through a tube introduced in the vein of the leg, a self-expanding patch, resembling two small umbrellas connected to one another may be used to close the defect in a 30-minute ambulatory procedure. This procedure has replaced open heart surgery for many patients.

Pulmonary Valve Replacement

In many patients with prior surgery, the pulmonary valve placed at the time of surgery can wear out over time, becoming either obstructed (not opening well) or insufficient (leaking). Rather than doing open-heart surgery to replace the valve again, a new valve can be implanted through a catheter, with minimal discomfort and a 1 day hospital stay.

Coarctation of the Aorta

Coarctation of the Aorta is a narrowing of the major cardiac artery (aorta) which carries the blood from the heart, to the entire body to supply oxygen and other nutrients. As an alternative to surgical repair, some patients with coarctation of the aorta may be candidates for a cardiac catheterization procedure involving the placement of a device called a stent, a thin expandable metal tube to expand the narrowed area and keep it open.

Other Common Congenital Interventions

• Balloon/stent dilation of other narrowed vessels including the major cardiac veins returning blood to the heart
• Creation of holes in the heart to improve heart performance
• Closure of other birth defects including ventricular septal defect (VSD), patent ductus arteriosus (PDA) and abnormal connections between arteries and veins in the lungs or in the coronary arteries

For more information regarding the diagnosis and treatment of adult congenital heart disease or to make an appointment with a congenital physician, please call 212-305-7060.

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