Why do so many adults suffer from congenital heart disease? Is there a cure?

Author: Huang Lianjun, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

Congenital heart disease is caused by developmental disorders or abnormalities during the fetal period and is present at birth.

The most common simple malformations include atrial septal defect, ventricular septal defect, and patent ductus arteriosus, while the most common complex malformation is tetralogy of Fallot.

Figure 1 Original copyright image, no permission to reprint

1. Why do so many adults in our country have congenital heart disease?

The first is that medical conditions were poor in the past, and many people did not undergo serious examinations and did not know that they had congenital heart disease. They only discovered it when they reached a certain age and had a physical examination. This is the case for a large number of people.

There are also some people who find out that they have congenital heart disease, but because there are no symptoms, they do not seek treatment. Only when they reach a certain age and experience symptoms such as palpitations and shortness of breath, do they come to the hospital for treatment.

The third type is some people who know they have congenital heart disease but are afraid of treatment and keep putting it off until they can no longer put it off and come for treatment.

Therefore, there are many patients with congenital heart disease among adults in my country. With the improvement of medical standards, the country's emphasis on health, and the management of the healthy population, the number of adult patients with congenital heart disease will gradually decrease.

In particular, the emerging interventional therapy, also known as interventional radiology, in recent years has greatly improved the treatment of congenital heart disease, making very complex operations simpler and more effective.

2. What is interventional treatment for congenital heart disease?

Interventional therapy has been developed in recent years. It uses imaging technologies, such as X-ray technology, digital subtraction technology, ultrasound, CT, magnetic resonance imaging, etc., and some instruments, such as guide wires and catheters, through the normal natural channels of the human body or minimally invasive channels to implant certain instruments into the human body, or use certain instruments to achieve the purpose of treating diseases. This is interventional therapy.

Many congenital heart diseases can be treated with interventional treatments. For example, atrial septal defect, ventricular septal defect and patent ductus arteriosus can be treated by implanting specific equipment to repair the hole, which is called occlusion. Valvular heart disease, such as pulmonary artery stenosis and aortic valve stenosis, can be treated by dilating the valve with a balloon, which is called balloon angioplasty. If the valve is damaged and needs to be replaced, a new valve can be implanted, which is called interventional valve implantation. Abnormal orifices, such as coronary artery fistula and pulmonary arteriovenous fistula, can be treated with embolic materials, the most commonly used of which is a spring steel coil, which is released to the site of embolism to embolize it, which is called embolization. Complex congenital heart disease can be treated in collaboration with surgery, where interventional treatment methods can be used to embolize abnormal arterial malformations, while surgery can be used to correct new malformations, thus achieving twice the result with half the effort, making complex operations simple and greatly improving the success rate.

Figure 2 Original copyright image, no permission to reprint

Interventional treatment for adult congenital heart disease can be done under local anesthesia in most cases, because the trauma is minimal. It is done by puncturing the femoral artery or vein, just like a needle. A local anesthetic is injected and the catheter is inserted. You will feel a little pain, but it is not too painful and is completely tolerable. If the operation is too complicated, general anesthesia may be required.

3. Is it better to treat congenital heart disease as early as possible?

For many diseases, most people think that the earlier the treatment, the better. However, some diseases have no symptoms at the beginning and do not need treatment.

For example, the common bicuspid aortic valve deformity is that the normal aortic valve has three leaflets, but many people are born with two leaflets. Most of them are asymptomatic until the age of 20 or 30, but after the age of 30 or 40, calcification will gradually appear, and aortic valve stenosis will occur, especially moderate to severe stenosis, which can lead to cardiac hypertrophy, heart failure, and angina pectoris. Treatment is needed at this time.

For example, a small atrial septal defect, an atrial septal defect less than 10 mm, has no symptoms at first. As age increases, it can lead to enlargement of the right heart and symptoms such as palpitations and shortness of breath, which require treatment.

For example, patent foramen ovale does not require treatment in most cases. However, if there is a headache, a special ultrasound examination called the bubble test is performed. If there is a right-to-left shunt, it is highly suspected that the migraine is related to patent foramen ovale. In this case, treatment may be required.

Or if symptoms of cerebral embolism appear at a young age and it is suspected to be related to patent foramen ovale, treatment is needed.

Some congenital heart diseases, such as ventricular septal defect, require interventional treatment. Children under two years old may not be suitable for interventional treatment. First, the blood vessels are relatively thin, and second, the heart is not yet fully developed. For example, for aortic coarctation, the most effective treatment is interventional treatment and stent implantation. The child must develop to a certain degree, such as over seven years old, so that the implanted stent will be effective for life. If the child is too young, the blood vessels are too thin, and the stent is not easy to implant. In addition, the blood vessels are not fully developed, and restenosis may occur with age.