How Are Congenital Heart Defects Treated?

Although many children with congenital heart defects don’t need treatment, some do. Doctors treat congenital heart defects with:

• Procedures using catheters to repair the defect
• Surgery to repair the defect

The treatment your child receives depends on the type and severity of his or her heart defect. Other factors include your child’s age, size, and general health. Treatment can be simple or very complex. Some children with complex congenital heart defects may need several catheter or surgical procedures over a period of years, or may need to take medicines for years.

Procedures Using Catheters

Catheter procedures are much easier than surgery on patients because they involve only a needle puncture in the skin where the catheter is inserted into a vein or an artery. Doctors don’t have to surgically open the chest or operate directly on the heart to repair the defect. This means that recovery can be much easier and quicker.

The use of catheter procedures has grown a lot in the past 20 years. They have become the preferred way to repair many simple heart defects, such as:

• Atrial septal defect. The doctor inserts the catheter through a vein and threads it up into the heart to the septum. The catheter has a tiny umbrella‑like device folded up inside it. When the catheter reaches the septum, the device is pushed out of the catheter and positioned so that it plugs the hole between the atria. The device is secured in place and the catheter is then withdrawn from the body.
• Pulmonary valve stenosis. The doctor inserts the catheter through a vein and threads it into the heart to the pulmonary valve. A tiny balloon at the end of the catheter is quickly inflated to push apart the leaflets, or “doors,” of the valve. The balloon is then deflated and the catheter is withdrawn. Procedures like this can be used to repair any narrowed valve in the heart.

Doctors often use an echocardiogram or a transesophageal (trans-e-SOF-ah-ge-al) echocardiogram (TEE) as well as an angiogram to guide them in threading the catheter and doing the repair. A TEE is a special type of echocardiogram that takes pictures of the back of the heart through the esophagus (the tube leading from the mouth to the stomach). TEE also is often used to define complex heart defects.

Catheter procedures also are sometimes used during surgery to help repair complex defects.

Surgery

A child may need open-heart surgery if his or her heart defect can’t be fixed using a catheter procedure. Sometimes, one surgery can repair the defect completely. If that’s not possible, a child may need more than one surgery over a period of months or years to fix the problem.

Open-heart surgery may be done to:

• Close holes in the heart with stitches or with a patch
• Repair or replace heart valves
• Widen arteries or openings to heart valves
• Repair complex defects, such as problems with where the blood vessels near the heart are located and how they develop

Rarely, babies are born with multiple defects that are too complex to repair. These babies may need a heart transplant. In this procedure, the child’s heart is replaced with a healthy heart from a deceased child that has been donated by that child’s family.