If a child's lips or tongue turn blue, or the child breathes rapidly and struggles to gain weight during feeding, it may be a sign of pediatric heart disease.
Pediatric heart disease is broadly divided into congenital and acquired heart disease. Congenital heart disease occurs when the heart's structure fails to form normally as the fetus develops in the mother's womb. Acquired heart disease occurs when a problem develops in the heart after birth due to viral infection or inflammation. If a child continues to appear lethargic and complains of chest pain or palpitations even after a fever has subsided following a cold or flu, "pediatric myocarditis," an inflammation of the heart muscle, should also be suspected.
"In children, congenital heart disease, in which the heart structure is abnormal from birth, is the most common," Director Jung Hyun explained. "It is known to occur in about 1% of newborns."
On "Now, the Master Doctor," airing on Seoul Economic Daily TV at 9:25 p.m. on the 18th, Dr. Jung Hyun, Director of Pediatrics at Bucheon Sejong Hospital, discusses the types of pediatric heart disease, its main symptoms, and treatment methods.
◇ 'Ventricular Septal Defect,' the Most Common Congenital Heart Disease
A representative congenital heart disease is ventricular septal defect. The heart is divided into the left and right ventricles, and this condition refers to a hole in the septum, the wall between the two ventricles. Other conditions include atrial septal defect, in which a hole forms between the left and right atria, and atrioventricular septal defect, in which the septum between the atria and ventricles fails to form properly.
There are also cyanotic heart diseases in which oxygen becomes insufficient. A representative condition is "tetralogy of Fallot." It is a condition in which four structural abnormalities appear together: a ventricular septal defect, narrowing of the passage to the pulmonary artery, misplacement of the aorta, and right ventricular hypertrophy.
Congenital heart disease is presumed to result from a combination of genetic factors and the intrauterine environment in which the fetus grows. However, in many cases it is difficult to clearly explain by a single cause.
"Just because a child has congenital heart disease does not mean it is the mother's or father's fault," Director Jung said. "As treatment techniques and critical care have advanced, many children grow up normally if treated at the appropriate time."
Newborns with congenital heart disease may show blue coloring on the lips or the tips of the hands and feet. In particular, if not only the lips but also the tongue or the mucous membranes inside the mouth turn blue, there is a possibility of hypoxia, so the child should receive medical care immediately.
They may also breathe rapidly or sweat all over the body during feeding. "Feeding is considerable exercise for an infant, so if heart function is reduced, the child may gasp for breath just from nursing, as if they had run 100 meters," Director Jung said. "If they cannot feed properly, weight will not increase and the growth curve may drop."
◇ Do Not Miss the Treatment Window... Surgery Considered From 2 Months of Age
The timing of treatment for congenital heart disease varies depending on the type of condition, the size of the hole, and the burden it places on the heart and pulmonary blood vessels. Large ventricular septal defects can cause respiratory difficulty or feeding problems from about one month of age, and surgery is generally considered from two to three months of age.
If the treatment window is missed, the pulmonary blood vessels can be damaged irreversibly, making surgery itself difficult. In Korea, large ventricular septal defects that burden the heart and lungs are generally treated before the first birthday. Tetralogy of Fallot is sometimes operated on at around three to six months of age depending on the patient's condition.
On the other hand, not all heart holes are subject to surgery. Small atrial septal defects in newborns often close naturally as the child grows. "Atrial septal defects smaller than 3 mm mostly close on their own, and even those around 3 to 8 mm can, in a significant number of cases, close by 18 months of age," Director Jung explained.
◇ Catheter Procedures Rising as an Alternative to Open-Chest Surgery
Treatment of congenital heart disease is broadly divided into surgery and interventional procedures. Surgery is performed by opening the chest, temporarily stopping the heart, and using a heart-lung machine to take over heart function. Holes inside the heart are closed by patching them with the patient's own pericardium or a medical patch.
An interventional procedure is a method of treatment without opening the chest, in which a thin catheter is inserted through a blood vessel in the groin up to the heart. It can be used to place an occlusion device to close a hole inside the heart, or to widen narrowed valves and blood vessels with a balloon. If necessary, a stent or an artificial valve may also be inserted.
◇ If Lethargy Persists After a Cold, Suspect Pediatric Myocarditis
Among acquired pediatric heart diseases, one condition to watch for is pediatric myocarditis. Myocarditis is a disease in which inflammation develops in the heart muscle. Although rare, occurring in about 1 to 2 children per 100,000, it can become life-threatening if it progresses severely.
The main cause is viral infection. It initially begins with common cold or gastroenteritis symptoms such as fever, cough, vomiting, and diarrhea, making it difficult to distinguish. In some cases, the illness passes as a mild episode, and the person is unaware that myocarditis has even developed. However, if heart function declines, chest pain, palpitations, respiratory difficulty, and severe fatigue and general weakness may appear. In severe cases, it can lead to arrhythmia or cardiac arrest.
"With a common viral infection, the fever often subsides and the child's condition improves after three to five days," Director Jung said. "If symptoms do not improve even after the infection, and the child becomes increasingly lethargic, cannot eat well, or complains of chest pain or palpitations, myocarditis should be suspected."
For infants who have difficulty expressing symptoms, parents should watch for reduced feeding compared to usual, excessive lethargy or fussiness, and shortness of breath. If myocarditis is suspected, the condition can suddenly worsen, so it is safer to be hospitalized at a large hospital for observation.
Treatment of pediatric myocarditis varies depending on the degree of decline in heart function. If symptoms are mild and heart function is normal, the course is monitored with blood tests and echocardiography while using antipyretic analgesics. If heart function has declined, heart failure treatment and anti-inflammatory treatment can be carried out in the intensive care unit.
Meanwhile, many caregivers worry about whether a child treated for congenital heart disease or myocarditis will grow normally and be able to attend school and exercise. However, as treatment techniques have advanced, a significant number of children can live much like their peers. There is no need to restrict exercise, and it can be done at an appropriate intensity in consultation with the attending physician.
"Treating a child's heart disease is not something that ends with a single operation, but a matter of watching over the child's growth together," Director Jung said. "Rather than parents feeling guilty, what is needed is to communicate closely with the medical team and help the child grow up healthy alongside their peers."
A hole in a newborn's heart? The golden hour for pediatric heart disease [Dr. Jung Hyun, Director of Pediatrics, Bucheon Sejong Hospital]
