Adult Congenital Heart Disease
UT Southwestern’s specialized program helps adults with congenital heart disease live long, healthy lives.
Congenital heart disease refers to any of a variety of structural defects in the heart that are present at birth. Thanks to major advances in surgical treatment, more than 90 percent of infants and children diagnosed with congenital heart disease now survive into adulthood, many of them reaching middle age and beyond.
Most adults with congenital heart disease don’t get the long-term follow-up care that’s recommended. Even when heart defects are surgically repaired during infancy or childhood, patients with congenital heart disease can experience recurring problems or develop complications years later. In addition, patients can be at higher risk for new heart problems as adults.
UT Southwestern’s Adult Congenital Heart Disease Program provides complete diagnostic, treatment, and consultive services for patients age 16 and above with all types of congenital heart disease, including those who are newly diagnosed with congenital heart disease as adults. We offer specialized care that can minimize or prevent complications of congenital heart disease and help patients live longer, healthier lives.
At UT Southwestern, our Adult Congenital Heart Disease Program team includes interventional cardiologists, electrophysiologists, and cardiac surgeons, as well as nurses, physician extenders, and other health professionals, all working together to provide truly comprehensive patient care. Our services are led by pediatric and adult cardiologists specifically accredited in the newly recognized board subspecialty of adult congenital heart disease.
To proactively address any new or recurrent problems that adults with congenital heart disease may experience, UT Southwestern combines the latest surgical techniques with the most sophisticated diagnostic tools to monitor patients’ hearts and optimize their overall well-being over the years. Our adult congenital heart disease services include:
- Cardiac imaging (including echocardiography, cardiac MRI, and multi-slice cardiac CT)
- Catheter-based diagnostic and interventional procedures
- Electrophysiology procedures to treat heart rhythm disorders
- Heart and lung transplant
- Management of pulmonary hypertension
- High-risk obstetrics
- Genetic counseling
- Cardiac rehabilitation
Congenital heart defects – the most common birth defect – include abnormal formation of heart valves, holes in the heart, obstruction of blood flow through the heart chambers and blood vessels, and abnormal formation of blood vessels taking blood to or from the heart.
Simple congenital heart defects have only a single problem in heart formation, such as a single hole in the heart (atrial septal defect or ventricular septal defect) or a malformed valve. Nearly half of patients with congenital heart disease, however, have what is considered to be either moderate or complex forms of congenital heart disease.
These more complicated forms often include multiple malformations of the heart. For example, Tetralogy of Fallot is a moderately complex defect that includes a hole in the heart (VSD), abnormal positioning of the aorta, and obstruction of blood flow out to the lungs (usually with an abnormal heart valve) that results in an inability to circulate an adequate amount of oxygen-rich blood through the body. Highly complex lesions include defects in which there may be only one major pumping chamber or failure of one of the heart valves to form.
Several congenital heart defects are relatively simple to correct, such as atrial septal defect or a blocked valve or a blood vessel. While surgeries to repair these conditions have been successfully performed for decades, newer catheter-based techniques may be used in many cases to correct these “simple” defects without requiring open-heart surgery. Likewise, catheter-based techniques can be helpful in certain patients with moderate or complex defects, including insertion of catheter-based valves.
Significant improvements in surgical techniques have allowed for more complex malformations to be treated and resulted in good survival and quality of life for the majority of patients, including patients who have one pumping chamber instead of two.
Such advances have transformed the lives of many people with congenital heart disease. Each year, about 20,000 young patients now survive into adulthood. However, for about half of these survivors, including those whose heart defects were repaired when they were infants or children, congenital heart disease remains a lifelong condition. Patients can be at elevated risk for arrhythmias, heart failure, stroke, or sudden death. Women who wish to have children may face complications during pregnancy and birth.
That’s why it’s extremely important for people with congenital heart disease to receive ongoing care from pediatric cardiologists throughout childhood, then transition to a skilled adult congenital heart disease clinic as they mature. In addition, adults who have symptoms of heart disease should always receive comprehensive evaluation. A thorough diagnostic workup occasionally reveals a congenital heart defect that was never diagnosed and did not cause problems until adulthood.
Congenital heart defects seem to occur spontaneously during a critical time in pregnancy for reasons not yet understood. Researchers are working to identify genes that control the development of the heart, as well as genetic abnormalities that may predispose a child to develop congenital heart disease. Genetic testing is now available for certain gene defects and may be useful for patients with
specific types of congenital heart disease or for families with a strong history of congenital heart disease.
The risk for congenital heart disease may also increase if a pregnant woman has measles or other viral infections, abuses alcohol, or is exposed to certain chemicals or medications early in her baby’s development. However, a definitive cause for most cases of congenital heart disease has not been established. Most patients are the only ones in their families with the condition.
Some forms of congenital heart disease cause severe symptoms early in life. Babies or children may have difficulty breathing. Due to low oxygen levels in the body caused by the heart’s inability to pump effectively, their bodies may look blue.
However, some signs of congenital heart disease, such as a soft heart murmur, are more subtle. Less severe heart defects may cause only vague, mildly debilitating symptoms in childhood, or no symptoms at all.
Whether diagnosed and treated in childhood or never previously identified, adult congenital heart disease may cause symptoms such as abnormal heart rhythm, shortness of breath, dizziness, fatigue, and edema (swelling of body tissues or joints).
The age at which a person is diagnosed with a congenital heart disorder depends on the defect. “Blue babies” usually receive diagnosis and care while very young. Prenatal imaging technologies such as ultrasound have made it possible to diagnose many infants with congenital heart disease before birth.
People with milder forms of congenital heart disease may not be aware of the condition until it is discovered in adulthood, sometimes in the course of being tested for another medical concern.
No two people with congenital heart disease are the same. That’s why UT Southwestern’s Adult Congenital Heart Disease team uses the most advanced diagnostic technologies to evaluate not only the anatomy of each patient’s heart, but how it is functioning. These tools may include:
- Echocardiogram – a noninvasive imaging technique that uses sound waves to reveal the structure of the heart and evaluate its pumping capacity
- Electrocardiogram (ECG or EKG) – a test that records the heart’s activity
- Exercise stress test – measures the heart’s function during physical exertion
- Cardiac MRI or CAT scan – visualizes the heart valves and arteries
- Heart catheterization – a minimally invasive procedure that can help assess damage and open blockages, without the need for surgery
Different types of congenital heart disease can cause different complications in adulthood, even if they were surgically repaired decades earlier. For example, certain congenital heart defects will cause heart valves to leak over time, necessitating a valve replacement. People born with a narrowing of the aorta may be especially vulnerable to the dangers of coronary artery disease.
Other complications of adult congenital heart disease include heart rhythm problems, which may require an electrophysiology procedure to correct. Even patients with uncomplicated ventricular septal defects that were addressed surgically decades ago are at increased risk for heart infections, pulmonary hypertension, rhythm problems, heart failure, and stroke.
Because of this, treatment depends on the exact type of congenital heart disease and the complications it may be causing in each individual patient. Our patients have direct access to the vast resources of UT Southwestern, including therapies ranging from medical management to multi-organ transplant.
We work with you and your family to develop treatment plans that are precisely tailored to your heart condition, stage of life, accompanying health issues, and treatment goals.
The nurses, cardiac rehabilitation specialists, psychotherapists, and social workers of UT Southwestern’s Adult Congenital Heart Disease Program provide intensive support, guidance, and education to help patients cope effectively with the long-term emotional and practical aspects of life with congenital heart disease.
Although heart defects are not passed from mother to child, adult women with congenital heart disease who wish to have children require close, specialized medical attention to ensure a safe pregnancy and delivery. Through comprehensive evaluation, consultations with specialists in electrophysiology and maternal-fetal medicine, and regular monitoring during pregnancy and childbirth, UT Southwestern’s multidisciplinary care helps many women with adult congenital heart disease become healthy mothers of healthy infants.
Heart and Lung Clinic
Professional Office Building 2
5959 Harry Hines Blvd.
6th Floor, Suite 600
Dallas, Texas 75390-9253
Medical Center at Park Cities
8611 Hillcrest Road
Dallas, Texas 75225
Medical Center at Richardson/Plano
3030 Waterview Parkway
Richardson, Texas 75080