My next memorable story:-
One morning at the end of surgery I was asked to phone a mum about her 9 month baby Ella. I pride myself in knowing the young children in the practise but on this occasion I could not recall having seen Ella. When I phoned, even after talking to the mum I still could not think who we were discussing even after asking mum directly. Mum’s main worry was that Ella was constipated and all she wanted was something to ease the problem. With a combination of not knowing the baby and the fact she was under 12months I was not happy to prescribe anything over the telephone so I asked the mum to bring her to the surgery.
After about half an hour mum arrived carrying Ella. Mum was a short slim lady, hence I would not have expected to see a large baby but this baby was pale and small and certainly not at all wholesome. Infact I was instantly concerned. When a baby is not thriving it can be for absolutely any reason and it was imperative that the infant was examined thoroughly. It was not long before I discovered the reason. Ella had a loud machinery heart murmur diagnostic of an atrial septal defect (hole in the heart) and was in heart failure with a very fast heart rate and poor breath sounds. There was no time to waste but before doing anything I had to break the news to mum. Like many Mothers she took the news very well and was almost relieved to think she was not being an over anxious mum, but when she asked dad to come to the surgery he was devastated. Meanwhile, I had telephoned the paediatricians to arrange an urgent referral. Ella was seen promptly but it was evident this baby needed specialist care and she was eventually referred to Great Ormond Street after stabilising her heart failure. Ella went on to have open heart surgery and made an excellent recovery. The memory of this came back a couple of weeks ago when she ran upstairs ahead of mother for her routine immunisation full of chat about school and thrilled to let me see her scar and listen to her heart and share her story with the medical student.
Congenital heart disease is caused when something disrupts the normal development of the heart. As a baby develops during pregnancy, there are normally several openings in the wall dividing the upper chambers of the heart (atria). These usually close during pregnancy or shortly after birth. In this case it was a failure of a hole in the wall between the two upper chambers of the heart to close.
It’s thought most cases of congenital heart disease occur when something affects the heart’s development during about week five of pregnancy. This is when the heart is developing from a simple tube-like structure into a shape more like a fully developed heart.
While some things are known to increase the risk of congenital heart disease, no obvious cause is identified in most cases.
To learn more about congenital heart disease the following link is useful:-