Young Hearts Africa
Young Hearts Africa

What is congenital heart disease (CHD)?

What is congenital heart disease (CHD)?


From the minute a woman falls pregnant until the baby is born, the parents spend their time worrying about their baby and its health.


The mother will change many things such as her diet, her exercise routine and her sleeping pattern. She will avoid alcohol and certain medications, whilst starting others, predominantly vitamins and other supplements in order to ensure the baby’s optimal development.  Regular visits to the doctor are undertaken and other antenatal classes are enrolled in. In short, in an ideal world, every conceivable step is taken to ensure the health of both the mother and the baby.


Unfortunately, though, even with all a mother does in order to keep her unborn baby safe, some medical conditions cannot be prevented. (One must also remember that thorough antenatal care is a luxury only a handful of mothers in poorer countries have access to.)


Children who are born with congenital heart disease (CHD), have defects in the structure of their heart. These defects happen very early in pregnancy while the heart is being formed.


Congenital heart disease is the most common of all birth defect and occurs in about 1 in 100 babies. There are many different types of heart defects, the most common being a “hole in the heart”. This colloquialism refers to a defect in the septum between the left and right chambers within the heart. Other defects affect the blood vessels to and from the heart, or the coronary arteries. The heart valves between the chambers may also be affected in that the valves may leak blood or be too narrow to allow the natural flow of blood. In the most severe cases, one of the valves or heart chambers may fail to develop completely.


At what point does congenital heart disease occur?


A baby’s heart starts to develop at conception and development is usually complete by 12 weeks into the pregnancy. Congenital heart defects happen during these important first 12 weeks of the baby’s development. Specific steps must take place for the heart to form correctly. Often, congenital heart defects are a result of one of these steps not happening at the right time. For example, a hole is left where a dividing wall should have formed, or a single blood vessel is left, where 2 should have been.

What causes congenital heart disease?


Most congenital heart defects have no known cause. Mothers will often wonder if something they did during the pregnancy caused the heart problem. In most cases, no specific cause can be found. Some heart problems occur more often in families and genetic links to some heart defects have been identified. Heart defects also often occur along with a spectrum of other congenital abnormalities. The most common association is with Down Syndrome.  Factors affecting maternal health during pregnancy have also been identified, most notably the use of alcohol or certain medications.


Congenital heart problems range from simple to complex. Some heart problems can be watched by the baby’s doctor and managed conservatively. Others will require surgery, sometimes as soon as in the first few days after birth. Other babies will have a combination of defects and require several operations throughout their lives.


In many poor countries, people do not have access to medical facilities and when they do, they cannot afford doctors’ visits and check-ups that are needed. Often in these cases, children who have CHD go undetected as a result of them not having the luxury of getting the medical tests that they need.

South Africa has been steadily falling behind internationally accepted levels of care for children with congenital and acquired heart disease. A significant number of South African children die from conditions that can be successfully managed only at specialised centres.


More than 10 000 children are born annually in South Africa with a heart condition. In addition, a significant number acquire rheumatic valvular heart disease during childhood due to the lack of effective primary medical care.


Less than 25% of children in South Africa with CHD who rely on the public health services receive the care they need. More than 3 000 children die annually or remain disabled from their congenital heart condition.


Congenital Heart Disease (CHD) Symptoms 


Symptoms of CHD will differ depending on the heart defect and the child’s age. Many congenital heart defects can be detected in a baby before birth, allowing doctors to plan for the care of a new born after delivery. In other cases, doctors will note symptoms in a baby after birth, including:

  • difficulty breathing
  • abnormally low oxygen levels
  • abnormal colour of the skin, fingernails or lips
  • difficulty with feeding including breathing fast, fatigue with feeds, or not gaining weight
  • abnormal heart rates or rhythms
  • abnormal sounds of the heart (murmurs)

Other children will not have any symptoms at birth and may develop these symptoms later in life, or a congenital heart condition may be diagnosed by a cardiologist based on other symptoms.

Survival of children with CHD


Survival of infants with CHDs depends on how severe the defect is, when it is diagnosed, and how it is treated. Approximately 75% of babies born with a critical CHD are expected to survive to one year of age.


In contrast, about 95% of babies born with a non-critical CHD are expected to survive to 18 years of age, but only with the requisite specialist medical care. If not, this figure decreases dramatically to a tragically low level.