Normally, blood returns from the body and flows through the heart and lungs.
Blood that is low in oxygen (blue blood) returns from the body to the right side of the heart.
The right side of the heart then pumps the blood to the lungs, where it picks up more oxygen and becomes red.
The oxygen-rich blood returns from the lungs to the left side of the heart. From there, it is pumped to the rest of the body.
Heart defects that children are born with can change the way blood flows through the heart and lungs and cause non-oxygenated blood to be pumped out to the body without going through the lungs to pick up oxygen. As a result:
The blood that is pumped out to the body is lower in oxygen.
Less oxygen delivered to the body can make the skin look blue (cyanosis)
Many of these heart defects involve the heart valves. Heart valves are found between the heart and the large blood vessels that bring blood to and from the heart. These valves open up enough for blood to flow through. Then they close, keeping blood from flowing backward.
Heart valve defects that can cause cyanosis include:
Tricuspid valve (the valve between the two chambers on the right side of the heart) may be absent or unable to open wide enough.
Poorly controlled blood sugar levels in women who have diabetes during pregnancy
Medications prescribed by your doctor or bought on your own and used during pregnancy
Street drugs used during pregnancy
Some heart defects cause major problems right after birth.
The main symptom is cyanosis. This is a bluish color of the lips, fingers, and toes that is caused by the low oxygen content in the blood. It may occur while the child is resting or only when the child is active.
Some children have breathing problems (dyspnea). They may get into a squatting position after physical activity to relieve breathlessness.
Others have spells, in which their bodies are suddenly starved of oxygen. During these spells, symptoms may include:
Breathing too quickly (hyperventilation)
Sudden increase in bluish color to the skin
Infants may get tired or sweat while feeding and may not gain as much weight as they should.
Fainting (syncope) and chest pain may occur.
Other symptoms depend on the type of cyanotic heart disease, and may include:
Feeding problems or reduced appetite, leading to poor growth
Some infants may need to stay in the hospital after birth so they can receive oxygen or be put on a breathing machine. They may receive medicines to:
Get rid of extra fluids
Help the heart pump harder
Keep certain blood vessels open
Treat abnormal heartbeats or rhythms
The treatment of choice for most congenital heart diseases is surgery to repair the defect. There are many types of surgery, depending on the kind of birth defect. Surgery may be needed soon after birth, or it may be delayed for months or even years.
Your child may need to take water pills (diuretics) and other heart medicines before or after surgery. Be sure to follow the correct dosage. Regular follow-up with the doctor is important.
Many children who have had heart surgery must take antibiotics before, and sometimes after having any dental work or other medical procedures. Make sure you have clear instructions from your child's heart doctor.
Ask your child's doctor before getting any immunizations. Most children can follow the recommended guidelines for childhood vaccinations.
Women who are pregnant should get good prenatal care.
Avoid using alcohol and drugs during pregnancy.
Tell your doctor that you are pregnant before taking any prescribed medications.
Get a blood test early in the pregnancy to see if you are immune to rubella. If you are not immune, you must avoid any exposure to rubella and should get immunized right after delivery.
Pregnant women with diabetes should try to get good control over their blood sugar levels.
Some inherited factors may play a role in congenital heart disease. Many family members may be affected. If you are planning to get pregnant, talk to your health care provider about screening for genetic diseases.
Bernstein D. Cyanotic congenital heart disease: Evaluation of the critically ill neonate with cyanosis and respiratory distress. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 423.
Kurt R. Schumacher, MD, Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.