Medforum: Congenital heart defects often result from inhibited or abnormal development of the cardiovascular system in the early fetal period. What are the most common factors causing heart defects?

Dr Lesław Szydłowski, M.D.: It is impossible to state unequivocally what the causative factors of heart defects are, although in some it has been possible to demonstrate genetic factors. This can be evidenced, for example, by the so-called 'familial' occurrence of some congenital defects. Atrial septal defects - one of the most common congenital heart defects - are an example. Another factor known to cause congenital heart defects is when the pregnant woman suffers from serious viral infections especially during the first trimester of pregnancy. As I mentioned, viral infections, especially with the influenza virus or rubella, are particularly dangerous.

Medforum: Some of the symptoms of congenital heart defect in the newborn and infant may be difficult to notice because of their course without cyanosis. What additional symptoms are present in children with heart defects?

Dr Lesław Szydłowski, M.D.: There are different symptoms in neonates and infants and in older children. In the youngest children, persistent dyspnoea, lack of weight gain, appetite disorders and even such a non-specific symptom as increased irritability of the child are very dangerous symptoms of congenital heart disease. In infants and older children, sweating occurs, especially during mealtimes, as well as frequent upper respiratory infections. Of course, the most important clinical sign is the appearance of a heart murmur. It becomes more difficult to recognise a heart defect when there is no murmur and the symptoms of a heart defect can be similar to those of respiratory disease.

Medforum: What tests are used to diagnose heart defects in children?

Dr Lesław Szydłowski, M.D.: The basic examination is a very thorough history taking followed by a thorough physical examination of the child. When a defect is suspected, a number of specialised examinations are performed, one of the most important of which is echocardiography. This is a non-invasive method and therefore safe for the baby. However, a basic condition must be met: it must be performed by a very experienced doctor.

Medforum: In what cases is the decision to perform surgery taken after a heart defect has been diagnosed?

Dr Lesław Szydłowski, M.D.: The performance of surgery depends on the type of heart defect diagnosed. It should be strongly emphasised that not every defect requires treatment in the neonatal period, although current trends are such that congenital heart defects should be treated as early as possible.

Medforum: What should be the follow-up care after heart surgery?

Lesław Szydłowski, MD: It is believed that surgical treatment should result in the so-called complete cure of the defect. Unfortunately, in many cases of so-called complex heart defects, surgical treatment is multi-stage and performed at intervals of several or even several months. Therefore, each such case must be treated individually and there is no ready-made universal prescription for further postoperative management.