Treatment can vary with age and type of disease. A treatable cause, such as a rhythm problem, may require specific medications or procedures. In babies with ventricular septal defects, medical therapy can be used as a temporary solution to allow the hole to get smaller or close on its own, or to give the baby a little time to grow prior to heart surgery.
In more complex problems such as aortopulmonary window, truncus arteriosus, or hypoplastic left heart syndrome, when it is known that surgery will be needed, it is currently the practice in most centers to perform surgery in the first weeks of life.
Some congenital heart disease cannot undergo surgery and a heart transplant is the only option. In older children with weak heart muscles, medication can help decrease the workload of the heart to give it time to heal, though some of these children will also eventually require transplants.
Treatment can also include devices, such as ventricular assist devices (VADs) or the SynCardia Total Artificial Heart. These devices can help stabilize and support patients while they wait for a donor heart to become available for transplantation (bridge-to-transplant therapy), or to support patients who are not eligible for transplant (destination therapy). Destination therapy may be an alternative to heart transplant for some patients.
There are several types of medications used to treat congestive heart failure.
- A diuretic like furosemide (Lasix), which helps the kidneys to eliminate extra fluid in the lungs, is often the first medicine given both in babies and older children.
- Sometimes medicines to lower the blood pressure like an ACE inhibitor (Captopril), or more recently, beta blockers (Propranolol) are used. Theoretically, lowering the blood pressure will decrease the workload of the heart by decreasing the amount of pressure against which it has to pump.
- Sometimes a medication called Digoxin is used to help make the heart squeeze better, and help pump blood more efficiently. Since weight gain is a major challenge for infants with congestive heart failure, giving babies high calorie formula or fortified breast milk can help give the extra nutrition they require.
Sometimes babies will need to have extra nutrition given to them via a tube that goes directly from the nose to the stomach, a nasogastric feeding tube. This is good for babies who work hard or get very tired from feeding in order to prevent them from using up all the extra calories needed for growth.
Older children with significant heart failure can also benefit from nasogastric feeding to give them more calories and energy to do their usual activities.
Oxygen can worsen blood flow to the lungs in babies with large ventricular septal defects but may be helpful as a buffer to children with weak hearts.
Some kids with cardiomyopathy may also need restriction of certain kinds of exercise and competitive sports, although they may benefit from light activity like swimming.