A coarctation of the aorta is defined as a narrowing of the aorta, which is the main blood vessel that carries blood from the heart to the rest of the body. This type of heart defect is one of the more common ones, as it represents approximately 5% of all congenital heart malformations (with congenital heart defects occurring in approximately 0.8 to 1.2 out of 100 newborns, it still is relatively rare in the overall scheme of things).

Heart murmurs in children are very common. A heart murmur just means a sound. Some heart murmurs are sounds produced by actual defects or abnormalities with the heart. For example, a ventricular septal defect (a hole in the wall separating the lower 2 chambers of the heart) makes a very specific noise as blood travels through the hole. Abnormalities with heart valves like aortic valve stenosis can also produce heart murmurs. As blood flows past the defective valve the turbulent flow can produce a distinctive sound. On the other hand, many heart murmurs are what we call innocent heart murmurs. With an innocent heart murmur, the heart is perfectly normal. The murmur in this case is simply the normal sound that blood is making as it flows through the heart.

One question I frequently get from parents is whether it’s safe to travel with their children with congenital heart disease to high-altitude areas. Two considerations immediately come to mind: 1) what type of heart defect does the child have? and 2) specifically what altitude will you be traveling to?

B-type natruretic peptide, or BNP, is a hormone that is manufactured by the ventricular muscle in human hearts. The physiologic effects of BNP include the following: Diuresis (increased urination), loss of sodium, and vasodilation. It is expressed in response to either a pressure or volume load on the ventricle. This can be seen in a number of different settings, including valve stenosis (narrowing), an enlarged and poorly functioning heart muscle, or a heart muscle that is stressed by having to pump excess blood.

Critical congenital heart disease (CCHD), defined as heart disease requiring either surgical or catheter-based intervention in the first year of life, affects 2-3 out of every 1,000 live births. Specific defects include hypoplastic left heart syndrome, pulmonary atresia, tetralogy of Fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosus. The majority of CCHD is identified prior to discharge from the newborn nursery. Many patients have already been detected prenatally. A good portion of those not identified prenatally will present with signs or symptoms in the first 24 hours of life. These may include an audible murmur, abnormal heart sounds, the absence of palpable pulses, cyanosis, pallor, or tachypnea. Nevertheless, a small percentage of patients with CCHD may inevitably "slip through the cracks." Usually these are infants with ductal-dependent heart lesions whose ductus arteriosus has remained open and therefore either have sufficient pulmonary blood flow to prevent the noticeable detection of cyanosis, or have sufficient cardiac output to prevent signs of shock. It almost all cases, however, these patients will have a level of oxygen desaturation that may identify them as potential "risks" despite appearing normal to an examiner's eye.

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