HEART disease is not only a condition associated with advancing years and certain lifestyle choices.

Congenital Heart Disease (CHD) refers to the vast array of cardiac problems that develop while a baby is still forming in the womb.

From six weeks of gestation, the heart grows from a tube-like structure into a beautifully formed but complex organ with four chambers and valves between these to ensure blood flows in the correct direction.

Veins deliver deoxygenated or spent blood to the right side of the heart, which pumps it through the lungs where it receives oxygen. From here it travels to the left side of the heart and out through the main artery, the aorta, to supply all the tissues of the body.

Any incorrect step in the formation of this system will result in a complication, the severity of which ranges from something so mild it may only be picked up in adulthood, through to a situation which may only be remedied by a heart transplant.

The first time CHD may be detected is at the 20-week scan. If identified you will be referred to a specialist team, either in same hospital, or perhaps elsewhere. They will confirm the abnormality by a repeat ultrasound.

The seriousness of the condition will determine the level of medical input needed, which may necessitate procedures on your baby before birth, and/or delivery in a dedicated unit.

In certain circumstances you may decide not to continue the pregnancy, and will be supported throughout.

Congenital heart disease affects roughly eight in every 1,000 babies born. Thankfully only 25per cent have critical CHD, defined as a severe defect such as the absence of part of the heart, or a section of it significantly underdeveloped.

As yet, a cause for CHD has not been identified. It is associated with certain genetic conditions including Down’s syndrome, where around 50 per cent of infants born have some degree of congenital heart disease.

Some prescribed medications are linked with a greater incidence of CHD.

Smoking, alcohol and the use of recreational drugs in pregnancy are recognised risk factors.

Suffering rubella (German measles) or flu while pregnant increases the likelihood of a baby being born with CHD and for this reason all women attempting conception should ideally be vaccinated, though it is still recommended if you are already pregnant.

Mothers with poorly controlled diabetes are more likely to have babies with CHD.

The treatment of congenital heart disease is a highly specialised field, with dedicated cardiologists, surgeons, nurses and an array of allied health professionals.

Although some conditions, for example small holes between the chambers may simply be monitored by regular ultrasound scans, a group of babies will need multiple treatments and operations, some commencing within the first few days of life.

CHD not picked up at the 20-week scan may be found when a baby is examined after delivery, or at the six weeks check at your GP surgery.

In babies and toddlers, symptoms of congenital heart disease include breathing very fast, difficulty feeding, recurrent chest infections, a bluish tinge to the skin or lips, and failure to thrive. However, many of the above will have a much less serious cause.

The treatment of CHD has made rapid strides in the last 40 years, from a position where the majority of babies did not survive to their first birthday, to the present where eight in ten are reaching adulthood.

Prognosis is very much based on the specific abnormality, with some babies having more than one condition. As a very gross rule of thumb, those requiring surgery do not live as long as those not needing major intervention. The first year of life is the most critical in determining the course of events thereafter.

The physical and psychological burden of congenital heart disease on the individual and family should not be underestimated. All treatments and support have the aim of improving quality of life and alleviating suffering, so the child, parents and any siblings can enjoy as normal an existence as possible. Mild exercise where possible is now recommended as a way of improving mental health. CHD is not an absolute bar to getting pregnant as it was previously, though it will be dependent on the degree of the condition.

Current research is focussing on the genes that cause CHD, with the hope that successful identification of these will eventually make congenital heart disease a thing of the past.

* Useful websites: chfed.org.uk; childrenshearts.org.uk; tinytickers.org