Transcription:
At the Heart of the Matter

Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness. It's brought to you by our friends at MemorialCare Health System. I'm Deborah Howell. Today's guest is Dr. Shaun Setty, Medical Director of Pediatric and Adult Congenital Cardiac Surgery at Miller Children's Hospital Long Beach. Dr. Setty is triple board certified in surgery, thoracic surgery, and congenital heart surgery and is actively involved in cardiac research.
Welcome, Dr. Setty.

Shaun Setty (Guest): Thank you. Thanks for having me.

Deborah: Thanks for being here. Today we're going to talk a little bit about heart disease, so let's get right down to the heart of the matter, as it were. What is congenital heart disease?

Dr. Setty: Well, congenital heart disease is any defect that a baby can be born with that has to do with the heart. So it's something the baby's born with. It's not something they acquire. So if you look at adult heart disease, that's usually something called acquired heart disease, meaning they had something happened to their arteries. They get plaque in their arteries or their valves start to become calcified. With congenital, these are defects that the babies are born with. There's a whole wide spectrum of defects. Anything you can think of that could be wrong with the artery or a vein or a valve or one of the heart chambers can be wrong with these babies. So it's basically something a baby is born with.

Deborah: Just a luck of the draw. How common is it?

Dr. Setty: Babies who are born with congenital heart disease, it's 0.8 percent. So it works out to be 8 out of 1,000 births. And that could be anything. It could be either a simple defect, what we consider a moderate defect, or even something very complex. So that runs the whole gamut. It's eight out of a thousand births, and that works out to be approximately 35,000 children are born every year in the US with congenital heart defects.

Deborah: It's challenging, it is a little tragic, but we're living in a great day and age. So what are some of the signs and symptoms of congenital heart disease?

Dr. Setty: It all comes down to what the defect is, and that can be something that right at birth, something's wrong. The baby's saturations aren't high enough, their breathing isn't normal, it's more labored. Or it could be something that the baby is born with and it doesn't really exhibit itself until later on. It could be picked up as a child, it could be picked up as a teenager, it can even be picked up as an adult if it's one of the more simple defects.

Deborah: Interesting, I didn't know that.

Dr. Setty: Yes, so some of the signs that you could see throughout this whole period, it could start with the breathing. The breathing can be very rapid and labored. You can note the patient have very poor exercise tolerance. In a baby, that could be the baby really works to breathe. It's feeding, breathing really hard, becoming sweaty when they're feeding because their heart is working so hard to keep up. In some of the more severe defects, you can see the babies be a little blue and we call that cyanosis.

Deborah: Okay.

Dr. Setty: They can have blue tints to their nail beds, to their lips, to their skin, and then you can also have patients who have poor blood circulation to certain parts of the body.

Deborah: Okay. Now, there are basic types of congenital heart disease?

Dr. Setty: There's a whole spectrum of them. There's all the way simple to complex, and we talk about words called acyanotic or cyanotic, and that just means whether they are blue or whether they're not blue. So there's kind of a large category. Some of the more simple defects are patients who have what we consider holes in their heart, in layman terms. So a hole between two chambers, like in atrial septal defect, that's a hole between the two atria. And then ventricular septal defect, a hole between two ventricles. And then you just have a whole spectrum.

Deborah: Right. What kind of capabilities does Miller Children's have with respect to the treatment of congenital heart disease?

Dr. Setty: Miller Children's Hospital has the capability to treat any congenital heart defect. So that can be a patient who possibly has a simple defect that can be treated via catheter-based mechanisms, surgical, and even neonatal. So we deal with the whole spectrum, from a premature baby all the way to a full-grown adult, and that's the one thing that makes Miller Children's and Long Beach Memorial special in that both hospitals are next to each other on the same camp, and we're one of the few that can take care of that whole spectrum. We can deal with adults because we have adult hospital here also.

Deborah: Good to know. Now, if a patient has a straightforward defect that's caught early, what can they expect the outcome to be?

Dr. Setty: It all depends on the symptoms and what the patient has. Sometimes you can actually follow those patients for a little while. Certain types of defects can be dealt with via catheter-based treatments, or they can have surgery. But let's just say the patient does need something done, and you repair the defect. We expect those patients to have as close to a normal lifespan as everybody else, and so that's the nice thing about the simple defects in that when you do treat them, you can really alter the course of a patient who otherwise would be developing heart failure.

Deborah: Okay. Are a lot of these things picked up early on? And then later in life, are they picked up at maybe an annual checkup with your physician, or...?

Dr. Setty: Correct, so we kind of see them picked up throughout the whole spectrum. But now that more and more patients are having prenatal checkups, more mothers are going and having prenatal care and having ultrasounds done, a lot of times, some of the more complex defects are being picked up, which is nice for the family. It at least gives them an opportunity to be prepared for it. And definitely, in terms of where it's picked up, yeah, primary care physicians will sometimes hear a murmur, which is an abnormal sound that the heart can make. Some murmurs can be normal, and others aren't. So yes, they're kind of picked up throughout. We may have a patient come in who's just getting tired more easily, and then the whole work of what we've done will reveal a congenital heart defect.

Deborah: Okay. Doctor, for our soon-to-be moms listening or mothers who have a child with a congenital heart defect, where can they go to learn more?

Dr. Setty: Anything they can do to learn more -- the first thing, if there is an issue, they can always contact the Miller Children's Pediatric Heart Center. That phone number is 1-855-999-MCH1 or 1-855-999-6241. That's our clinic, and that deals with any type of patient, whether it's prenatal checkups all the way through to adult congenital. And they can also go to our website.

Deborah: Okay, very good. As you were speaking, I was thinking. The next question I might want to ask is about inheritance. Is congenital heart disease passed down?

Dr. Setty: That's a very tricky question because each defect is very different, and that's a big area of study right now with genetics is to see which ones are transmitted. I would say the majority of them are not, or they haven't found a transference, but there are some that can be and are. But it's a very complex question in terms of each defect is very different.

Deborah: So you can't just say, "Yes, it's passed down. No, it's not." Each case is individual?

Dr. Setty: Correct. And there's some sort of disorders of the heart muscle called cardiomyopathy. Those are inherited, and there's a known inheritance with those. So when we do find a patient who has that, we actually test the remainder of the family members to rule them out. But in terms of a simple atrial septal defect or a ventricular septal defect, there is no known inheritance with those.

Deborah: You said you tested the other family members. What kind of tests do you undergo?

Dr. Setty: Usually, they would have a checkup with a pediatric cardiologist, and they'll also have an ultrasound of the heart, which is called and echocardiogram. So they would be able to see the heart with an ultrasound and see if the muscle chambers were thickened.

Deborah: Excellent. What else should we know about Miller Children's Hospital?

Dr. Setty: Well, I think Miller Children's Hospital really serves the whole spectrum for pediatrics. There's a Pediatric Intensive Care Unit that's fully staffed 24/7; there's a cardiac part of our Pediatric Intensive Care Unit. There's a very large Neonatal Intensive Care Unit. We have dedicated cardiovascular operating rooms. We have specialists, really, for every part of what we do, all the medical subspecialties. We have a special Pediatric Cardiac Anesthesia Group; we have a dedicated Pediatric Heart Perfusion. They run the heart-lung machine when we do the case. And we have a dedicated Pediatric OR team. When I say this, we really have the people that need to get things done here in terms of taking care of children or even adults with congenital heart disease.

Deborah: And all working in concert?

Dr. Setty: All working in concert. It's very fluid, and it's very patient-centered and family-centered care, and I think we're really proud of that.

Deborah: Well, thank you so, so much, Dr. Setty for, being on the program today. It's been really informative talking about congenital heart disease and Miller Children's Hospital. We really want to thank you for being here.

Dr. Setty: Thank you so much for having me.

Deborah: To listen to the podcast or for more information, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Health System. Have yourself one fantastic day.