Congenital heart disease (CHD) or defects refers to structural abnormalities of the heart or the large vessels of the heart, present at birth. These defects range in severity from minor anomalies that may cause no symptoms to complex malformations that require urgent attention, shortly after birth.
According to CDC, CHDs are among the most common birth defects worldwide, affecting approximately 1 in every 100 babies born in the United States and representing a leading cause of infant morbidity and mortality due to congenital anomalies. 1
Each year approximately 40,000 babies are born in the United States with a congenital heart defect. This equates to 1 child every 15 minutes.
Approximately two to three million individuals are thought to be living in the United States with CHDs.
CHDs are broadly classified into acyanotic and cyanotic lesions based on whether the defect leads to reduced oxygen levels in the blood.
Acyanotic defects, such as ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), typically allow normal oxygenation but can increase the workload on the heart, potentially leading to symptoms like rapid breathing, poor feeding, or congestive heart failure as blood flow patterns change postnatally.
Cyanotic defects, including transposition of the great arteries (TGA) and hypoplastic left heart syndrome (HLHS), interfere with oxygen delivery to the body, turning the skin bluish and often present more critically in the newborn period, requiring timely intervention.
Diagnosis of CHD may occur before birth through advanced imaging such as fetal echocardiography or at birth via abnormal heart sounds or low oxygen levels detected during routine screening, or later in infancy or childhood if symptoms emerge.
Signs of CHD can include heart murmurs, cyanosis (bluish discoloration of the skin or lips), tachypnea (rapid breathing), poor weight gain, and feeding difficulties. Early detection enables appropriate monitoring, medical management, and, where necessary, surgical or catheter-based interventions.
Although the causes of most CHDs remain unknown, a combination of genetic and environmental factors, including maternal conditions like diabetes or obesity may contribute to risk. With advances in pediatric cardiology and cardiac surgery, many children with CHDs now survive into adulthood, but lifelong care and follow-up are often needed.
See also: Five Most Common Congenital Heart Defects | CHD Awareness Week 2026
MedBound Times connected with Dr. Munish Kumar Raizada, MBBS, MD, FAAP, board certified neonatologist, to know more about the concerns of parents of children with CHDs.
What parents should expect after a baby is diagnosed with CHD? What are their immediate concerns?
Dr. Munish Kumar Raizada: When a baby is diagnosed with congenital heart disease (CHD), parents usually have immediate and understandable concerns. The most common questions include:
Will the hole in the heart close on its own?
Will my baby become very sick?
Will surgery be required?
The outcome depends on the specific type and severity of the heart defect.
Common acyanotic heart defects include:
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Tricuspid valve abnormalities
These conditions are often not diagnosed at birth because many babies are not symptomatic immediately. In particular:
VSD is the most common congenital heart defect.
Symptoms usually appear when right ventricular pressure falls after birth.
At that point, blood begins flowing from the left to the right side of the heart, which may cause:
Difficulty breathing (dyspnea)
Feeding problems
Congestive heart failure (CHF)
Poor weight gain
Parents frequently ask whether the defect will close on its own. If the VSD is small, it often closes spontaneously within 1–2 years.
Interestingly:
Smaller VSDs are easier to diagnose because they produce louder, harsher murmurs due to turbulent blood flow.
Larger VSDs may produce softer murmurs because blood flows more freely, causing less turbulence.
Diagnosis is usually made when a pediatrician hears a murmur and orders an echocardiogram.
Cyanotic heart diseases are generally more serious. These include:
Tetralogy of Fallot
Transposition of the Great Arteries (TGA)
Hypoplastic Left Heart Syndrome (HLHS)
Tricuspid atresia
Ebstein anomaly
Some of these, particularly TGA and HLHS, are critical and present early. Without timely diagnosis and intervention, they can lead to severe morbidity or mortality.
Parents are counseled carefully regarding urgency and the need for prompt treatment.
When is heart surgery needed in newborns with CHD? When do surgeons recommend surgery?
Dr. Munish Kumar Raizada: The decision for surgery depends on several factors:
The type of defect
Severity
Symptoms
Hemodynamic stability
A large VSD causes recurrent congestive heart failure.
The baby has poor weight gain due to cardiac overload.
A large Patent Ductus Arteriosus (PDA) causes significant left-to-right shunting.
Cyanotic heart disease is diagnosed, especially critical conditions like TGA or HLHS.
In cyanotic heart disease, surgery is often required urgently or shortly after diagnosis.
Dr. Raizada emphasizes that there is no single universal rule, decisions are individualized based on the baby’s clinical condition.
What happens when a preterm baby has a heart defect?
Dr. Munish Kumar Raizada: In premature babies, Patent Ductus Arteriosus (PDA) is relatively common.
In full-term babies:
The ductus arteriosus typically closes naturally after birth.
In preterm babies:
PDA may persist and can sometimes be a physiological finding initially.
However, if PDA causes symptoms such as:
Lung congestion
Pneumonia
Congestive heart failure
Hemodynamic instability
Then treatment is required.
Conservative management:
Fluid restriction
Monitoring
Diuretics
Medical treatment:
Ibuprofen to help close the duct
Surgical closure:
If medical therapy fails
If the baby remains hemodynamically unstable
Waiting for weight gain is not always appropriate.
If the heart defect is preventing weight gain, correcting the defect may be necessary first.
What are the conditions where surgery is not necessary in a CHD? When is surgery not recommended?
Dr. Munish Kumar Raizada: Surgery may not be required in cases such as:
Small VSD
Small ASD
Mild acyanotic heart defects without symptoms
If:
The baby is feeding well
Gaining weight normally
Not experiencing heart failure
Not developing recurrent pneumonia
Then doctors may choose careful monitoring.
Small VSDs often close spontaneously within 1–2 years.
In these cases:
Regular follow-up
Echocardiographic monitoring
Clinical observation
How are different congenital heart conditions managed?
Dr. Munish Kumar Raizada: Management depends entirely on:
The type of defect
Size of the lesion
Presence of symptoms
Hemodynamic impact
Gestational age (term vs preterm)
Each baby is evaluated individually. There is no one-size-fits-all protocol.
Early diagnosis, regular follow-up, and individualized management are key to improving outcomes. With advances in neonatal care, pediatric cardiology, and cardiac surgery, many children with CHD now lead healthy lives. For parents, understanding the condition and maintaining open communication with their healthcare team can make a significant difference in navigating the journey ahead.
Reference
Children’s Heart Foundation. “CHD Facts & Information.” Children’s Heart Foundation. Accessed February 2026. https://www.childrensheartfoundation.org/about-chds/chd-facts-information.html.