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This one is about: Heart Murmurs in Children with Clefts

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by Joanne Green

We often hear, when talking about the physiology of cleft lip and palate, mention of "other midline defects". This is a reference to various other congenital problems our children may have that are located along the vertical axis of the body (brain, spine, heart, genitals, etc.) It is assumed that, while the cleft and other midline defects are not related per se, they may have occurred at the same time during the baby's gestation. That is, if something occurred that affected the formation of the face and palate, that same something may at the same time have affected the formation of another developing organ. Clefting occurs during the fourth to the eighth weeks of pregnancy, and we understand that that is the same time that other organs, such as the brain, the spine and the heart are developing. So it stands to reason that when a child is born with a cleft - even an isolated cleft - one should at least look for other midline defects, (Many of the syndromes which include clefting as a characteristic trait also include some other midline defects.)

Many children with cleft lip and palate do NOT have an accompanying midline defect. Of those who do have something else "attached" to the cleft, most of those are very minor. One of the more common midline defects that occurs in children with clefts is heart murmur.

Some sort of heart condition is detected in approximately 5% of children who have isolated clefts (all syndrome-related clefts are ruled out in this number). While that is a very low percentage, it is still higher than that found in the non-cleft population of children. The overwhelming majority of heart conditions detected constitute heart murmurs. A heart murmur is defined as "a sound caused by turbulent blood flow through the heart, as heard by a physician through a stethoscope." Murmurs are not indicative of a disease, but rather mark the possibility of abnormality.

A heart murmur can be detected by your pediatrician during a regular physical examination. Heart murmurs are defined by using a grading system, as well as a descriptive term. for example, a heart murmur may be defined as a "harsh systolic grade 3" murmur. "Harsh" describes the type of sound heard through the stethoscope. "Systolic" describes when it is heard relative to the normal sounds of the heart beat. The grading system simply gives the cardiologist more information concerning the intensity of the murmur. Neither the descriptive phrase nor the grade fully determine the actual impact of the murmur on the patient's health. That can be determined by further testing, which usually includes and echocardiogram. An EKG is also usually done to check the electrical pathways in the heart and may show changes if one part of the heart is being forced to work extremely hard because of the problem causing the murmur.

Most heart murmurs are considered benign, or "innocent" murmurs. That means they well not interfere with the development or activity level of the child. Benign murmurs may be outgrown by school age. Although they bear watching, they may not require any medications or therapy or medical intervention throughout the child's life, and have a chance to go away by themselves.

Some heart murmurs, however, indicate more serious heart problems. The most common of those is a septal defect, or a hole in the wall separating the right and left sides of the heart. A Septal Defect is repaired only if it is serious enough to cause problems or is complications develop. Small holes may grow smaller and even close by themselves as the child grows. A large ventricular septal defect may be treated with drugs (often diuretics and digitalis). Open heart surgery is only suggested in the most extreme cases, and, when done by experienced teams, the operation has a good safety and success rate. The outlook for persons born with a septal defect can be very good. Again, it is important to remember that the occurrence of this problem is low and septal defects are only present in a small portion of the cleft population.

Only a medical professional can diagnose a heart murmur and determine whether or not medical intervention is necessary. However, if a heart murmur is detected in your child, don't despair. They are almost always either benign or minor, and maybe outgrown, It is imperative, however, that a doctor follow any heart murmur, and you should feel comfortable discerning the treatment and future need for follow-up with him. With improving medications, monitoring, and surgical techniques, the restrictions that these types of heart problems place on the patient are declining.

------------------------------------Joanne Green is the mother of three cleft-affected children. She is also the Editor of WIDE SMILES Magazine.

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