At the Heart of the Matter

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness, it’s brought to you by MemorialCare Health System. I'm Deborah Howell, and 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, MD: Thank you. Thanks for having me.

Deborah Howell (Host): 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?

Shaun Setty, MD: 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 have something happen to their arteries, they get plaque in their arteries, or their valves stretch to become calcified. With congenital, these are defects that the babies are born with. And there's a whole wide spectrum of defects, anything you can kind of 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 Howell (Host): Just a luck of the draw. How common is it?

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

Deborah Howell (Host): Well, 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?

Shaun Setty, MD: So it all comes down to what the defect is, and that can be something that right at birth you know something's wrong, the baby's saturations aren't high enough, they're not breathing normally, it's more labored. Or it could be something that the baby's born with and it doesn't really exhibit itself till 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 Howell (Host): Interesting, I didn't know that.

Shaun Setty, MD: Yeah. So some of the signs that you could see throughout this whole period, it could start with breathing, the breathing can be very rapid and labored. You can note the patient have very poor exercise tolerance, and in a baby, that could be the baby really works to breathe, is feeding, breathing really hard, becoming sweaty when they're feeding because their heart's working so hard to kind of keep up. With some of the more severe defects, you can see the babies be a little blue, and we call that word is cyanosis. Okay. So they can have a blue tint to their nail beds, to their lips, to their skin. And then you know, you can also have patients who have poor blood circulation to certain parts of the body.

Deborah Howell (Host): Okay. Now are there basic types of congenital heart disease?

Shaun Setty, MD: There's a whole spectrum of them, you know, they start 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 the heart in layman's terms. So a hole between the two chambers, like an atrial septal defect, that's a hole between the two atria. And then ventricular septal defect, a hole between two ventricles, and then it just, and then you just have a whole spectrum.

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

Shaun Setty, MD: Miller Children's Hospital has the capability to treat any congenital heart defect. And 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 campus, so we're one of the few that can take care of that whole spectrum. We can deal with adults because we have the adult hospital here also.

Deborah Howell (Host): Good to know. Now, if a patient has a straightforward defect that's caught early, what can be expected the outcome to be?

Shaun Setty, MD: So it all depends on the symptoms and what the patient has. And so 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 simple defects, in that when you do treat them, you know, you can really alter the course of a patient who otherwise would be developing heart failure.

Deborah Howell (Host): Okay. So 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...?

Shaun Setty, MD: Correct. So they are picked up, you know, 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 they're 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 yeah, they're kind of picked up throughout. You may have a patient come in who's just, you know, getting tired more easily, and then the whole workup will be done and it'll reveal a congenital heart defect.

Deborah Howell (Host): 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?

Shaun Setty, MD: So anything they can do to learn more... I mean, the first thing if there is an issue they can always contact the Miller Children's pediatric heart center, and 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 Howell (Host): 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?

Shaun Setty, MD: So 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, and I would say the majority of them are not or they haven't found a transfer. But there are some that that can be and are. But that it's a very complex question in terms of each defect is very different.

Deborah Howell (Host): So there's no... you can't just say, "Yes it's passed down, no it's not," it's each case is individual?

Shaun Setty, MD: 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 like a simple atrial septal defect or a ventricular septal defect, there's no known inheritance with those.

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

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

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

Shaun Setty, MD: 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. So I mean when I say this, it's 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 Howell (Host): And all working in concert.

Shaun Setty, MD: 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 Howell (Host): Well thank you so, so much, Dr. Setty, for being on our 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.

Shaun Setty, MD: Thank you so much for having me.

Deborah Howell (Host): To listen to the podcast or for more information, please visit memorialcare.org. That's 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.