Congenital Heart Defects and Medical Negligence in Chicago
Congenital heart disease includes abnormalities in the heart or the major vessels connected to it that develop before a baby is born. Depending on the particular condition, the abnormal anatomy may change how blood reaches the lungs, passes through the heart, or circulates to the rest of the body.
The medical effects vary widely. A small opening between heart chambers may close naturally and cause few or no lasting problems. At the other end of the spectrum, a critical heart condition can interfere with oxygen delivery or circulation and require medication, catheter-based treatment, surgery, or intensive care shortly after delivery.
Most congenital heart defects are not the result of medical malpractice. They commonly arise during fetal development and may be associated with genetic influences, maternal medical conditions, certain exposures, or factors that remain unknown. The fact that a child was born with a heart abnormality does not, by itself, establish negligence by a physician, hospital, or other healthcare provider.
A legal question may exist in limited circumstances when a medically indicated study was not ordered, a significant prenatal finding was overlooked, newborn screening was mishandled, concerning symptoms were not investigated, or delayed treatment produced additional preventable harm.
Free legal evaluation: When the concern involves a particular testing, diagnosis, communication, or treatment error rather than the underlying heart condition alone, contact Sexner Injury Lawyers LLC or call (312) 243-9922.
Why Do Congenital Heart Defects Develop?
These conditions arise when part of the fetal heart or one of the major connected blood vessels does not form in the expected way. For many children, no single cause can be identified.
Factors that may affect risk include:
- Certain genetic or chromosomal changes
- A parent or sibling with congenital heart disease
- Diabetes that existed before pregnancy or was present during early fetal development
- Particular infections during pregnancy
- Exposure to certain medications or substances
- A combination of inherited and developmental influences
A risk factor describes an association and does not prove why an individual child developed a defect. It also does not establish that the condition was preventable or that a medical provider failed to meet the standard of care.
How These Conditions May Be Identified
Routine Prenatal Ultrasound
Prenatal ultrasound examinations commonly include views of the developing heart. Some major abnormalities can be recognized through these images. Others may be difficult to see because of fetal position, gestational age, maternal anatomy, technical limitations, or the nature of the particular defect.
Fetal Echocardiography
A fetal echocardiogram provides a more detailed evaluation of the baby’s heart before delivery. It may be recommended when:
- A routine ultrasound raises concern about cardiac anatomy
- A parent or sibling has congenital heart disease
- A genetic or chromosomal condition is known or suspected
- The mother has a medical condition associated with increased risk
- A medication or other exposure creates a recognized concern
- The fetal heart rate or rhythm appears unusual
- Another clinical factor supports specialized cardiac imaging
This specialized examination is not automatically required for every pregnancy. A reassuring result also cannot eliminate every possibility, because very small openings, subtle valve abnormalities, and conditions that become apparent only after birth may not be visible prenatally.
Evaluation After Delivery
After birth, healthcare providers may suspect a cardiac condition because of the baby’s skin color, breathing pattern, feeding ability, circulation, oxygen level, pulses, weight gain, activity, or an unusual sound heard through a stethoscope.
A heart murmur is a sound created by blood moving through or near the heart. It is not necessarily a diagnosis. Many murmurs are harmless, while others may be associated with abnormal circulation or an underlying cardiac defect. The need for further testing depends on the sound’s characteristics, the infant’s symptoms, the physical examination, and other findings.
Newborn Pulse-Oximetry Screening
Pulse oximetry measures oxygen saturation in the blood and can help identify certain serious congenital heart conditions before a newborn leaves the hospital. The test is quick and does not require a needle.
A passing result does not rule out every heart defect. Screening results should be considered together with the physical examination, medical history, and any symptoms that develop.
Possible Complications and Related Conditions
Pulmonary hypertension involves elevated pressure in the arteries that transport blood from the heart toward the lungs. Some congenital defects direct an excessive amount of blood into the pulmonary circulation or create pressure changes that gradually injure these vessels.
Possible symptoms include shortness of breath, fatigue, dizziness, chest discomfort, and fainting. Advanced disease may place substantial strain on the right side of the heart.
An arrhythmia is a disturbance in the heart’s normal electrical rhythm. The heartbeat may become unusually fast, unusually slow, or irregular. Congenital anatomy, enlargement of a chamber, prior surgery, scar tissue, and changes in the electrical pathways can all contribute.
- Bradycardia describes a heart rate slower than expected for the person’s age and circumstances.
- Tachycardia describes a rate faster than expected.
Depending on the particular rhythm disturbance, treatment may include observation, medication, catheter ablation, a pacemaker, another implanted device, or surgery.
Infective endocarditis is an infection involving the inner surface of the heart, a valve, or implanted cardiac material. The degree of risk differs among people with congenital heart disease. Greater concern may exist with certain unrepaired abnormalities, artificial valves, conduits, or prosthetic materials.
Treatment generally involves intravenous antibiotics and may sometimes require an operation. Preventive antibiotics before dental or medical procedures are recommended only for selected patients rather than everyone with a congenital defect.
Heart failure can develop when the heart cannot deliver enough blood to meet the body’s needs or must work excessively hard because blood is circulating through an abnormal route.
In infants, warning signs can include rapid breathing, sweating during feeding, tiring before finishing a feeding, slow weight gain, swelling, or decreased activity. Treatment may involve medication, nutritional assistance, catheter intervention, surgery, or another procedure directed at the underlying problem.
Examples of Congenital Heart Defects
A ventricular septal defect, or VSD, is an opening in the tissue separating the heart’s two lower pumping chambers. Because pressure is normally greater on the left side, blood carrying more oxygen may cross through the opening into the right ventricle and increase the amount sent toward the lungs.
Small openings may close naturally and require only continued observation. A larger defect can contribute to rapid breathing, feeding difficulty, sweating, inadequate weight gain, enlargement of the heart, or heart failure.
Treatment may include medication to control symptoms, catheter closure in selected cases, or surgery. Common anatomical categories include muscular, perimembranous, inlet, and outlet defects.
An atrial septal defect, or ASD, is an abnormal passage in the wall between the two upper chambers. It differs from the normal fetal opening known as the foramen ovale, which ordinarily closes after delivery.
A small ASD may close on its own or remain without causing significant symptoms. A larger opening may allow excess blood to pass toward the lungs and eventually contribute to enlargement of the right side of the heart, rhythm problems, pulmonary hypertension, or reduced exercise tolerance.
Some ASDs can be closed with a device delivered through a catheter. Others require surgery. Medication may help control complications, but it does not repair the opening itself.
Truncus arteriosus is a critical condition in which a single large vessel leaves the heart rather than separate vessels serving the body and lungs. A VSD is generally present as well, permitting blood with different oxygen levels to mix.
Babies may develop blue or gray skin, rapid breathing, poor feeding, limited weight gain, unusual sleepiness, or signs that the heart is struggling. Surgical repair is usually performed during early infancy to create separate pathways for pulmonary and systemic circulation.
An atrioventricular septal defect, often called an AV canal defect, affects the center of the heart. It can involve openings between chambers as well as abnormalities in the valves separating the upper and lower chambers.
In the complete form, there is a large central opening and one common atrioventricular valve. Partial and transitional forms involve fewer structures but may still cause substantial leakage through a valve.
AV canal defects occur more frequently in children with Down syndrome. Surgical correction is often required, with timing based on symptoms, anatomy, growth, and the effect on the lungs.
Tricuspid atresia occurs when the valve that should connect the right atrium with the right ventricle does not develop. Blood therefore cannot travel through the right side of the heart in the usual way, and the right ventricle is commonly smaller than normal.
Other openings must permit blood to mix and reach the lungs. Initial treatment may include medication and catheter procedures, followed by staged operations that redirect circulation. These can include a shunt, a bidirectional Glenn procedure, and a Fontan procedure.
The operations improve blood flow but do not create ordinary two-ventricle circulation. Ongoing care from specialists is therefore important throughout life.
Coarctation of the aorta is a narrowed section of the main artery that transports blood from the heart to the body. The heart must generate additional pressure to move blood through the restricted area.
A severe narrowing can lead to poor circulation, breathing difficulty, shock, kidney problems, or heart failure during the newborn period. A less pronounced narrowing may not be discovered until later, when a clinician notices higher blood pressure in the arms, lower pressure in the legs, or weak pulses in the lower body.
Treatment may involve surgical reconstruction, balloon angioplasty, or a stent. Continued monitoring is needed because narrowing or elevated blood pressure can persist or return.
Total anomalous pulmonary venous return, commonly abbreviated TAPVR, occurs when the veins returning oxygenated blood from the lungs connect somewhere other than the left atrium.
For blood to reach the left side of the heart and circulate to the body, it must cross through another opening between the chambers. TAPVR can be classified as supracardiac, cardiac, infracardiac, or mixed according to the location of the abnormal venous pathway.
When the veins are obstructed, a newborn can become critically ill soon after delivery. Surgical repair is necessary.
Tetralogy of Fallot combines four cardiac abnormalities:
- Narrowing in the pathway carrying blood from the right ventricle toward the lungs
- An opening between the two ventricles
- An aorta positioned partly over that opening
- Thickening of the right ventricular muscle
The combined abnormalities can reduce the oxygen content of blood delivered to the body. Some infants develop blue coloring or sudden episodes of worsening cyanosis, sometimes called tet spells.
Surgical repair is usually performed during infancy. The exact timing and procedure depend on the child’s anatomy, oxygen level, symptoms, and overall health.
In dextro-transposition of the great arteries, or d-TGA, the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. The result is two circulatory loops that run alongside one another rather than in the normal sequence.
Survival initially depends on enough blood mixing through another connection, such as an atrial opening, a ventricular opening, or a patent ductus arteriosus. Medication or an emergency catheter procedure may be needed to improve mixing before definitive repair.
An arterial-switch operation is commonly performed during the early weeks of life to reconnect the major arteries to the appropriate ventricles.
Pulmonary atresia is a critical condition in which the normal opening from the right side of the heart toward the pulmonary artery is sealed rather than functioning as a valve. Blood cannot follow its usual route from the right ventricle to the lungs.
The anatomy is not the same in every child. In some babies, the wall dividing the lower chambers has no opening and the right-sided pumping chamber may be markedly underdeveloped. In others, a passage between the ventricles is also present, producing a different pattern of blood flow and a different treatment plan.
Early care may include medication to keep the ductus arteriosus open, cardiac catheterization, surgery, or a sequence of procedures. The approach depends on the development of the right ventricle, the pulmonary arteries, the coronary circulation, and any additional abnormalities.
Hypoplastic left heart syndrome involves severe underdevelopment of several structures on the left side of the heart. These may include the left ventricle, mitral valve, aortic valve, and ascending aorta.
Because the left side cannot adequately supply blood to the body, medication is generally started soon after birth to maintain temporary fetal circulation while the cardiac team determines the treatment plan.
Management frequently includes a staged series of operations:
- Norwood procedure: Usually performed during the newborn period
- Bidirectional Glenn procedure: Usually performed several months later
- Fontan procedure: Usually performed during early childhood
Heart transplantation may be considered in selected situations. Lifelong follow-up with congenital cardiology specialists remains necessary after either staged surgery or transplantation.
Most Congenital Heart Conditions Do Not Involve Malpractice
A healthcare provider generally does not cause a congenital cardiac defect simply because it developed or could not be prevented. The potential legal issue is usually whether a separate medical mistake produced additional harm.
Qualified medical experts ordinarily must evaluate what care was required, whether a provider failed to meet that standard, and whether the alleged error made a meaningful difference in the child’s medical outcome.
When Might Medical Negligence Be Relevant?
Failure to Address a Prenatal Finding
A legal review may be appropriate when:
- A routine ultrasound contained an abnormal cardiac finding that was not recognized
- A report recommended additional testing that was never arranged
- A fetal echocardiogram was medically indicated but not ordered
- An abnormal finding was not communicated to the patient or another treating provider
- A referral to maternal-fetal medicine, pediatric cardiology, or genetic counseling was unreasonably delayed
An earlier diagnosis would not remove the congenital defect. It may, however, permit additional testing, informed counseling, delivery planning at a hospital with appropriate resources, and immediate access to pediatric cardiac care.
Failure to Recognize a Critical Condition After Birth
Potential issues may include:
- Failure to perform required pulse-oximetry screening
- Failure to respond appropriately to an abnormal oxygen result
- Discharging a newborn despite blue coloring, breathing difficulty, abnormal pulses, feeding problems, or other warning signs
- Failure to investigate a concerning murmur or abnormal examination
- Incorrect interpretation of an echocardiogram or another diagnostic study
- Unreasonable delay in obtaining pediatric cardiology consultation
Because pulse-oximetry screening does not detect every heart defect, a normal result does not justify ignoring other symptoms or examination findings.
Delayed or Negligent Treatment
The congenital condition may have developed without malpractice, but a child can still suffer preventable additional injury when necessary care is delayed or performed improperly. Possible concerns include:
- Failure to stabilize a critically ill infant
- Failure to begin an indicated medication
- Unreasonable delay in catheterization or surgery
- A preventable surgical error
- An anesthesia, medication, perfusion, or monitoring error
- Failure to recognize bleeding, infection, reduced circulation, or another postoperative complication
- Failure to arrange necessary cardiology follow-up
A poor outcome or recognized complication does not automatically establish negligence. The issue is whether the medical team failed to use the level of care required under the circumstances and whether that failure caused additional damage.
Records Used to Review a Potential Case
A complete medical and legal evaluation may require:
- Prenatal and obstetric records
- Ultrasound reports and original images
- Fetal echocardiogram recordings and interpretations
- Maternal-fetal medicine and genetic counseling records
- Newborn examination notes
- Pulse-oximetry screening results
- Echocardiograms, electrocardiograms, CT scans, and MRI studies
- Pediatric cardiology consultations
- Hospital and intensive-care records
- Catheterization and operative reports
- Anesthesia, perfusion, medication, and monitoring records
- Postoperative and follow-up documentation
Medical experts may need to distinguish the consequences of the original congenital condition from any separate harm allegedly caused by delayed diagnosis or negligent care.
Contact Sexner Injury Lawyers LLC
Most congenital heart defects do not involve medical malpractice. A legal evaluation may nevertheless be appropriate when there is a specific concern involving prenatal imaging, newborn screening, failure to investigate symptoms, delayed referral, surgery, or treatment.
Contact Sexner Injury Lawyers LLC or call (312) 243-9922 for a free and confidential evaluation. We will explain honestly whether the circumstances appear to justify further investigation.
