Heart, Congenital Defect

Acceptability at Recruitment

QUALIFIED

Acceptability at VT / Work-Up

QUALIFIED

Individual at Risk

Donor

Explanation of Condition

This covers a wide range of heart abnormalities that are, by definition, present from birth. The most common defects are simple 'hole-in-the-heart' abnormalities, such as an atrial septal defect (ASD), patent foramen ovale (PFO) or ventricular septal defect (VSD).

Apheresis and bone marrow harvest may increase the risk of small clots passing across such a defect in the heart and into the circulation of the brain, leading to a stroke. With a normal heart, these clots would be harmlessly filtered out by the lungs. In addition, there is a theoretical risk of infection in the heart (endocarditis), particularly if a central venous catheter is inserted.

Many people with congenital heart disease or with previous heart surgery take long-term antibiotics to prevent endocarditis. However, the evidence to support this use is weak, and there is no evidence to support their use in people with simple congenital defects such as an atrial or ventricular septal defect. As a result, this should not be used as a criteria to accept or decline a donor.

In addition, the latest NICE (National Institute of Clinical Evidence) guidance suggests that there is no increased risk of infectious endocarditis is those with a simple atrial septal defect, or surgically corrected ASD, VSD or PDA following invasive procedures.

Guidance

Guidance at recruitment

Acceptable

ASD, VSD, PFO, PDA if corrected OR surgically uncorrected but small & asymptomatic.

Guidance at VT

Acceptable

Surgically corrected simple defect (ASD, VSD, PFO, PDA).

Uncorrected small ASD/VSD/PFO/PDA, as long as the donor is asymptomatic, has no related cardiac problems and the shunt is minor. Cardiology letters should be reviewed by the MO. An echocardiogram should be undertaken at medical.

Unacceptable

Large septal defect (ASD/VSD/PFO)

Any complex congenital defect, such as Tetralogy of Fallot (TOF), Transposition of the Great Arteries (TGA), Anomalous pulmonary circulation.

Coarctation of the aorta, including if repaired.

See also Heart, Valve Disease

Discuss each case with medical officer.

Pseudonyms or Related Conditions

Ventricular septal defect (VSD)

Atrial septal defect (ASD)

Patent foramen ovale (PFO)

Tetralogy of Fallot

Hole in the heart

Patent ductus arteriosus (PDA)

Transposition of the great vessels

Anomolous pulmonary venous return

Version

Version 1, Edition 3

Date of Last Update

3rd September 2024