Hole in the Heart-(Atrial Septal Defect or Ventral Septal defect)

A hole in the heart is problem found in babies. It is congenital. This means that there is a defect (fault) in the growth or development of the heart before or just after a baby is born.

There are two types that your doctor may mention:

  • Atrial Septal Defect
  • Ventral Septal Defect

 Structure of the Normal Heart

The heart has four rooms or chambers. There are two top rooms called atria (one atrium), and two bottom rooms called ventricles. Between the two atria is a wall called a septum. Between the two ventricles, there is also a septum.

Between the right atrium and the right ventricle, there is a valve. Between the left atrium and left ventricle (left top and left bottom chambers of the heart), there is also a valve.

The valves allow blood to pass from each atrium, or upper chamber, to each ventricle, or lower chamber, but does not allow the blood to return to the atria. This means that your blood will flow in one direction only.

There is normally no movement of blood between left atrium and right atrium (top chambers of the heart), because the wall stops any movement of blood.  Similarly, there is normally no movement of blood between the right and left ventricles, or lower chambers of the heart.  This is really good thing, because blood with oxygen in it should not be mixing with blood that has carbon dioxide in it.

Now, as the baby develops in the womb, it is normal for there to be holes in the walls or septa of the heart. However, just before, or during birth, these holes close up – normally. Problems arise when these holes do not close up just after or just before birth, resulting in holes in the heart walls (septa) when the baby is born.

Normal Blood Flow in the Heart

Now, the blood flows from the body to the heart. The blood that the body has used has little oxygen.  It comes into the heart via two large veins into the right atrium and goes via the one-way valve into the right ventricle.

The valve closes, and your right ventricle then pumps the blood into an artery called the Pulmonary artery, and the blood flows to the lungs. In the lungs, it gets oxygenated (receives oxygen), and travels back to the heart.

It goes into the left atrium this time, and flows via a valve into the left ventricle. The valve closes, and the heart pumps the blood into the large artery called the aorta. The aorta sends this oxygen-rich blood to the rest of the body.

There are a couple more valves from the heart to the vein or artery, but they are not important here.

Hole in the Heart

Hole in the Heart: Explanation or Definition

A hole in the heart is a hole that develops in the wall, or septum of the heart. If it occurs between the right and left atria, it is called an Atrial Septal Defect. This causes oxygenated and deoxygenated (carbon-dioxide-rich) blood to mix, instead of being separate, as normal.

If it is occurs between the right and left ventricles, it is called a Ventricular Septal Defect. It also causes oxygenated and deoxygenated (carbon-dioxide-rich) blood to mix. However, this defect can also cause too much blood to go into the right ventricle through the little hole, and then too much blood goes to the lungs.  This can sometimes cause problems in the lungs. However, this does not always occur.

There are many different types of atrial and ventricular septal defect, and your doctor will explain this carefully to you.

Causes:

There is normally no cause. Sometimes, it can be hereditary – it is in the family, and is passed to the child or children. Sometimes, it occurs with a genetic condition like Down’s Syndrome. Sometimes, there are factors in the environment, like the mother smoking. However, most of the time, doctors do not, as yet, know the causes for congenital septal defects.

 Diagnosis:

If the hole is big enough, it can be detected by ultrasound during pregnancy. However, many holes are fairly small, and cannot be detected on ultrasound. There will be other symptoms after birth that the doctor will look for. Sometimes, these are only picked up during adulthood.

 Symptoms

  • A heart murmur. This is called whooshing or swishing by doctors. It occurs between normal beats of the heart. It can be heard when the doctor examines the heart with a stethoscope. Sometimes, this is only discovered six to eight weeks after birth.
  • Difficulty breathing
  • Getting tired when feeding
  • Repeat chest infections
  • Shortness of breath, especially when a person is being active
  • Swelling of stomach, or legs, or feet
  • Skipping of heartbeat

Hole in the Heart

Once they notice the Symptoms doctors may include further tests:

  • Echocardiograph and Electrocardiogram: These looks at what the heart looks like inside and at the rhythm of the heart.
  • Chest x-ray: to see if the heart is enlarged.
  • Cardiac MRI: A big machine scans the chest to see the structure of the heart and whether there is a defect or not.
  • Pulse Oximetry: A small machine with a peg placed on the finger measures how much oxygen is in the blood.

Complications

  • Arrhythmias: This means an irregular heartbeat. This is from the atrium or ventricle stretching over time from the extra blood flowing into it.
  • Pulmonary Hypertension: this is when the pressure in the arteries that travel from your heart to your lungs is very high. This causes the arteries to become hard and not work well.
  • Heart Failure: One one side of the heart has to work extra hard to pump blood to your lungs, and this can cause too much strain on the heart, leading to this side of the heart not working well.
  • Stroke: The lungs normally filter out clots in the blood which are sent by the heart. However, if clots pass from the right to the left atrium via an Atrial Septal Defect, then these clots are pumped to the rest of the body and can go to an artery in the brain and cause a blockage. This is called a stroke.
  • Failure to grow: babies don’t grow well because their body sends all the energy to the heart and its needs.

Treatment

These holes can close up by themselves after a while, and there is no need for further treatment. Often, this is the first course of action of any doctor – to watch closely for several months or years before they decide if they need to do anything (surgery).

Treatment varies, and depends on a number of factors:

  • Size of the hole
  • The seriousness of the symptoms
  • Age of diagnosis
  • The seriousness of other conditions

Sometimes the person will need surgery to repair the hole in their heart. Sometimes, medication is needed to manage the symptoms. No medicine can cure a hole in the heart.

The doctor may recommend that a hole in the heart is closed by surgery even if there are no negative symptoms. This will be to prevent problems in adulthood.  However, for an adult, only if there are severe negative symptoms will they need surgery.

Surgery:

The type of surgery is cardiac catheterization or open-heart surgery. The surgeon will repair the hole with a device or a patch.

Cardiac catheterization:

This is when the surgeon inserts a thin tube inside a vein or artery in your arm, neck or leg. The tube runs all the way to the heart, and the surgeon can either just look at the heart via a camera, or do surgery via tools at the end of the catheter. A tiny object that looks like an umbrella is placed in the hole and opened out so that it plugs the hole. Natural tissue will grow over this and remain a permanent plug.

Open-heart surgery:

This is where the surgeon cuts the chest open while the child or adult is under anesthetic. They patch the hole with a patch and close up the heart and the chest again.

There are more complications from surgery, but most heal very well.

In summary, a person who has a hole in their heart can live a normal life, especially with the help of surgery, medication, or nutrition where needed. 

Sources of Support:

As a parent, or even as an adult, this can seem very concerning. You can find support through your health-care team.  In many countries, there is also a Heart Foundation. You will learn how to look after your child’s health, but not overprotect them. You will also have the advice of other people with heart conditions. You are not alone – there is always help available.

Always take a pen and paper to the doctor or to the support group – often the information can be overwhelming, and you can forget.