What Are Holes in the Heart?

Holes in the heart are simple congenital (kon-JEN-ih-tal) heart defects. Congenital heart defects are problems with the heart’s structure that are present at birth. These defects change the normal flow of blood through the heart.

The heart has two sides, separated by an inner wall called the septum. With each heartbeat, the right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the body.

The septum prevents mixing of blood between the two sides of the heart.

A hole in the septum between the heart’s two upper chambers is called an atrial septal defect (ASD). A hole in the septum between the heart’s two lower chambers is called a ventricular septal defect (VSD).

ASDs and VSDs allow blood to pass from the left side of the heart to the right side. Thus, oxygen-rich blood mixes with oxygen-poor blood. As a result, some oxygen-rich blood is pumped to the lungs instead of the body.

Over the past few decades, the diagnosis and treatment of ASDs and VSDs have greatly improved.

How Are Holes in the Heart Treated?

Many holes in the heart don’t need treatment, but some do.

Treating an Atrial Septal Defect

If someone has an atrial septal defect (ASD), routine checkups are done to see whether it closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life.

For an ASD, frequent checkups aren’t needed.

If an ASD requires treatment, catheter or surgical procedures are used to close the hole.

Catheter Procedure

Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, doctors can use catheter procedures to close secundum ASDs. These are the most common type of ASD.

Before a catheter procedure, your child is given medicine so he or she will sleep and not feel any pain. Then, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh). He or she threads the tube to the heart’s septum. A device made up of two small disks or an umbrella-like device is attached to the catheter.

When the catheter reaches the septum, the device is pushed out of the catheter. The device is placed so that it plugs the hole between the atria. It’s secured in place and the catheter is withdrawn from the body.

Within 6 months, normal tissue grows in and over the device.

Doctors often use echocardiography (echo), transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE), and coronary angiography (an-jee-OG-rah-fee) to guide them in threading the catheter to the heart and closing the defect. TEE is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from the mouth to the stomach.

Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin where the catheter is inserted. This means that recovery is faster and easier.

Surgery

Most doctors recommend surgery to close large VSDs that are causing symptoms, or affecting the aortic valve. Surgery may be needed earlier if medicines are needed to control the symptoms of heart failure.

Rarely, medium-sized VSDs that are causing enlarged heart chambers are treated with surgery after infancy. However, most VSDs that require surgery are repaired in the first year of life. Doctors use open-heart surgery and patches to close VSDs.

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.