The worst nightmare for a parent is to discover that their child has a heart hole. heart hole is an abnormal opening in the wall that separates the left and right chambers. It is a form of congenital heart defect that is present at birth and changes the normal flow of blood to the heart and hence, can be potentially dangerous depending on the situation. While we all wish for no one to ever experience this condition, but as a responsible parent, one must know when to act and thus, it is imperative to understand what a heart hole means, its symptoms, causes, types, and treatment.

Types of heart hole

Atrial Septal Defect or ASD: This type of heart hole is present in the portion of the septum that separates the right and left chambers of the heart, causing oxygen-rich blood from the left chamber (atrium) to flow into the right chamber rather than flowing into the left ventricle as per normal process. This leads to oxygen-rich blood flowing back into the lungs instead of flowing into the body. ASD could be small or large depending on condition. A small ASD is often harmless and does not require any special treatment, in fact closes on its own as the child grows. Whereas a large ASD cause more blood leakage and could cause potential harm to the baby. These heart holes do not fill up on their own instead require special treatment and care. Most of the cases do not show any signs of a heart hole up until 30 years or later. But if a large ASD is not repaired in time, it might cause right heart failure, irregular heartbeats, stroke, pulmonary hypertension leading to sever complications.

Ventricular Septal Defect or VSD:  A VSD is a type of heart hole where there is an opening in the septum that divides the lower chambers of the heart – the ventricles. This heart hole causes the oxygen-rich blood from the left ventricle to flow into the right ventricle and mix up with the oxygen-poor blood, instead of flowing out of the body through the aorta. A baby might have more than one VSD but in most cases, VSD close as the baby grows up and do not cause any trouble. Large size VSD, however, might cause some symptoms and would require surgery if they do not close on their own. A large VSD could result in heart failure, growth failure, irregular heartbeats, and pulmonary hypertension.

Symptoms of heart hole

Symptoms of a heart hole may not be evident until adulthood and hence, vary on the severity of the situation and the type of heart hole – ASD or VSD. However, in general cases, there is a heart murmur which indicates a heart hole, though not all heart murmurs are an indication of heart hole. More so, symptoms that can potentially indicate a hole in baby’s heart include:

  • Fatigue
  • Extreme tiredness during normal physical activity
  • Shortness of breath
  • Blood and fluid buildup in lungs
  • Fluid accumulation in feet, ankles and legs
  • Irregular heartbeats
  • Low appetite
  • Poor growth

Causes of heart hole

heart hole be it ASD or VSD is a birth defect and is often present at the time of birth and could have formed due to improper development. These are also referred to as congenital heart defects. The clear cause of a heart hole or a hole in baby’s heart cannot be defined. It may be due to hereditary reasons where the parent has a history of heart problem or a congenital heart defect, though this is a very rare case. However, smoking during pregnancy has been highly related to congenital heart problems. Also, a heart hole may be caused due to presence of extra or missing pieces of chromosomes in the baby at the time of formation. Moreover, genetic disorders, such as Down syndrome are also linked to heart hole problems.

Treatment of heart hole

In many cases, a hole in baby’s heart closes on its own as they grow. While in some cases, where trouble symptoms of the heart hole begin to show, treatment becomes necessary depending on the type of hole, locations, size, age of the child, general health, etc.

Most heart holes only need periodic check-ups to check the position of heart hole closure over time. The doctor will advise on the frequency of check-ups depending per case. In many cases (especially non-complicated, small VSDs), proper nutrition also helps close the hole in baby’s heart. In other complicated cases, the doctors might follow either of two treatment options:

Catheter Procedure: In this procedure, a thin, flexible tube is inserted into blood vessel in the leg that reaches that heart. This tube has a small device folded inside, which is pushed out of the catheter when the catheter reaches the septum and placed to cover the heart hole. Within 6 months, normal tissue grows over the device. This is a fairly simple procedure which is also less stressful for the patient. The recovery period is short and fast.

Surgery: Often the last resort, an open-heart surgery is done to repair a heart hole that causes problematic symptoms and is showing no signs of closure on its own. The surgery requires an incision to be made in the chest of the patient, to repair the defect with a special patch to cover the heart hole. The child is then placed on a heart-lung bypass and surgery is performed. The recovery is about 3-4 days long and includes precautions, medications, and utmost care.

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