Hole in the Heart

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Do you know how your heart normally functions when it has the naturally retained heart anatomy? Let’s have a quick review!
Your heart is the engine of your body! Separated by the septum (inner walls), it has two sides (left and right) and further each side divided into atria and ventricle. As far as the function is concerned, it is “blood pumping”. And, yes, it is not as simple as it sounds. In simple words: The oxygen-poor blood is received to the right side of the heart from the body which is further pumped directly to the lungs. Now, coming to the left side, the heart receives oxygen-rich blood flowing from the lungs. The heart pumps and delivers this refreshed blood to the body. And it happens in EVERY heartbeat!

Hole in the Heart

The role of the septum is to act as a wall to keep oxygenated and deoxygenated blood from mixing. Well, some babies can be born with a septum having holes either in the upper or lower parts. This Congenital heart condition is called “the holes in heart at birth” and it can potentially change the course of the normal blood flow inside the heart.
It has two types: atrial septal defect (ASD) and ventricular septal defect (VSD). In both defects, the oxygenated blood is mixed with deoxygenated blood as it gets the free passage to flow from left to right and vice versa.
The result? A fraction of oxygen-rich blood starts getting pumped to the lungs rather than getting pumped to the body.
In most ASD cases, babies show no distinctive signs or symptoms. The very symptom the patient can experience is the “heart murmur”. A baby born with VSD will show certain symptoms majorly heart murmur, that may be present at the birth. The murmuring sounds tend to disappear after the baby is 6-8 weeks old. Babies having medium to large VSDs can show signs of heart failure.

 Atrial Septal Defect
ASD is defined as a defect where the baby is born with a hole in the septum separating the upper chambers of the heart (atria). The size can vary from small hole in heart to medium to large. But, no matter what the size is, the hole is always large enough to allow oxygenated blood flow from the left atrium to the right rather than flowing into the left ventricle following the normal physiology.

 Three major types

Secundum – Being the most common type, it affects the middle of the atrial septum. Surprisingly, half of all secundum is closed with the natural course of time. Primum – You would not find this defect so common and it affects the lower part of the atrial septum. Unfortunately, they require treatment and are not closed naturally.Sinus venosus – Affecting only the upper part of the atrial septum, it is the rarest type. Just like Primum, it stays open and needs medical procedures.


  • RHF (Right heart failure)
  • Irregular heartbeat/Arrhythmias
  • Stroke
  • Pulmonary hypertension (PH)

 Ventricular Septal Defect

If the newborn has a hole in the septum separating the lower chambers of the heart (ventricles), the condition is called VSD, where the oxygenated blood flows from the justify to the right ventricle rather than going to the body where it must flow naturally.

Do you know the child can have more than one hole in the septum at a time? It only complicates the heart function.

 Three major types

  • Membranous – Closest to the heart valves, it gets close at any time without needing any additional treatment.
  • Muscular – Affecting the lower part of the septum, it usually gets closed during early childhood. The child will not need any outside treatment.
  • Inlet and Outlet – Only targeting the part of the ventricle or the point blood leaving the heart. And it is the rarest type.


  • Heart failure
  • Infancy Growth failure
  • Irregular heartbeat/Arrhythmias
  • Pulmonary hypertension (PH)
  • Endocarditis

 How the sizes play the part in complications?

  1. Patients with a small ASD and VSD will not require any extra medical attention as they do not affect the normal functioning of the heart. Besides, during childhood, they can be closed on their own.
  2. Children with small VSDs also named restrictive VSDs do not show any symptoms.
  3. Medium to large ASDs usually do not close naturally. Because of the larger size, more blood tends to mix causing complications.
  4. Medium VSDs do not show the tendency to get closed on their own. They may show symptoms during infancy or childhood.
  5. Large VSDs also called nonrestrictive VSDs cause more complications and do not close completely, but there are chances of the hole getting smaller.

 How is the diagnosis performed? 

The expert cardiologists should be asked for instant guidance and an overall checkup. Pediatric cardiologists must be held accountable for diagnosing heart problems. Here are the ways to diagnose the hole in the heart.

  1. A comprehensive physical examination where the doctor will listen to the infant’s heart and lungs for a heart murmur.
  2. Echocardiography is another painless assessment to see the heart’s structure. It is important for diagnosing a hole as well as contemplating the possible heart problems that could develop over time.
  3. An EKG is performed to evaluate the heart’s electrical activity telling how slow or fast the child’s heart is beating.
  4. Chest X-ray to get the pictures of the heart anatomy. It will show if the size of the heart is unnecessarily big or small.
  5. Pulse Oximetry will provide information about oxygen present in the blood.
  6. Cardiac Catheterization is a painless but critical test where a catheter is inserted inside a vein and threaded to the heart to release a special dye. It helps you observe the flow of blood through the heart and vessels.


Do you know, what are the basic factors that must be considered before deciding or carrying out the “Closures of atrial septal defects (ASD) and ventricular septal defect”?

  • Age
  • Severity of symptoms
  • Hole size
  • Comorbidities

The possible treatment options are:

  1. Medications
  2. Open-heart surgery – Mostly used for primum and sinus venosus ASDs
  3. Catheter procedures – The easiest and preferable treatment with faster recovery time

 Risks associated with ASD and VSD repair

  • Allergic reaction
  • Arrhythmia
  • Bruising
  • Bleeding
  • Infection
  • Embolus
  • Device getting dislodged