| Sometimes a baby
is born with a hole in the septum. (The septum
is the wall that separates the left and right sides of the heart). This
defect is sometimes referred to as a “hole in the heart”. A defect
may be between the two upper chambers or atria (atria
septal defect, see figure) or between
the two lower chambers or ventricles (ventricular
septal defect, see figure). Sometimes,
both upper and lower chambers are involved. If
a septal defect is small it doesn’t hurt the heart. In that
case, the only abnormal finding is a heart murmur. This type of
murmur is different than an “innocent murmur” because it indicates
something is different about the heart. Closing these small defects
with surgery is usually not needed. In fact, they often close
on their own.
When there is a large defect, a significant
amount of oxygen-rich (red) blood from the left side of the
heart flows into the right side and is then pumped back to the
lungs. This causes an extra
load on the heart and lungs.
In this situation the heart may become over-worked
and enlarged. If
untreated the extra work causes the heart muscle to tire and over
time it may fail. Closing the defect by open-heart surgery in childhood
usually prevents serious problems later in life.
Atrial Septal Defects (ASD) Many children with atrial septal
defects have few, if any, symptoms. A
small hole does not allow enough blood to pass through to cause
a child any problems. If the opening remains large, open-heart
surgery, or non-surgical closure, is recommended to prevent serious
problems. The long-term outlook for a corrected atrial septal defect
is excellent.
Ventricular Septal Defects (VSD) Symptoms of a ventricular septal
defect may not occur until several weeks after birth. Some babies with a large ventricular septal
defect don’t grow normally and may become undernourished. Babies
with VSD may also develop respiratory symptoms (grunting or rapid
breathing) due to an increased workload on the heart and lungs.
Over time, this may cause permanent damage to vessels in the lungs.
Closing a large VSD by open-heart surgery
usually is done in infancy or early childhood even in patients
with few symptoms. If
completed before permanent damage has occurred to the lungs, correction
of a VSD prevents later complications. Early repair is often necessary,
but may be delayed in some babies for other reasons.
When a VSD is large enough for surgery, it
usually requires a cloth patch sewn over it to close it completely. The
patch is eventually covered by the normal heart lining tissue
and becomes
a permanent part of the heart.
Repairing a VSD with surgery usually restores
the blood circulation to normal. Patients do very well in the long term. After
surgery a child must be examined regularly by a pediatric cardiologist
to make sure that the heart is working normally.
Children with a VSD risk getting an infection
of the heart’s
walls or valves (endocarditis). To prevent this, a child should
take antibiotics such as amoxicillin before dental work and certain
surgeries. After a VSD has been successfully repaired with surgery,
your child may no longer need these antibiotics. Good dental hygiene
also helps lower the risk of endocarditis. For more information
about dental hygiene and preventing endocarditis, ask your pediatric
cardiologist.
Figures and Text Adapted from “If Your Child has a Congenital
Heart Defect” by the American Heart Association |
