Living With Holes in the Heart

The outlook for children who have atrial septal defects (ASDs) or ventricular septal defects (VSDs) is excellent. Advances in treatment allow most children who have these heart defects to live normal, active lives with no decrease in lifespan.

Many children who have these defects need no special care or only occasional checkups with a cardiologist (a heart specialist) as they go through life.

Living With an Atrial Septal Defect

Small ASDs often close on their own and don't cause problems or require treatment. Children and adults who have small ASDs that don't close and don't cause symptoms are healthy and don't need treatment.

Others who have ASDs that don't close may need catheter procedures or surgery to close the holes and prevent possible long-term problems. Children recover well from these procedures and lead normal, healthy lives. Adults also do well after closure procedures.

Ongoing Care

Arrhythmias. The risk of arrhythmias (irregular heartbeats) increases before and after surgery. Adults who have ASDs and are older than 40 are especially likely to have arrhythmias. People who had arrhythmias before surgery are more likely to have them after surgery.

Followup care. Routine followup care into adult life is advised for people who have had:

• An ASD repaired as an adult
• Arrhythmias before and after surgery
• An ASD repaired with a catheter procedure
• Pulmonary hypertension (increased pressure in the pulmonary arteries) at the time of surgery

Antibiotics. Children who have severe heart defects may be at slightly increased risk for infective endocarditis (IE). IE is a serious infection of the inner lining of the heart chambers and valves.

ASDs aren't associated with a risk of IE, except in the 6 months after repair (for both catheter procedures and surgery).

Your child's doctor or dentist may give your child antibiotics before medical or dental procedures (such as surgery or dental cleanings) that can allow bacteria into the bloodstream. Your child's doctor will tell you whether your child needs to take antibiotics before such procedures.

To reduce the risk of IE, gently brush your young child's teeth every day as soon as they begin to come in. As your child gets older, make sure he or she brushes every day and sees a dentist regularly. Talk with your child's doctor and dentist about how to keep your child's mouth and teeth healthy.

Special Considerations for Children and Teens

• Physical activity. Children who have a repaired or closed ASD have no restrictions on their activity.
• Growth and development. Children who have ASDs don't have growth or development problems.
• Ongoing care. Your child should see his or her regular doctor for routine health care.
• Additional surgery. When a child has an ASD but no other heart defects, additional surgery isn't needed.

Special Considerations for Adults

If you have an ASD repaired, your cardiologist or surgeon will explain what to expect during the recovery period. He or she will tell you when you can return to driving, working, exercising, and other activities.

Living With a Ventricular Septal Defect

Children who have small VSDs and no symptoms only need occasional followup with a cardiologist.

Children and adults who've had successful repair of VSDs and have no other congenital heart defects can expect to lead healthy, active lives.

Ongoing Care

Sometimes problems and risks remain after surgical closure. They include:

• Arrhythmias. Serious and frequent arrhythmias require regular medical followup. The risk of arrhythmias is greater if surgery is done later in life.
• Residual or remaining VSDs. This problem usually is caused by a leak at the edge of the patch used to close the hole. These VSDs tend to be very small and don't cause problems. They very rarely require another surgery.

Antibiotics. Children who have severe heart defects may be at slightly increased risk for IE. IE is a serious infection of the inner lining of the heart chambers and valves.

Your child's doctor or dentist may give your child antibiotics before medical or dental procedures (such as surgery or dental cleanings) that can allow bacteria into the bloodstream. Your child's doctor will tell you whether your child needs to take antibiotics before such procedures.

To reduce the risk of IE, gently brush your young child's teeth every day as soon as they begin to come in. As your child gets older, make sure he or she brushes every day and sees a dentist regularly. Talk with your child's doctor and dentist about how to keep your child's mouth and teeth healthy.

Special Considerations for Children and Teens

• Physical activity. Children who have small VSDs that don't require surgery or who have recovered from VSD repair shouldn't have activity restrictions. Be sure to check with your child's doctor about whether your child can take part in sports.
• Growth and development. Your pediatrician or family doctor will check your child's growth and development at each routine checkup. Babies who have large VSDs may not grow as quickly as other infants. These babies usually catch up after their VSDs are closed.
• Ongoing care. Your child should see his or her regular doctor for routine health care.
• Additional surgery. Teens and young adults rarely need additional surgery once VSDs are closed or repaired.

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