Many holes in the heart don't need treatment, but some do. Those that do often are repaired during infancy or early childhood. Sometimes adults are treated for holes in the heart if problems develop.
The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health.
Treating an Atrial Septal Defect
If a child 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.
Your child's doctor will let you know how often your child should have checkups. For an ASD, frequent checkups aren't needed.
If an ASD requires treatment, catheter or surgical procedures are used to close the hole. Doctors often decide to close ASDs in children who still have medium- or large-sized holes by the time they're 2 to 5 years old.
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 It's secured in place and the catheter is withdrawn from the body.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. The closure device does not need to be replaced as the child grows.
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.
The outlook for children having this procedure is excellent. Closures are successful in more than 9 out of 10 patients, with no major leakage. Rarely, a defect is too large for catheter closure and surgery is needed.
Open-heart surgery generally is done to repair primum or sinus venosus ASDs. Before the surgery, your child is given medicine so he or she will sleep and not feel any pain.
Then, the cardiac surgeon makes an incision (cut) in the chest to reach the ASD. He or she repairs the defect with a special patch that covers the hole. A heart-lung bypass machine is used during the surgery so the surgeon can open the heart. The machine takes over the heart's pumping action and moves blood away from the heart.
The outlook for children who have ASD surgery is excellent. On average, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, are very rare.
In some children, the outer lining of the heart may become inflamed. This condition is called pericarditis (PER-i-kar-DI-tis). The inflammation causes fluid to collect around the heart in the weeks after surgery. Medicine usually can treat this condition.
While in the hospital, your child will be given medicine as needed to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home.
They will talk about preventing blows to the chest as the incision heals, limiting activity while your child recovers, bathing, scheduling ongoing care, and deciding when your child can go back to his or her regular activities.
Treating a Ventricular Septal Defect
Doctors may choose to monitor children who have ventricular septal defects (VSDs) but no symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on its own or gets smaller.
More than half of VSDs eventually close, usually by the time children are in preschool. Your child's doctor will let you know how often your child needs checkups. Checkups may range from once a month to once every 1 or 2 years.
If treatment for a VSD is required, options include extra nutrition and surgery to close the VSD. Doctors also can use catheter procedures to close some VSDs. They may use this approach if surgery isn't possible or doesn't work. More research is needed to find out the risks and benefits of using catheter procedures to treat VSDs.
Some infants who have VSDs don't grow and develop or gain weight as they should. These infants usually:
- Have large VSDs
- Are born too early
- Tire easily during feeding
Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give babies extra nourishment.
Some infants need tube feeding. A small tube is inserted into the mouth and moved down into the stomach. Food is given through the tube.
Tube feeding can add to or take the place of bottle feeding. This treatment often is short-term because a VSD that causes symptoms will likely require surgery.
Most doctors recommend surgery to close large VSDs that are causing symptoms, affecting the aortic valve, or haven't closed by the time children are 1 year old. Surgery may be needed earlier if:
- A child doesn't gain weight
- 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.