Key Points

• A hole in the heart is a type of simple congenital heart defect (a problem with the heart's structure that's present at birth). Congenital heart defects change the normal flow of blood through the heart.
• The heart has two sides, which are separated by an inner wall called the septum. An atrial septal defect (ASD) is a hole in the upper part of the septum, which separates the atria. A ventricular septal defect (VSD) is a hole in the lower part of the septum, which separates the ventricles.
• ASDs and VSDs allow oxygen-rich blood from the left side of the heart to mix with oxygen-poor blood from the right side of the heart, increasing the flow of blood out of the heart to the lungs.
• ASDs and VSDs can be small or large. Many small ASDs and VSDs close on their own as the heart grows during childhood. Large holes in the septum are less likely to close on their own over time.
• Doctors don't know what causes most holes in the heart.
• A heart murmur (an extra flow sound associated with the heartbeat) is the most common sign of both ASD and VSD. Sometimes, it's the only sign.
• Many babies born with ASDs have no signs or symptoms.
• Children with small VSDs also have no symptoms, but babies with large VSDs can have symptoms of heart failure.
• ASDs and VSDs are usually diagnosed based on results from a physical exam and special tests.
• Echocardiography is commonly used to diagnose ASD and VSD. Other tests include EKG (electrocardiogram), chest x ray, pulse oximetry, and cardiac catheterization.
• Depending on where the hole is located and how large it is, treatment may be needed. Catheter procedures and surgery are used to treat holes in the heart.
• With new advances in testing and treatment, most children with holes in the heart grow into adulthood and lead normal, healthy, and productive lives.