How Are Holes in the Heart Treated?

Although many holes in the heart don't need treatment, some do. These days, most holes in the heart that need treatment are repaired in 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 Atrial Septal Defect

Periodic checkups are done to see whether the defect 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 recommend how often your child should be checked. For an ASD, frequent checkups aren't needed. When treatment of an ASD is required, it involves catheter or surgical procedures to close the hole.

Catheter or Surgical Procedures To Repair ASD

Doctors often decide to close an ASD in children who still have medium to large holes by the time they are 2 to 5 years old.

Catheter procedure. Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, catheter procedures can be used to close secundum ASDs, which are the most common type of ASD. This procedure is done under general anesthesia, so the child sleeps throughout and doesn't feel any pain.

During the procedure, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh) and threads it to the heart's septum. The catheter has a tiny umbrella-like device folded up inside it. When the catheter reaches the septum, the device is pushed out of the catheter and positioned so that it plugs the hole between the atria. The device is secured in place and the catheter is withdrawn from the body. Within 6 months, normal tissue grows in and over the device. There is no need to replace the closure device as the child grows.

Doctors often use echocardiography or a transesophageal (trans-e-SOF-ah-ge-al) echocardiography (TEE) as well as angiography to guide them in threading the catheter to the heart and closing the defect. A TEE is a special type of echocardiography that takes pictures of the heart through the esophagus (the tube leading from the mouth to the stomach).

Catheter procedures are much easier than surgery on patients because 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 significant leakage. Rarely, a defect is too large for catheter closure, so surgery is needed.

Surgery. Open-heart surgery is generally done to repair primum or sinus venosus ASDs. General anesthesia is used so the child will sleep through the operation and not feel any pain.

During this procedure, the surgeon makes an incision in the chest to reach the ASD and repairs the defect with a special patch that covers the hole. The child is placed on a heart-lung bypass machine so that the heart can be opened to perform the operation.

The outlook for children after ASD surgery is excellent. On average, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, from ASD surgery are very rare. Some children may develop inflammation of the outer lining of the heart, causing fluid to collect around the heart in the weeks after surgery. This is a reaction to the heart operation and usually resolves with medicine.

While in the hospital, the child is given medicines as needed to reduce pain or anxiety. The doctors and nurses at the hospital teach parents how to care for the child at home. They will talk about preventing blows to the chest as the incision heals, limiting activity while the child recovers, bathing, scheduling followup appointments with the doctor, and determining when the child can resume regular activities.

Treating Ventricular Septal Defect

The doctor may choose to monitor and observe a child with VSD who doesn't have symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on it own or gets smaller. More than half of VSDs eventually close, usually by the time a child is in preschool. Your child's doctor will recommend how often your child should be checked, ranging from monthly checkups to checkups every 1 or 2 years.

When treatment for VSD is required, options include extra nutrition and surgery to close the VSD.

Surgical treatment is needed if a child's VSD:

• Is large
• Is causing your child to have symptoms
• Is medium-sized and is causing enlargement of the heart chambers
• Affects the aortic valve

Extra Nutrition

Some infants with VSDs don't grow and develop or gain weight as they should. These infants usually:

• Have large VSDs
• Are born prematurely
• 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 the baby extra nourishment.

In some cases, tube feeding is needed. Food is given through a small tube that is placed through the nose into the stomach. Tube feeding can add to or take the place of bottle feeding. This treatment is usually temporary, because a VSD that causes symptoms will likely need surgery.

Surgery To Repair VSDs

Today, most doctors recommend surgery to close a large VSD that's causing symptoms or hasn't closed by 1 year of age. Surgery may be required earlier if:

• The child fails to gain weight
• Medicines are required to control the symptoms of heart failure

Rarely, a medium-sized VSD that's causing enlargement of the heart chambers is treated with surgery after infancy. However, most VSDs that need surgery are repaired in the first year of life.