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device is secured in place and the catheter is withdrawn from the body.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.
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