a hole in the heartis something that you're born with. that's what "congenital" means. it's something that's formedgenerally at about seven or eight weeks of pregnancy,so very early on. and then there areabout four different types. a patent foramen ovale, or pfo, is a hole betweenthe top two collecting chambers. it's a normal finding, in thatall babies in the womb have such a hole. after birth there is a piece of skinthat closes the hole.
and if it doesn't completely close over,that is termed a patent foramen ovale. if the patent foramen ovaleis less than three millimetres we regard itas an entirely normal finding. atrial septal defect, or asd, is a hole between the top two collectingchambers of the heart, the atria. this hole does not have any skin in itlike the pfo, and therefore blood can flowfrom one chamber to the other, putting strain on one side of the heartif the hole is big enough. the symptoms you getfrom an atrial septal defect are
breathlessness, tire on exercise,and sometimes it affects your growth. a ventricular septal defect, or vsd, is a hole between the two main pumpingchambers of the heart, the ventricles. this allows blood to flowfrom one chamber, the left ventricle, to the right ventricle. no blood goes outside the heart but it can put strainon one side of the heart if extra blood is flowing through it. an atrioventricular septal defect,or an avsd,
is a combination of a holebetween the upper two chambers and a hole betweenthe bottom two chambers, so asd and a vsd, but in additionthere is an abnormal valve. this is a much more severe lesion than the asd or the vsd, as it combines both features. there's multiple screening processesput into action to try and pick up these childrenas soon as possible.
once someone has heard a murmurin the heart we would very much like to seethat child for a cardiac evaluation within the first three or four monthsof life. sometimes the heart problems they mayhave may require immediate attention. the treatment of holes in the heartdepends on where they are. a small hole, such as pfo, or a small asd does not need any treatment. if the hole is larger,
so it's putting a degree of strainon the heart, then it is a good idea to treat that. usually these are closedbetween the ages of three and four. the treatment of an atrial septal defectdepends on the size and where it is. if it is a hole right at the top, then it's not possible to close thatfrom a keyhole approach. if the hole is in the middleof the heart, with good rims, then it is possible to close thatby device. what that means is thatunder anaesthetic
a needle is put into a veinat the top of the leg and a very, very small tube calleda catheter is passed up into the heart. down the middle of the catheteris passed a device. you can think of itas a double umbrella. this can be scrunched upas it goes up the catheter and when it comes out,it reforms into a double disc and these two discssit either side of the hole. and you leave that device in there. the procedure takes about 60 minutes.
by three months the device hascompletely been covered over by skin. after that you might need to havesome cardiac follow-up but your heart is essentially normal. the other treatmentof atrial septal defects where they're too largeor do not have good rims is surgical treatment. and surgical treatmentinvolves a general anaesthetic. a cut is made through the chest. the heart is then exposed
and then put ona heart-lung bypass machine. and that takes over the workof the pumping of the heart and the lung functions. the heart is then stopped, the surgeon then closes the hole. you're usually in hospitalfor three or four days. symptoms disappear within a coupleof months of doing the procedure. often the child has a growth spurt, they often put on a bit of weight,
they often havebetter exercise tolerance. and they are also less proneto chest infections. a ventricular septal defectmay require a surgical treatment. the surgeon would thenopen the heart itself, expose the hole, and then sew a patch into the holeto close the hole off. and the child would recover in hospitalover about five days. avsd is a much more severe disease. the treatment for this isgiving medicines called diuretics
to make you urinate out more, and a high-calorie feedto make sure you grow. but then between the agesof about three and five months the child would needto have a surgical repair. once the surgeon has exposed the heart,the holes are visualised. these are then closedand the valve is repaired. in the long termthese children do extremely well. they do need ongoing cardiac follow-up but once you've had an operationfor an atrial septal defect
or a ventricular septal defect, it's unusual to needany further operations. if someone has had an avsd repaired,they definitely need life-long follow-up because we need to watch the degreeof valve leak over the course of time. the prognosis for these typesof holes in the heart is excellent. either they're too smallto ever need anything doing or if they are big enoughto need any intervention, that will be dealt with and then the child would still havea near-normal life after that.
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