A hole in the heart

A hole in the heart
is something that you're born with.

That's what "congenital" means.

It's something that's formed
generally at about

seven or eight weeks of pregnancy,
so very early on.

And then there are
about four different types.

A patent foramen ovale, or PFO,

is a hole between
the top two collecting chambers.

It's a normal finding, in that
all babies in the womb have such a hole.

After birth there is a piece of skin
that closes the hole.

And if it doesn't completely close over,
that is termed a patent foramen ovale.

If the patent foramen ovale
is less than three millimetres

we regard it
as an entirely normal finding.

Atrial septal defect, or ASD,

is a hole between the top two collecting
chambers of the heart, the atria.

This hole does not have any skin in it
like the PFO,

and therefore blood can flow
from one chamber to the other,

putting strain on one side of the heart
if the hole is big enough.

The symptoms you get
from 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 pumping
chambers of the heart, the ventricles.

This allows blood to flow
from one chamber, the left ventricle,

to the right ventricle.

No blood goes outside the heart

but it can put strain
on one side of the heart

if extra blood is flowing through it.

An atrioventricular septal defect,
or an AVSD,

is a combination of a hole
between the upper two chambers

and a hole between
the bottom two chambers,

so ASD and a VSD,

but in addition
there 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 processes
put into action

to try and pick up these children
as soon as possible.

Once someone has heard a murmur
in the heart

we would very much like to see
that child for a cardiac evaluation

within the first three or four months
of life.

Sometimes the heart problems they may
have may require immediate attention.

The treatment of holes in the heart
depends 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 strain
on the heart,

then it is a good idea to treat that.

Usually these are closed
between the ages of three and four.

The treatment of an atrial septal defect
depends on the size and where it is.

If it is a hole right at the top,

then it's not possible to close that
from a keyhole approach.

If the hole is in the middle
of the heart, with good rims,

then it is possible to close that
by device.

What that means is that
under anaesthetic

a needle is put into a vein
at the top of the leg

and a very, very small tube called
a catheter is passed up into the heart.

Down the middle of the catheter
is passed a device.

You can think of it
as a double umbrella.

This can be scrunched up
as it goes up the catheter

and when it comes out,
it reforms into a double disc

and these two discs
sit either side of the hole.

And you leave that device in there.

The procedure takes about 60 minutes.

By three months the device has
completely been covered over by skin.

After that you might need to have
some cardiac follow-up

but your heart is essentially normal.

The other treatment
of atrial septal defects

where they're too large
or do not have good rims

is surgical treatment.

And surgical treatment
involves a general anaesthetic.

A cut is made through the chest.

The heart is then exposed

and then put on
a heart-lung bypass machine.

And that takes over the work
of the pumping of the heart

and the lung functions.

The heart is then stopped,

the surgeon then closes the hole.

You're usually in hospital
for three or four days.

Symptoms disappear within a couple
of months of doing the procedure.

Often the child has a growth spurt,

they often put on a bit of weight,

they often have
better exercise tolerance.

And they are also less prone
to chest infections.

A ventricular septal defect
may require a surgical treatment.

The surgeon would then
open the heart itself,

expose the hole,

and then sew a patch into the hole
to close the hole off.

And the child would recover in hospital
over about five days.

AVSD is a much more severe disease.

The treatment for this is
giving medicines called diuretics

to make you urinate out more,

and a high-calorie feed
to make sure you grow.

But then between the ages
of about three and five months

the child would need
to have a surgical repair.

Once the surgeon has exposed the heart,
the holes are visualised.

These are then closed
and the valve is repaired.

In the long term
these children do extremely well.

They do need ongoing cardiac follow-up

but once you've had an operation
for an atrial septal defect

or a ventricular septal defect,

it's unusual to need
any further operations.

If someone has had an AVSD repaired,
they definitely need life-long follow-up

because we need to watch the degree
of valve leak over the course of time.

The prognosis for these types
of holes in the heart is excellent.

Either they're too small
to ever need anything doing

or if they are big enough
to need any intervention,

that will be dealt with

and then the child would still have
a near-normal life after that.