What Are Holes
in the Heart?
Holes
in the heart are simple congenital heart defects. Congenital heart defects are
problems with the heart's structure that are present at birth. These defects
change the normal flow of blood through the heart.
Your
heart has two sides, separated by an inner wall called the septum. With each
heartbeat, the right side of your heart receives oxygen-poor blood from your
body and pumps it to your lungs. The left side of your heart receives
oxygen-rich blood from your lungs and pumps it to your body. The septum
prevents mixing of blood between the two sides of the heart. However, some
babies are born with holes in the upper or lower septum.
A
hole in the septum between the heart's two upper chambers is called an atrial
septal defect (ASD). A hole in the septum between the heart's two lower
chambers is called a ventricular septal defect (VSD).
ASDs
and VSDs allow blood to pass from the left side of the heart to the right side.
This means that oxygen-rich blood can mix with oxygen-poor blood. As a result,
some oxygen-rich blood is pumped to the lungs instead of out to the body.
Over
the past few decades, the diagnosis and treatment of ASDs and VSDs have greatly
improved. Children who have simple congenital heart defects can survive to
adulthood and live normal, active, and productive lives because their heart
defects close on their own or have been repaired.
Types of Holesin the Heart
Atrial Septal
Defect
An atrial
septal defect (ASD) is a hole in the part of the septum that separates the
atria (the upper chambers of the heart). This hole allows oxygen-rich blood
from the left atrium to flow into the right atrium instead of flowing into the
left ventricle as it should. This means that oxygen-rich blood gets pumped back
to the lungs, where it has just been, instead of going to the body.
Cross-Section
of a Normal Heart and a Heart with an Atrial Septal Defect
The
normal structure and blood flow in the interior of the heart. Figure B shows a
heart with an atrial septal defect. The hole allows oxygen-rich blood from the
left atrium to mix with oxygen-poor blood from the right atrium. An ASD can be
small or large. Small ASDs allow only a little blood to flow from one atrium to
the other. Small ASDs don't affect the way the heart works and don't need any
special treatment. Many small ASDs close on their own as the heart grows during
childhood.
Medium to large
ASDs allow more blood to leak from one atrium to the other, and they're less
likely to close on their own. Most children who have ASDs have no symptoms,
even if they have large ASDs.The three major types of ASDs are:
- Secundum. This
defect is in the middle of the atrial septum. It's the most common form of
ASD. About 8 out of every 10 babies born with ASDs have secundum defects.
At least half of all secundum ASDs close on their own. However, this is
less likely if the defect is large.
- Primum. This defect
is in the lower part of the atrial septum. It often occurs along with
problems in the heart valves that connect the upper and lower heart
chambers. Primum defects aren't very common, and they don't close on their
own.
- Sinus venosus. This
defect is in the upper part of the atrial septum, near where a large vein
(the superior vena cava) brings oxygen-poor blood from the upper body to
the right atrium. Sinus venosus defects are rare, and they don't close on
their own.
AtrialSeptal Defect Complications
Over time, if
an ASD isn't repaired, the extra blood flow to the right side of the heart and
lungs may cause heart problems. Usually, most of these problems don't show up
until adulthood, often around age 30 or later. Complications are rare in
infants and children.Possible complications include:
- Right heart
failure. An ASD causes the right side of the heart to work harder because
it has to pump extra blood to the lungs. Over time, the heart may become
tired from this extra work and not pump well.
- Arrhythmias
(ah-RITH-me-ahs). Extra blood flowing into the right atrium through an ASD
can cause the atrium to stretch and enlarge. Over time, this can lead to
arrhythmias (irregular heartbeats). Arrhythmia symptoms may include
palpitations or a rapid heartbeat.
- Stroke. Usually,
the lungs filter out small blood clots that can form on the right side of
the heart. Sometimes a blood clot can pass from the right atrium to the
left atrium through an ASD and be pumped out to the body. This type of clot
can travel to an artery in the brain, block blood flow, and cause a
stroke.
VentricularSeptal Defect
A ventricular
septal defect (VSD) is a hole in the part of the septum that separates the
ventricles (the lower chambers of the heart). The hole allows oxygen-rich blood
to flow from the left ventricle into the right ventricle instead of flowing
into the aorta and out to the body as it should.
Cross-Section
of a Normal Heart and a Heart With a Ventricular Septal Defect
The
normal structure and blood flow in the interior of the heart. two common
locations for a ventricular septal defect. The defect allows oxygen-rich blood
from the left ventricle to mix with oxygen-poor blood in the right ventricle.
An infant who is born with a VSD may have a single hole or more than one hole
in the wall that separates the two ventricles. The defect also may occur by
itself or with other congenital
heart defects.
Doctors
classify VSDs based on the:- Size of the defect.
- Location of the
defect.
- Number of defects.
- Presence or absence
of a ventricular septal aneurysm-a thin flap of tissue on the septum. This
tissue is harmless and can help a VSD close on its own.
Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle. They're sometimes called nonrestrictive VSDs. A large VSD is less likely to close completely on its own, but it may get smaller over time. Large VSDs often cause symptoms in infants and children, and surgery usually is needed to close them.
VSDs are found in different parts of the septum.
- Membranous VSDs are
located near the heart valves. These VSDs can close at any time.
- Muscular VSDs are
found in the lower part of the septum. They're surrounded by muscle, and
most close on their own during early childhood.
- Inlet VSDs are
located close to where blood enters the ventricles. They're less common
than membranous and muscular VSDs.
- Outlet VSDs are
found in the part of the ventricle where blood leaves the heart. These are
the rarest type of VSD.
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