Thursday 26 December 2013

Heart Defects Treatment Options available in India – Types and Treatment for Holes in the Heart


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.
These problems develop over many years and don't occur in children. They also are rare in adults because most ASDs either close on their own or are repaired in early childhood.

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.
VSDs can be small or large. Small VSDs don't cause problems and often may close on their own. Because small VSDs allow only a small amount of blood to flow between the ventricles, they're sometimes called restrictive VSDs. Small VSDs don't cause any symptoms. Medium VSDs are less likely to close on their own. They may require surgery to close and may cause symptoms during infancy and childhood.
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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