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This is a hole between the two pumping chambers (ventricles). It allows some oxygenated blood to pass from the left side back into the right side and through the lungs. The amount of abnormal blood flow depends on the size and site of the hole as well as the pressure difference between the two sides of the heart.
If the hole is small, the child is well and there are no problems. If the hole is moderate, the extra blood in the lungs makes them heavy and the child may breathe quickly, be slow to feed with poor weight gain, and have increased chest infections. These complaints are more marked if the hole is large.
The children with medium or large holes require medications, those with small ones do not. Echocardiography can show where it is, how big it is and often give an indication of whether it will close by itself.
Most holes will close spontaneously or get significantly smaller. Some will not and will require operation. The usual indications for operation are:
Failure to thrive adequately, despite medication in the first year of life.
The worry about high blood pressure in the lung arteries.
The persistence of a large blood flow into the lungs at over 7 years of age.
Development of a leaking aortic valve related to the hole.
Development of extra muscle in the right ventricle secondary to the abnormal blood flow.
Atrial Septal Defect
This is a hole between the two receiving chambers which allows blood from the left side to pass back to the right side and into the lungs.
There are three types: the commonest is in the middle of the atrial septum (the secundum defect). Sometimes it is in the lower part of the septum (the primum defect) and is associated with an abnormality (often a leak) of the mitral valve. Occasionally, it is in the top of the septum (the sinus venosus defect) associated with an abnormality of the right upper lung vein.
Usually children have no symptoms, and a routine examination finds a murmur present Occasionally, there is poor weight gain and failure to thrive.
Small defects that allow little blood to shunt from one side of the heart to the other often cause no problems. Such defects in the middle portion of the septum may close spontaneously in young children.
Moderate and large defects do not close by themselves, and the extra work which has t be done by the heart over many years into adult life causes a strain on its right side, with enlargement of the receiving chamber and pump chamber. As a result, the heart gets tired in middle life. The result of repairing the defect at that age are not as good as when undertaken earlier. The plan, therefore is to close these defects during childhood.
Many which are in the mid portion of the atrial septum, have good margins, are free from adjacent structures and are not too large, can be closed by a plastic and metal device, or a plug inserted at cardiac catheterisation.
In others, the defect will be too large or adjacent to important structures. This needs to be closed by open heart surgery either by direct suture or with a patch