Question: What causes Holes in the Heart ?
Answer: Mothers of children who are born with atrial septal defects (ASDs), ventricular septal defects (VSDs), or other heart defects may think they did something wrong during their pregnancies. However, most of the time, doctors don't know why congenital heart defects occur. Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect is slightly more likely than other people to have a child who has the problem. Very rarely, more than one child in a family is born with a heart defect. Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. Half of all babies who have Down syndrome have congenital heart defects. Smoking during pregnancy also has been linked to several congenital heart defects, including septal defects. Scientists continue to search for the causes of congenital heart defects.
Source: NHLBI

Question: What are the symptoms of Holes in the Heart ?
Answer: Atrial Septal Defect Many babies who are born with atrial septal defects (ASDs) have no signs or symptoms. However, as they grow, these children may be small for their age. When signs and symptoms do occur, a heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat. Often, a heart murmur is the only sign of an ASD. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Doctors can listen to heart murmurs and tell whether they're harmless or signs of heart problems. If a large ASD isn't repaired, the extra blood flow to the right side of the heart can damage the heart and lungs and cause heart failure. This generally doesn't occur until adulthood. Signs and symptoms of heart failure include: Fatigue (tiredness) Tiring easily during physical activity Shortness of breath A buildup of blood and fluid in the lungs Swelling in the ankles, feet, legs, abdomen, and veins in the neck Ventricular Septal Defect Babies born with ventricular septal defects (VSDs) usually have heart murmurs. Murmurs may be the first and only sign of a VSD. Heart murmurs often are present right after birth in many infants. However, the murmurs may not be heard until the babies are 6 to 8 weeks old. Most newborns who have VSDs don't have heart-related symptoms. However, babies who have medium or large VSDs can develop heart failure. Signs and symptoms of heart failure usually occur during the baby's first 2 months of life. The signs and symptoms of heart failure due to VSD are similar to those listed above for ASD, but they occur in infancy. A major sign of heart failure in infancy is poor feeding and growth. VSD signs and symptoms are rare after infancy. This is because the defects either decrease in size on their own or they're repaired.
Source: NHLBI

Question: How to diagnose Holes in the Heart ?
Answer: Doctors usually diagnose holes in the heart based on a physical exam and the results from tests and procedures. The exam findings for an atrial septal defect (ASD) often aren't obvious. Thus, the diagnosis sometimes isn't made until later in childhood or even in adulthood. Ventricular septal defects (VSDs) cause a very distinct heart murmur. Because of this, a diagnosis usually is made in infancy. Specialists Involved Doctors who specialize in diagnosing and treating heart problems are called cardiologists. Pediatric cardiologists take care of babies and children who have heart problems. Cardiac surgeons repair heart defects using surgery. Physical Exam During a physical exam, your child's doctor will listen to your child's heart and lungs with a stethoscope. The doctor also will look for signs of a heart defect, such as a heart murmur or signs of heart failure. Diagnostic Tests and Procedures Your child's doctor may recommend several tests to diagnose an ASD or VSD. These tests also will help the doctor figure out the location and size of the defect. Echocardiography Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. The sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen. Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working. Echo is an important test for both diagnosing a hole in the heart and following the problem over time. Echo can show problems with the heart's structure and how the heart is reacting to the problems. This test will help your child's cardiologist decide whether and when treatment is needed. EKG (Electrocardiogram) An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart. An EKG can detect whether one of the heart's chambers is enlarged, which can help diagnose a heart problem. Chest X Ray A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart, lungs, and blood vessels. This test can show whether the heart is enlarged. A chest x ray also can show whether the lungs have extra blood flow or extra fluid, a sign of heart failure. Pulse Oximetry Pulse oximetry shows the level of oxygen in the blood. A small sensor is attached to a finger or ear. The sensor uses light to estimate how much oxygen is in the blood. Cardiac Catheterization During cardiac catheterization (KATH-e-ter-i-ZA-shun), a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck. The tube is threaded to the heart. Special dye is injected through the catheter into a blood vessel or one of the heart's chambers. The dye allows the doctor to see the flow of blood through the heart and blood vessels on an x-ray image. The doctor also can use cardiac catheterization to measure the pressure inside the heart chambers and blood vessels. This can help the doctor figure out whether blood is mixing between the two sides of the heart. Doctors also use cardiac catheterization to repair some heart defects. For more information, go to "How Are Holes in the Heart Treated?"
Source: NHLBI

Question: What are the treatments for Holes in the Heart ?
Answer: Many holes in the heart don't need treatment, but some do. Those that do often are repaired during infancy or early childhood. Sometimes adults are treated for holes in the heart if problems develop. The treatment your child receives depends on the type, location, and size of the hole. Other factors include your child's age, size, and general health. Treating an Atrial Septal Defect If a child has an atrial septal defect (ASD), routine checkups are done to see whether it closes on its own. About half of all ASDs close on their own over time, and about 20 percent close within the first year of life. Your child's doctor will let you know how often your child should have checkups. For an ASD, frequent checkups aren't needed. If an ASD requires treatment, catheter or surgical procedures are used to close the hole. Doctors often decide to close ASDs in children who still have medium- or large-sized holes by the time they're 2 to 5 years old. Catheter Procedure Until the early 1990s, surgery was the usual method for closing all ASDs. Now, thanks to medical advances, doctors can use catheter procedures to close secundum ASDs. These are the most common type of ASD. Before a catheter procedure, your child is given medicine so he or she will sleep and not feel any pain. Then, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh). He or she threads the tube to the heart's septum. A device made up of two small disks or an umbrella-like device is attached to the catheter. When the catheter reaches the septum, the device is pushed out of the catheter. The device is placed so that it plugs the hole between the atria. It's secured in place and the catheter is withdrawn from the body. Within 6 months, normal tissue grows in and over the device. The closure device does not need to be replaced as the child grows. Doctors often use echocardiography (echo), transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE), and coronary angiography (an-jee-OG-rah-fee) to guide them in threading the catheter to the heart and closing the defect. TEE is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from the mouth to the stomach. Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin where the catheter is inserted. This means that recovery is faster and easier. The outlook for children having this procedure is excellent. Closures are successful in more than 9 out of 10 patients, with no major leakage. Rarely, a defect is too large for catheter closure and surgery is needed. Surgery Open-heart surgery generally is done to repair primum or sinus venosus ASDs. Before the surgery, your child is given medicine so he or she will sleep and not feel any pain. Then, the cardiac surgeon makes an incision (cut) in the chest to reach the ASD. He or she repairs the defect with a special patch that covers the hole. A heart-lung bypass machine is used during the surgery so the surgeon can open the heart. The machine takes over the heart's pumping action and moves blood away from the heart. The outlook for children who have ASD surgery is excellent. On average, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, are very rare. In some children, the outer lining of the heart may become inflamed. This condition is called pericarditis (PER-i-kar-DI-tis). The inflammation causes fluid to collect around the heart in the weeks after surgery. Medicine usually can treat this condition. While in the hospital, your child will be given medicine as needed to reduce pain or anxiety. The doctors and nurses at the hospital will teach you how to care for your child at home. They will talk about preventing blows to the chest as the incision heals, limiting activity while your child recovers, bathing, scheduling ongoing care, and deciding when your child can go back to his or her regular activities. Treating a Ventricular Septal Defect Doctors may choose to monitor children who have ventricular septal defects (VSDs) but no symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on its own or gets smaller. More than half of VSDs eventually close, usually by the time children are in preschool. Your child's doctor will let you know how often your child needs checkups. Checkups may range from once a month to once every 1 or 2 years. If treatment for a VSD is required, options include extra nutrition and surgery to close the VSD. Doctors also can use catheter procedures to close some VSDs. They may use this approach if surgery isn't possible or doesn't work. More research is needed to find out the risks and benefits of using catheter procedures to treat VSDs. Extra Nutrition Some infants who have VSDs don't grow and develop or gain weight as they should. These infants usually: Have large VSDs Are born too early Tire easily during feeding Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give babies extra nourishment. Some infants need tube feeding. A small tube is inserted into the mouth and moved down into the stomach. Food is given through the tube. Tube feeding can add to or take the place of bottle feeding. This treatment often is short-term because a VSD that causes symptoms will likely require surgery. Surgery Most doctors recommend surgery to close large VSDs that are causing symptoms, affecting the aortic valve, or haven't closed by the time children are 1 year old. Surgery may be needed earlier if: A child doesn't gain weight Medicines are needed to control the symptoms of heart failure Rarely, medium-sized VSDs that are causing enlarged heart chambers are treated with surgery after infancy. However, most VSDs that require surgery are repaired in the first year of life. Doctors use open-heart surgery and patches to close VSDs.
Source: NHLBI