Holes in the heart are considered to be congenital heart diseases or defects. These are considered to be a problem in the structure formation of the heart right at the time when a foetus is deriving its nutrition in the womb. With latest procedural technologies these problems can be mended right after birth. The holes in the heart disrupt the normal blood through the heart thus causing a general problem in blood circulation in the entire body.
In order to understand the holes in heart we must briefly understand the working of the heart. The heart works like a pump beating on an average of 100,000 times in a day. It has two sides which is divided by a wall called septum. The right side of the valve pumps blood to the lungs and picks up oxygen. The oxygen rich blood then returns to the left side of the heart from the lungs and then the left side pumps it to the rest of the body.
These two sides are divided into 4 chambers having four valves connecting them to various blood vessels. For carrying blood from the body to the heart, veins are responsible while arteries carry the blood away from the heart to be circulated to the body. The atria are two upper chambers that collect blood while ventricles are the two lower chambers pumping the blood to the lungs and other parts of the body.
The valves act like doors allowing flow of blood through the next chamber to arteries and then they close to keep the blood from again returning back to the previous chamber from where it came. In a systolic contraction ventricle pump blood from the heart and in a diastolic contraction the ventricles relax to receive blood pumped by the atria while aortic and pulmonary valves close at the beginning of the diastole to prevent the chances of backflow.
Heart murmur is usually found in the ventricular septal defect and this is considered as a major difference between ASD and VSD. This kind of defect can be the only and the first sign of VSD. In many infants this murmur sound can be heard right after birth, and in many cases it can be heard once the baby grows 6 or 8 weeks old.
These new born do not have heart related symptoms, but babies who have medium or large sized holes can easily become victims of heart failure and the symptoms of heart failure can be seen within 2 months of their initial life.
The other signs and symptoms of heart failure are common with ASDs but the difference is that it can be seen to occur during infancy. One of the major signs of heart failure during infancy is seen as poor growth and feeding difficulty. However as the baby grows up VSD signs and symptoms become very minimum since the hole size decreases in volume or gradually close on their own.
Depending on location, age and general health of the child the operation procedure is decided
When ASDs do not close by themselves as observed in periodic checkups then catheter or surgical procedure has to be adopted. Surgeons decide to close the holes when the child is 2 to 5 years old and the hole size is medium or large
Till 1990s surgery was the only usual method to close ASDs but due to advance technologies now catheter procedures can close secundum ASDs. The child will be given medicine so that he or she sleeps through the ASD device closure procedure. Now a catheter is inserted into the groin’s vein and threads it up to the septum of the heart. A tiny umbrella like device is folded up inside the catheter. Angiography or echocardiography is used to see the threading path of the catheter.
The device is pushed out of the catheter after reaching the septum and so positioned that it acts like a plug in the hold between the atria. The device will be kept in position while the catheter will be slowly withdrawn.
Within a period of 6 months, over this device normal tissues will start growing in. As the child grows the closure device is not required to be replaced. Normal development would take place gradually without affecting the operations of the heart.
Only a needle puncture is made in the above described procedure and hence this is less invasive as a procedure. They are usually successful until and unless the hole is too large and only an open surgery can solve the problem.
For primum or sinus venosus ASDs an open heart surgery is recommended. Here too medicines will ensure that the child sleeps though the process. In the chest an incision is made at first. With a special path that covers the hole the defect is repaired. On a heart lung bypass machine the child is placed to ensure that the heart can be opened to perform the surgery.
Antibiotics will be administered to the child to prevent infection like endocarditis. Regular checkups will follow for a while to ensure that the hole gets closed properly. To prevent blood clots the child may be given aspirin. Apart from all these, for the first few months, activities will be kept limited till he or she is fit enough to exert more with physical activities.
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