Hole in the Heart: Diagnosing and Treating Cardiac Disease in Children

Parents who hear from pediatricians that their child has a “hole in the heart” are understandably concerned. Fortunately, there are treatment options available that can treat and possibly cure your child’s cardiac disease.

Many cases of hole in the heart will not require treatment, since they can resolve by themselves in time or can be managed with medications and lifestyle habits. The cases that require surgery are repaired in infancy or early childhood, although adults can also undergo the procedure, if heart problems develop. The treatment will depend on the type, location and size of the hole, as well as the age, size and physical condition of the patient.

The following treatment pertains to atrial septal defect (ASD), a hole in the heart that can close on its own over time. This is true in about 50% of cases, while 20% of cases will close within the first year of life. Routine check-ups are then needed to determine whether surgical procedures are necessary.

Catheter Procedure

Doctors usually perform the catheter procedure for cases of secundum ASDs, the most common type. Before its development in the early 1990s, surgery was the only option.
Before the operation, the anesthesiologist administers anesthesia to the patient. Then, the surgeon inserts a catheter into a vein in the groin, thread into to the heart’s septum. The umbrella-like device attached to its end is then released. Said device is positioned so that it plugs the hole in the heart (i.e., between the atria) and is secured in place before the catheter is withdrawn from the body.
The normal tissue surrounding the device grows in and over the device within 6 months, thus making it part of the heart, so to speak. The device does not be replaced as the young patient grows, since the hole itself closes in.
A catheter procedure has many benefits over surgery. First, it is less invasive because only a needle puncture will be made on the skin, and the patient’s recovery will be faster and easier. Second, it provides excellent outlook for patients – no major leakage, less risks, and rarely an after-procedure surgery; 9 out of 10 patients will enjoy success, too.

Surgical Procedure

Surgery is usually performed on primum or sinus venosus ASDs. Before the surgery, the patient will also be injected with general anesthesia.

The cardiac surgeon makes a chest incision to reach the hole in the heart and then proceeds to repair the hole with a special patch. The patient is hooked up to a heart-lung bypass machine, which takes over the heart’s pumping action and moves the blood away from it.

As with a catheter procedure, the outlook for patients undergoing surgery is excellent. Children spend 3-4 days on average in the hospital for the initial recovery phase, as well as to lessen the risks for infections and bleeding, which are very rare in the first place. The hospital confinement is considered a precautionary measure.

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