Hole in the heart


By Dr Khushboo Shah Sawant

When we use the term `hole in the heart`™ it is only a generic term for there is no hole in the heart as such. More simply put, it is a defect in the heart. To understand this further, we will need to briefly understand exactly how a normal heart functions.

The main function of the heart is to receive impure blood or blood whose oxygen the other body parts have utilized. This is sent to the lungs for purification or oxygenation, which then receives the same purified blood. The purified blood is supplied to other parts of the body to perform their respective functions. For this function, the heart is divided into four chambers. The right half of the heart receives the impure blood which it sends to the lungs while the left half receives the oxygenated blood from the lungs. These two halves of the heart are divided by a wall which is known as the septum. Each of these halves is further divided into upper and lower halves each, which are known as the atrium and ventricle respectively. The importance of the septum is that it prevents the mixing of the blood in the left and right chambers of the heart.

When we say that a baby is born with a hole in the heart we actually mean that there is a defect in the wall which divides the left side of the heart from the right, thus resulting in the mixing of impure blood from the right side with the pure oxygenated blood from the left. This is called as a septal defect. If the defect is in the upper half which divides the right atrium from the left, it is known as an `atrial septal defect`™ or ASD. If the defect is in the lower half, which divides the ventricles, then it is known as a `ventricular septal defect`™ or VSD. This defect in a child is a birth defect as it is formed when the baby is growing in the womb of the mother. Often, it is seen that this defect which may be seen during pregnancy often clears out on its own even before the baby is born and sometimes after birth. However there are cases where the defect does not clear out thus requiring medical attention.

So what causes this defect? The exact reason for this birth defect is still not known but it has been seen that heredity may play a role in heart defects. Children with genetic disorders like `Down`™s syndrome`™ are more prone to such heart defects with smoking during pregnancy is also linked to it. Babies with such defects appears much smaller than its age, may be smaller in size as well as weight. Another symptom is a slight difference in the heartbeat which can be noted by a doctor with the use of a stethoscope In cases when the `hole`™ is very large and not treated for a long time, the child may show signs and symptoms like easy tiredness at the slightest exertion, having shortness of breath, collection of blood in the lungs, swelling in the ankles, feet, leg, abdomen, and veins in the neck. Young babies also feed very poorly and grow much slower as compared to other babies.

Diagnosis of this condition is based mostly on physical examination where the doctor can elicit the difference in the heart beat. This can be further confirmed by various tests like a cardiogram of the heart, and tests like echo-cardiography and confirmed also by cardiac catheterization. Treatment options for holes in the heart depend upon the severity and type of hole. Often such cases do not need any treatment and may sometimes need to be surgically treated in infancy itself.

Children with surgically corrected `holes`™ can lead a fairly normal life and do not need any other special care later on in life. Thanks to the remarkable improvement in the field of medicine, this heart condition, which was once taken as life threatening, has been tamed.


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