A normal human heart is divided into four chambers (ventricles and atrium) which are separated by a wall known as the septum. It is the septum that prevents the mixing of pure and impure blood between the two sides. However, some babies are born with a hole in the heart septum, at the upper or lower walls. A hole in the septum dividing the upper left and right heart chambers is known as Atrial Septal Defect (ASD) and a septum hole of the lower chambers is known as Ventricular Septal Defect (VSD). In both ASD and VSD, purified blood in the left chamber mixes with oxygen-deficient blood on the right side.
Hole in the heart can be due to genetic disorders, heredity or if the mother smokes during pregnancy. Hole in the heart, in general, are the leading cause of death in birth defect related deaths. Although, the number is declining with the advances in health care over the past few decades increasing the chances of survival.
PREPARING FOR THE SURGERY
Cardiologist suspects for ASD or VSD or other heart defect during a regular check-up if he or she hears a heart murmur while listening to the heart using a stethoscope. A detailed examination and investigations are done such as ECG, X-Ray, Cardiac Catheterization, MRI and CT scan to check the condition of the heart, record the electrical activity and exact look of the hole its size and position as well. Sometimes, hole in the heart don’t show any symptoms in childhood and is diagnosed in adulthood.
After complete diagnosis and type of hole has been done, your doctor decides the treatment plan and in both ASD and VSD surgery is required. Continuous monitoring of the heart is suggested before the surgery, also doctor will advise medicines like anti-coagulants which will help in preventing any further complication post-surgery.
ON THE DAY OF THE SURGERY
Open-heart surgery is done to repair the hole. It is done under general anaesthesia means child will be asleep during the surgery. The repair of the hole will take several hours. The surgeon makes a cut (incision) down the middle of the chest and separate the breastbone to reach the heart. Child will be attached to a heart-lung machine. This machine will act as your child’s heart and lungs during the procedure. The surgeon usually reaches the wall between the septum by looking through one of the valves of the heart and then closes the hole in the atrium or ventricle with a tightly woven patch material. Once the procedure has been completed, the heart-lung machine will be removed. Your child’s breastbone will be put back together with wires. The surgeon will close the muscle and the skin and a bandage will be applied.
After the surgery, child will be kept in a recovery room or ICU for constant observation and monitoring of heart rate, blood pressure, oxygen levels, and breathing. There may be mild pain which will be managed by antibiotics. Diagnostic test like an electrocardiogram or an echocardiogram may be performed after the procedure. By the second day, your child should be up and moving around as much as possible. And he/she will probably be able to go home about a week after the surgery.
Most children can get back to their normal activities when they get home after the surgery for hole in the heart. But they may tire more easily for a while. Children should avoid activities that might result in blows to the chest. Your child may need to have stitches removed in a follow-up appointment. Be sure to keep all follow-up appointments and instructions.
Always be alert for any symptoms such as increased swelling, increased bleeding or drainage, a fever and immediately contact your doctor. A little drainage from the site is normal. Follow all the instructions your doctor has given you about medicine, exercise, diet, and wound care. For a short time after the procedure, your child will need regular check-ups by a cardiologist. After recovering from the surgery, most children are able to lead normal lives without any activity restrictions. Adults who’ve had atrial septal defect repair need to be monitored throughout life to check for complications, such as pulmonary hypertension, arrhythmias, heart failure or valve problems. Follow-up exams are typically done on a yearly basis.
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Q: When should we suspect that our child could be having a hole in the heart?
A: When the child has: Rapid and distressed breathing, Blue discolouration of the nails, lips or tongue, feeding difficulty, Recurring cough with fever, when the child is not growing well or gaining weight.
Q: If my child has a ‘murmur’ in the heart, does it mean he has a heart problem?
A: Not all murmurs are produced by abnormalities in the heart. In some children with murmurs, the heart is functionally and structurally normal. Such murmurs are referred to as ‘innocent’ or ‘functional’ murmurs.
Q: Can Atrial septal defects close by itself?
A: Small ASDs detected immediately after birth or during infancy may close spontaneously, but most of the ASDs that are moderate or large sized do not close on their own.
Q: Is surgery the only option to close hole in the heart?
A: for medium or large holes’ surgery is recommended otherwise there are non-surgical treatment option also available such as catheterization.
Q: Can congenital heart problems like ASD/ VSD be checked during pregnancy?
A: Yes, thanks to the advanced technologies, heart defects can be checked in foetus at 4th month of pregnancy through prenatal ultrasound.
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