Hole in the Heart (ASD, PDA, VSD)
A hole in the heart is an opening present from birth between heart chambers or vessels; small ones may close naturally, while larger ones may need device closure or surgery.
How a hole changes blood flow
The heart has four chambers. The right side sends blood to the lungs, and the left side pumps it to the rest of the body at higher pressure. A hole lets blood leak from the left side to the right, so extra blood goes round the lungs and the heart has to work harder. Over time the right side or the lungs can be strained.
Three types you may hear about
- ASD (atrial septal defect): a hole in the wall between the two upper chambers. It is often found only in adulthood.
- VSD (ventricular septal defect): a hole between the two lower chambers. Common in babies, and many small VSDs close on their own.
- PDA (patent ductus arteriosus): a blood vessel every baby has before birth, which normally closes soon after birth but stays open. More common in premature babies.
Why it happens
Most holes are present from birth and form while the heart develops in the womb. Prematurity, some genetic conditions, a family history of heart defects, and certain infections (such as rubella) or poorly controlled diabetes in the mother during pregnancy can raise the chance. Often no cause is found.
How it is found
A doctor may hear a murmur with the stethoscope. An echocardiogram confirms the type, size and effect on the heart. An ECG and chest X-ray help, and in adults a transoesophageal echo (TEE) gives a closer look before closure is planned.
Treatment choices
Small holes that do not strain the heart are often only watched. When a hole is large enough to enlarge the heart or strain the lungs, closing it is usually advised. Many ASDs and PDAs can be closed without open surgery, using a device passed through a vein in the leg: see ASD device closure and PDA device closure. Some VSDs can also be closed with a device, while others need surgery. The decision depends on the size, position and edges of the hole.
Why timing matters
A large hole left for years can raise the pressure in the lungs (pulmonary hypertension), which may make closure unsafe later. Seek urgent care for a baby with fast breathing, bluish colour or poor feeding, or for anyone with fainting or severe breathlessness.
Diagnosis and treatment are decided only after examination by your doctor. This page is for understanding the condition.
For understanding only — the right test or treatment is decided after examination.
