Congenital heart disease - septal defects

Introduction

Congenital heart disease is the name used for a difference or problem with how a baby's heart has grown during pregnancy. A septal defect is a type of congenital heart disease where there is a hole in the septum. The septums are the walls that separate the four chambers of the heart. 

Septal defects happen during pregnancy when the walls in your baby's heart do not develop properly.

There are three common types of septal defects:

1. atrial septal defect (ASD) - a hole between the heart's two upper chambers, called the atria
2. ventricular septal defect (VSD) – a hole between the heart's two lower chambers, called ventricles  
3. atrio ventricular septal defect (AVSD) – holes between all four heart chambers.

A hole in the septum means that a larger amount of blood flows towards the lungs. Over time, this can damage the blood vessels in the lungs and cause problems with the heart.  

Septal defects can range from small to large. Most children with a smaller septal defect will look healthy and might not show any signs or symptoms until they get older.

Children with a larger septal defect, or one that has been left untreated, can show signs like:

• difficulty breathing
• running out of breath quickly when doing activities or exercise
• getting tired quickly when feeding from the breast or bottle
• frequent respiratory or lung infections, like pneumonia
• skipping heartbeats
• a whooshing sound in the heart, also known as a heart murmur
• swelling in the legs, feet, or belly.

Children with larger or untreated septal defects are also at a higher risk of stroke. A stroke is when blood cannot get to the brain properly because of a blockage or bleeding. A stroke can cause brain damage, disability and, in some cases, death. 

A septal defect can be diagnosed during pregnancy with ultrasound scans. Some babies will be diagnosed when they are born, and other children may not be diagnosed until they grow older.

Your local doctor will refer you to a heart specialist, called a cardiologist.

To diagnose a septal defect, the cardiologist will use a test called an echocardiogram.

An echocardiogram uses sound waves to make an image of your child’s heart, showing how well the blood moves through. This test should be able to tell the cardiologist:

• what type of septal defect your child has
• how big it is
• where it is
• how severe it is
• whether your child has any other heart issues.

Some septal defects will close on their own, while others can be treated with medication or will need surgery to repair.

Most septal defects are diagnosed and treated successfully.

Treatment will depend on:

• how old your child is
• the signs and symptoms they are showing, and how severe they are
• the size of the hole
• whether your child has any other health conditions. 

If your child’s septal defect is found early, their doctor might choose to treat the symptoms with medication and wait to see if the hole closes on its own.

There are two common procedures used to close a septal defect:

1. cardiac catheterisation – where a tiny tube is inserted into a blood vessel in your child’s groin and through to the septal defect. A device is passed through the tube and used to plug the hole. The tube is removed, and heart tissue grows around the device.  
2. open heart surgery – where your child’s chest wall is opened so the surgeon can repair the heart directly. 

The procedure used for your child will depend on the type of septal defect they have, and how severe it is.

Your child’s doctor will talk to you about the procedures, what they involve and the time it will take for your child to recover.

Most children who have surgery will recover quickly. Your child will have ongoing check-ups with their cardiologist to make sure their heart is still working well, and there are no other problems. 

When to seek help

See your local doctor or your child’s cardiologist if they show any signs like:

• poor appetite
• trouble with feeding or eating
• lower activity levels
• fever that lasts longer than 72 hours.

Call triple zero (000) for an ambulance, or go to your nearest emergency department if your child has:

• trouble breathing
• chest pains
• increasing pain and tenderness around their surgery wound
• pus or blood coming from their surgery wound.