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. 

The heart is made up of four chambers:

• left and right atria, at the top
• left and right ventricles, at the bottom.

The septum is a wall of tissue that separates the left and right sides of the heart.

A septal defect is a type of congenital heart disease where there is a hole in the septum. 

There are three common types of septal defects:

1. atrial septal defect (ASD) - a hole between the left and right atria at the top
2. ventricular septal defect (VSD) – a hole between the left and right ventricles, at the bottom  
3. atrio ventricular septal defect (AVSD) – holes between all four chambers of the heart.

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 they may not show any signs or symptoms until they get older.

Children with a larger septal defect, or one that has been left untreated for a long time, can have symptoms 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 have 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
• permanent disability
• death. 

A septal defect can be diagnosed with an ultrasound scan during pregnancy. 

Some babies will be diagnosed when they are born, others may not be diagnosed until they are older.

To diagnose a septal defect, your local doctor will refer you to a heart specialist, called a cardiologist.

The cardiologist will use a test called an echocardiogram to get an image of your child’s heart. This image will show how well the blood moves through the heart, and will tell the doctor:

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

Most septal defects are diagnosed and treated successfully.

Septal defects can be treated with:

• watching and waiting
• medication for symptoms
• surgery to repair.

Treatment will depend on:

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

Septal defects that are found early may be treated with medication to manage symptoms while waiting to see if the hole closes on its own.