"There's a hole in the heart" — words that stop a parent cold
The doctor picks up the echo report and says: "There's a small opening in the septum." Every parent who has heard those words knows exactly what that moment feels like.
Here is what matters most: a hole in the heart is the most common congenital heart defect in children — and in most cases it either closes on its own or is fully corrected with modern treatment.
Let's go through what it is, the different types, when intervention is needed, and when watchful waiting is the right approach.
What exactly is a "hole" in the heart?
In a healthy heart, the left and right sides are completely separated by two walls (septa): one between the ventricles (lower chambers) and one between the atria (upper chambers).
If an opening remains in either of these walls — that's the "hole". In medical terms:
VSD — Ventricular Septal Defect (opening between the lower chambers). The most common type.
ASD — Atrial Septal Defect (opening between the upper chambers).
PDA — Patent Ductus Arteriosus (a connection between the two major vessels). Technically not a hole, but falls in the same family.
Through these openings, blood flows from left to right — placing extra work on the lungs.
Which defects close on their own?
Small VSD — the most likely to close spontaneously. VSDs under 3 mm close in the majority of children within the first 1–2 years of life. Up to 5 mm — a significant proportion also close under observation.
Small ASD (ostium secundum type) — some close during childhood, particularly before age 3–4. Larger ASDs generally do not close on their own.
PDA — normally closes in the first days after birth. In premature babies it may stay open longer. Small PDAs often close spontaneously.
The likelihood of spontaneous closure depends on the size, type, location of the defect, and the child's age. Only serial echocardiograms over time will show what's happening.
Which defects need intervention?
Intervention does not necessarily mean open-heart surgery. Modern medicine offers several options.
Large VSD (over 5–6 mm): the baby tires quickly during feeding, isn't gaining weight, sweats excessively — these signs mean intervention is needed. Closed surgically or by catheter.
Large ASD: typically observed until age 4–5. If it hasn't closed — closed by catheter using an Amplatzer device. No incision, very short recovery.
PDA: small ones close on their own. Large ones are closed by catheter or surgically.
Timing of intervention is critical. Long-standing large defects can damage the pulmonary vessels (pulmonary hypertension). Waiting too long is not advisable.
Symptoms — when should parents be concerned?
Small defects often cause no symptoms at all — discovered only on an echocardiogram.
With larger defects, you may notice:
— The baby sweats heavily during feeds, tires quickly, and isn't gaining weight normally;
— Frequent breathlessness or difficulty breathing;
— Recurrent chest infections (bronchitis, pneumonia);
— Excessive fatigue during physical activity.
If these symptoms are present — see a paediatric cardiac surgeon promptly. If there are no symptoms — review the echo result with a specialist and keep under regular monitoring.
Treatment options — surgery is not the only path
Watchful waiting: for small defects. Echo every 6–12 months, monitoring the trend. If the defect closes — no intervention needed.
Catheter closure (interventional cardiology): for most ASDs and some VSDs. No surgery — a catheter is introduced through the groin and a small "umbrella" device is deployed to seal the hole. Under anaesthesia, no incision, recovery takes 1–2 days.
Open-heart surgery: for defects with complex anatomy. Performed by a highly specialised team; outcomes are excellent. In modern cardiac surgery, the risks of this procedure are very low.
Which approach is right depends on the individual child — only the cardiac surgeon can determine this after assessment.
Is this treated in Azerbaijan?
Yes. Both catheter closure and surgical repair are successfully performed in Azerbaijan.
Most ASDs are closed by catheter — this is the world standard, and it is available here.
Complex cases are handled with open-heart surgery — following international protocols.
The desire to seek treatment abroad is understandable, but it is usually unnecessary. Consult a local specialist first — then make your decision with full information.
The bottom line: a "hole" is not a life sentence — it's a manageable condition
Finding a septal defect is a shock for any parent. But the reality is: this is one of the most well-understood and successfully treated conditions in paediatric cardiology.
Small defects close on their own. Larger ones are sealed by catheter or corrected surgically. Either way — children grow up healthy.
What matters: timely diagnosis, appropriate monitoring, and intervention at the right moment.
If you have questions — reach out. We'll find the best path together.