Hearing that your baby has a hole in the heart sounds like time to panic, but most of the time it’s not. In fact, all babies are born with a hole in the heart. The hole is called a foramen ovale. In about 25 percent of babies, this type of hole remains open into adult years and never causes a problem. A foramen ovale that fails to close is called a patent foramen ovale (PFO). PFO is very common and is nothing you need to worry about.
Other types of holes are much less common, a bit more serious, but still no reason to panic. These types are considered to be congenital heart defects, a defect a baby is born with. Like PFO, an atrial septal defect (ASD) is a hole between the upper chambers. ASD is caused by failure of the walls between the right and left upper chambers to form. There can also be a failure of the wall between the lower chambers of the heart to form. These are the pumping chambers called ventricles. A hole between the two lower chambers is called a ventricular septal defect (VSD).
PFO is actually more like a trap door than a hole. When your baby is growing in your womb, your baby is not breathing air through the lungs. Your baby is getting blood supplied by your lungs through your placenta. Your oxygen rich blood comes into the right side of you baby’s heart. Because it does not need to go to your baby’s lungs yet, it bypasses the lungs by flowing through a trap door (foramen ovale) into the left side of the heart, where your baby’s heart pumps the blood out to the body.
After your baby is born, and takes the first few breaths of life outside the womb, the pressure of blood flowing into your baby’s lungs usually shuts the trap door. It may take a few months to close completely. For 25 percent of babies, the foramen ovale remains as a small hole and never closes. The mount of blood that leaks through the PFO is usually too little to make a difference or cause and symptoms.
ASD and VSD
Unlike the foramen ovale, ASD and VSD are not normal structures. They are congenital heart defects. ASD is much less common than PFO. It occurs in about one out of 2000 babies. VSD is more common than ASD, occurring in about one out of 240 babies. Because ASD and VSD are holes, rather than a normal trap door, they are less likely to close and some may be large enough to cause symptoms.
Some ASDs and VSDs are large enough to be seen during your prenatal ultrasound exam. A small hole may not be diagnosed until after birth. Like the PFO, some adults grow up with an ASD or VSD and never know it. The cause of these congenital heart defects is not known.
If your baby has an ASD or VSD, your baby’s doctors may decide to wait before doing any treatment. Many of these holes are small, do not cause any symptoms, and close on their own.
If a baby has a large enough ASD or VSD to cause symptoms, the symptoms may include a bluish color of the lips and fingernails, called cyanosis, from lack of oxygen in the blood. This may occur during crying. Babies may also have trouble feeding because it is hard for them to breathe and feed at the same time. A doctor may hear an abnormal heart sound caused by blood flowing through the hole, called a heart murmur. Diagnosis after birth is usually made with an imaging study of the heart using sound waves, called an echocardiogram.
Even symptomatic holes may close on their own, but if a hole needs to be closed, it can often be done without open heart surgery. A catheter can be placed into the heart through a vein and a plugging device can be used to close the hole. This procedure is now common and has a high success rate. Many babies with ASD or VSD will never need surgery.