A hole in the heart is the common name given to congenital heart defects in the wall of the heart.
It is a hole in the wall that separates the right and left chambers of the heart, said Dr Tan Teng Hong, senior consultant at the Paediatric Cardiology Service, KK Women's and Children's Hospital (KKH).
'A hole in the heart can occur solitarily or as part of a more complex heart defect," he said. 'Those with small holes may show no symptoms at all, while large holes may present very early within the first few months after birth."
Symptoms include shortness of breath and exhaustion. Some babies may also exhibit poor growth and do not feed well.
The heart is built like a container with four chambers. The right chambers collect and redirect deoxygenated blood to the lungs, while the left receive freshly oxygenated blood and pump it to the rest of the body.
When there is a hole between the chambers, leaks occur. Each time the heart pumps, some oxygenated blood gets shunted into the chambers containing deoxygenated blood.
This backflow creates additional flow and pressure on the lungs, said Dr Tan. If left untreated, this may lead to pulmonary hypertension.
There are two common types of holes. An atrial septal defect is a hole in the wall that separates the two upper chambers of the heart, the atria. Meanwhile, a ventricular septal defect is a hole in the wall between the lower chambers, or ventricles. Ventricular holes can either be in the muscular part or in the membranous part of the heart.
In Singapore, congenital heart defects occur in eight out of 1,000 live births, according to KKH. Of this number, about 20 per cent suffer from ventricular septal defects, while about 6 to 10 per cent have atrial septal defects. Some are born with more than one hole in the heart.
Holes in the heart are diagnosed with a stethoscope which the doctor uses to listen for heart murmurs, said Dr Tan. A heart murmur is a sound made by the flow of blood through the hole every time the heart beats.
'We may perform an echocardiogram, which is an ultrasound of the heart, to observe the flow of blood," said Dr Tan. 'If there is a hole, we will be able to see blood flowing through a gap in the wall within the heart."
While small holes may close spontaneously - about 90 per cent of muscular ventricular holes close within a year - large holes often require intervention.
Cardiac catheterisation can be performed to close the hole. This is where a narrow, flexible tube called a catheter is inserted through a blood vessel into the heart chamber, carrying tiny devices at its tip to help patch up the hole.
Open-heart surgery is another option.
Though the outlook may appear gloomy, having a hole in the heart is not that devastating. Many patients may need only to go for regular check-ups to ensure that their condition is under control, said Dr Tan.
If the condition is not serious, patients may wait until they are older before the need for surgery is considered.
'Most children with small holes are allowed to take part in physical education classes," he said.
'They can take part in sports if they don't show any negative symptoms." However, it is best to seek the doctor's advice before participating, Dr Tan added.
