If your child is breathing very fast, going blue around the lips, too breathless to feed, or unusually drowsy, go to hospital now. These are signs of a heart that is struggling and they need assessment where you are, today.
Three of the commonest defects children are born with. Blood crosses from the left side of the heart to the right through an opening that should not be there, and the lungs receive more blood than they were designed for.
This page is written for parents. Most of these defects are entirely correctable, many close without any treatment at all, and children who are treated in good time usually grow up with no restrictions whatsoever. There is one important exception, covered below, and it is the reason not to wait indefinitely.
Atrial septal defect (ASD) is an opening in the wall between the two upper chambers. Blood passes from left to right, and the right side of the heart and the lungs handle more volume than they should. Small ASDs frequently cause no symptoms for decades and are sometimes only found in adulthood.
Ventricular septal defect (VSD) is an opening in the wall between the two pumping chambers. It is the commonest congenital heart defect. Small VSDs often close by themselves during the first years of life. Large ones cause symptoms early — a baby who feeds poorly, sweats while feeding, breathes fast and does not gain weight.
Patent ductus arteriosus (PDA) is a vessel that every baby has before birth and which normally closes within days of delivery. When it stays open, blood flows from the aorta into the lung arteries continuously.
In all three, the underlying problem is the same: too much blood going to the lungs. Over years, the lung arteries respond by thickening and stiffening, and the pressure inside them rises. That process is the reason timing matters.
If a large defect is left untreated for many years, the arteries in the lungs thicken permanently and the pressure inside them rises until it exceeds the pressure in the rest of the body. The flow through the hole then reverses, the child becomes blue, and closing the defect at that stage would be harmful rather than helpful. This is called Eisenmenger syndrome, and it is irreversible. It is the single reason we urge families not to postpone assessment. If your child or adult relative has an unrepaired large defect, send the echocardiogram now rather than later.
One test answers nearly everything, and most children will already have had it.
The full echocardiogram report, including the defect size in millimetres, its position, and any estimate of pulmonary artery pressure. Also your child's current weight and age, since both affect what is possible and when. If the report mentions raised pulmonary pressures, say so in your first message — it changes the urgency.
Whether a device or surgery is right depends on the type of defect, its position, and the rim of tissue around it.
Many small VSDs and some small ASDs close spontaneously during the first years of life, and small defects that do not close may never cause a problem. Monitoring means regular echocardiograms and attention to feeding and growth, not neglect. Doing nothing to a defect that will close by itself is the right treatment.
A closure device is delivered through a vein in the leg and deployed across the hole, with no chest incision and no scar. The hospital stay is usually one to two days and the child is running about within a week. Well established for suitable ASDs and PDAs, and for some VSDs depending on their position.
The defect is closed with a patch or stitches under direct vision. It requires opening the chest and using the heart-lung machine, with a hospital stay of around a week. It remains the standard for most VSDs, for ASDs without a suitable rim, and for defects that are very large or sit close to a valve.
A very small or unwell baby may need medication and nutritional support to grow before any closure is attempted. Occasionally a temporary procedure is used to protect the lungs until definitive repair is safe.
An ASD in the middle of the septum with good rims suits a device. A VSD close to the aortic valve almost always needs surgery. This is read from the echocardiogram, not from preference.
Device delivery systems need a certain vessel size. Very small infants are often better served by surgery, or by waiting under close supervision until they grow.
This is the question that overrides everything. If pulmonary pressures are already high, catheterisation may be needed to establish whether closure is still safe and beneficial. We will tell you honestly if we believe it is not.
Not every hospital advertising cardiac surgery has a paediatric cardiac intensive care unit and a paediatric perfusion team. For children, that is the first thing we verify and the reason we will sometimes recommend a hospital that is not the best known name.
For children, we would rather see the echocardiogram early and tell you there is no hurry than see it late and have to tell you something worse. Send it whenever you have it.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Often, yes — particularly small ventricular septal defects, most of which close during the first few years of life, and small atrial septal defects. Size and position determine the likelihood, and your echocardiogram report will have both. A defect that is closing does not need an operation, and any centre recommending surgery for a small defect in a thriving child should be asked why.
Whichever the anatomy allows. Device closure avoids a chest incision and the recovery is far quicker, which is why it is preferred where it is feasible. But it needs a rim of tissue around the defect to hold the device, and it is not suitable for most ventricular septal defects. Surgery gives a reliable, permanent result for defects that a device cannot safely close.
Usually not, but this is exactly the situation to have assessed promptly. What determines the answer is the pressure in the lung arteries, and that requires an echocardiogram and sometimes a catheter study. Many older children and adults are closed successfully. Some, unfortunately, have passed the point where closure would help — and we will tell you plainly which applies.
For a simple defect closed in good time, in the great majority of cases yes — including sport and normal schooling, usually with no medication. Your cardiologist will advise on any period of restricted activity after the procedure and on follow-up intervals.
For a device closure, usually around two weeks in total. For surgical closure, plan on four weeks, allowing for pre-operative assessment, around a week in hospital, and recovery before your child is fit to fly. One parent can travel on a medical attendant visa.
For some defects and for a period after repair, yes — to reduce the risk of infection settling on the heart. The advice depends on the specific defect and what was done, and your treating cardiologist will give you written guidance to take home.
Send your child's echocardiogram report along with their current weight and age. Dr. Varughese will tell you whether closure is needed, which method suits, and how urgent it is.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.