My Baby Has a Hole in Their Heart (Atrial Septal Defect)
The short answer
An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. Small ASDs are very common — a patent foramen ovale (PFO), which is essentially a small ASD, is present in about 25% of all people. Many small ASDs close on their own during childhood. Moderate to large ASDs may need closure to prevent long-term complications like heart enlargement or pulmonary hypertension. Closure is done either through a catheter-based procedure (device closure) or surgery, both with excellent success rates.
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By Age
What to expect by age
0-6 months
Small ASDs are often discovered incidentally during evaluation of a heart murmur or during echocardiography performed for other reasons. Many small ASDs — particularly those under 5mm — close spontaneously in the first 1-2 years. Your pediatric cardiologist will monitor with periodic echocardiograms. Most babies with small ASDs have no symptoms and feed, grow, and develop normally.
6-12 months
If the ASD is small and your baby is asymptomatic, watchful waiting continues. Moderate to large ASDs may cause subtle symptoms — slightly faster breathing, difficulty with feeds, or slower weight gain — though many moderate ASDs are still asymptomatic in infancy. Your cardiologist will assess the amount of blood flow across the defect to determine if and when closure is needed.
1-5 years
Small ASDs that have not closed may continue to be monitored. Moderate to large ASDs with significant left-to-right blood flow are typically recommended for closure during this period, before they cause right heart enlargement. Catheter-based device closure (Amplatzer or similar device) is the preferred method for secundum ASDs and is performed in a cardiac catheterization lab without open-heart surgery. Recovery is quick — most children go home the next day.
5 years+
If closure is performed, long-term outcomes are excellent — the heart returns to normal size, and there are typically no activity restrictions after recovery. Children who had device closure take aspirin for about 6 months and need endocarditis prophylaxis for 6 months after the procedure. If surgical closure was required (for large or non-secundum ASDs), recovery takes several weeks but outcomes are equally excellent.
What Should You Do?
When to take action
- Your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate
- Your baby has a PFO (patent foramen ovale) — this is present in 25% of all people and rarely needs treatment
- Your child had ASD closure and has recovered with normal heart function
- Your baby seems to tire easily during feeds or sweats during feeding
- Your baby is not gaining weight as expected
- You hear your baby breathing faster than usual, especially during feeding or activity
- You have questions about whether and when the ASD should be closed
- Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911
- Your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation
- After device or surgical closure, your child develops fever, chest pain, or sudden shortness of breath — seek immediate medical care
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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