Hole in the heart is a layperson's term to describe a congenital abnormality of the heart - congenital meaning present at the time of birth.
The term is used to describe an actual hole in the walls separating the heart chambers, or as a general term to describe a structural abnormality of the heart.
The heart is the central blood pumping station of the body. It is constructed like a house with four rooms. The top two rooms are called atrium and the bottom two rooms are called ventricles. The wall which separates the top two rooms is called the atrial septum and the wall which separates the bottom two rooms is called the ventricular septum.
Therefore a hole in wall between the top rooms is called an atrial septal defect (ASD) and a hole in the wall between the bottom two rooms is called a ventricular septal defect (VSD).
The blood which is low in oxygen, or blue blood, returns to the right sided rooms where it is passed from the top room to the bottom room and to the lungs. In the lungs, the blood receives oxygen. This blood with the increased oxygen content, or pink blood, returns to the left top and bottom rooms and then to the body.
Inlet valves separate the top and bottom rooms of the heart. An outlet valve allows blood to be pumped from the right lower room to the lungs. This is called the pulmonary valve. The outlet door which allows blood to pump from the left lower room is called the aortic valve.
Hence the "heart house" has four rooms and four doors and two separating walls. Blue blood is pumped through the right heart to the lungs and the pink blood is pumped through the left heart to the body. The term hole in the heart may encompass not only holes between separating walls but also includes abnormal connection between the rooms, and abnormality of the doors and blood vessels.
This is estimated to be about 8 per 1,000 live births. If we have 50,000 live births a year, then we expect about 400 children a year with congenital heart defects.
The most common is ventricular septal defect i.e. a hole in wall between the bottom two rooms. This forms about 30% of all congenital heart defects. The other defects in the range of 6% to 10% include atrial septal defect (hole in wall between the top two rooms), pulmonary valve stenosis (narrowing of the right outlet door), aortic valve stenosis (narrowing of the left outlet door) and patent ductus arteriosus (persistence of a communication between the two major blood vessels of the heart).
This group of heart conditions belong to the "pink" hearts i.e. the blood travelling out from the heart to the body is fully oxygenated.
About a quarter of congenital heart defects are what we call "blue" hearts or cyanotic hearts. Here, the defect of the heart allows the right heart blood which has low oxygen content, or "blue" blood, to mix with the left heart blood which has high oxygen content, or "pink" blood.
The most common of the "blue" heart is called Fallot's tetralogy, named after a French doctor who described the condition. Here, the combination of hole in the heart, narrowing of the vessel to the lungs and overriding of the blood vessel to the body across the hole results in the "blue" blood mixing with the "pink" blood. Hence the child appears "blue". This is visible on the finger tips and lips.
The majority of patients with heart defects have no symptoms and do not require treatment. It is estimated that about 25% of infants presenting in infancy require medical treatment or surgery.
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