2 Complex Heart Holes Closed through a Key-Hole Incision Through Advanced Paediatric Cardiac Surgery (ASD & VSD Closure)

Jessica, an 8-year-old from Rewari, had been living with a congenital heart condition since birth. She was diagnosed at just 6 months of age. Over time, her parents began to notice subtle concerns, such as her tiring more easily than expected and not gaining weight for her age.

Cardiac Assessment: Complex Heart Conditions

Despite otherwise stable health and normal daily activity, these signs prompted further evaluation, and they visited Sarvodaya Hospital, Sector 8, Faridabad. A detailed cardiac assessment was performed by Dr Jay Relan, Senior Consultant, Paediatric Cardiology & Congenital Heart Disease, which revealed a complex heart conditions.

• Two Atrial Septal Defects (ASD); (15 mm and 7 mm holes in between the two upper chambers of the heart)
• One Ventricular Septal Defect (VSD) (hole in between the two lower chambers of the heart)
• Absent aortic rim (little or no support on one side of the hole, near the aorta)
• Mild Moderate Mitral Regurgitation (MR) (blood leakage)
• Dilated heart chambers (enlarged chambers)

Minimally Invasive Paediatric Heart Hole Surgery

Given the presence of multiple defects and structural changes in the heart, timely surgical intervention was planned by the paediatric cardiac surgery team, led by Dr Anupam Das, Senior Consultant and Head, Cardiothoracic and Vascular Surgery.

The surgical team performed a minimally invasive ASD and VSD closure, repairing all defects through a small incision on the right side of the chest, without cutting the breastbone.

Sarvodaya is one of the very few hospitals in the region to perform minimally invasive VSD Closure.

Traditionally, open-heart surgeries were performed for such defects, where a large cut was made through the chest, affecting the ribs, causing more pain and trauma to the child, and recovery took months.

But here at Sarvodaya, the team performed the complex, advanced and rare surgery for Ventricular Septal Defect and Atrial Septal Defect, in which the holes were closed, making a small cut, causing less pain and trauma. All the chest bones and tissues were unaffected. The surgery is safer, causes less blood loss, and ensures a faster recovery for the child. Even the surgery was cosmetically beneficial as there was no visible scar on the front of the body, just a small incision on the right side of the chest.

Through a single surgery, all defects were corrected. Jessica recovered smoothly, was extubated early, and was discharged in stable condition within a few days.

Understanding Atrial and Ventricular Septal Defects

Let us first understand the basic structure of the heart. The human heart is divided into four chambers:

• Upper two chambers (atria) – receive the oxygenated and deoxygenated blood
• Lower two chambers (ventricles) – pump blood out to the body and lungs

The four chambers:

• Right Atrium (RA): Receives oxygen-poor blood from the body
• Right Ventricle (RV): Pumps this blood to the lungs to pick up oxygen
• Left Atrium (LA): Receives oxygen-rich blood from the lungs
• Left Ventricle (LV): Pumps oxygen-rich blood to the entire body

A wall called the septum separates the left and right sides of the heart to keep oxygen-rich and oxygen-poor blood from mixing.

Atrial Septal Defect (ASD) is a hole in the septum of the two upper chambers (atria) of the heart. Due to the hole, the oxygen-rich and oxygen-poor blood mix with each other. With time, it increases the blood flow to the lungs, stimulating the heart.

Ventricular Septal Defect (VSD)  is a hole in the septum between the two lower chambers (ventricles). Since ventricles pump blood with more force, this leads to higher pressure and extra workload on the heart.

Symptoms of a Hole in the Heart Parents May Notice

• Easy fatigue or low energy
• Poor weight gain or slow growth
• Breathlessness during activity
• Heart murmur (detected during check-ups)

Why Timely Treatment is Important

If left untreated, ASD and VSD can lead to:

• Enlargement of the heart
• Increased pressure in the lungs
• Valve-related complications
• Irregular heart rhythms
• Long-term heart weakness

Early diagnosis and timely treatment significantly improve outcomes.

Treatment Approach for ASD and VSD

Treatment depends on the size and severity of the defect:

• Small defects may close on their own
• Medications can help manage symptoms
• Some ASDs can be treated through catheter-based procedures
• Larger or complex defects require surgical repair

In Jessica’s case, due to multiple defects and associated structural changes, surgery was necessary.

Minimally Invasive Surgery – What Was Different?

• A small incision on the side of the chest
• Both ASD and VSD were repaired through a single approach
• The breastbone (sternum) was not cut
• Less pain and trauma
• Faster recovery
• Shorter hospital stay
• Minimal scarring (especially beneficial for children)

A Message for Parents

Not all heart conditions present with obvious symptoms. Sometimes, mild fatigue or slow weight gain may be the only early signs.

Jessica’s journey highlights that with timely diagnosis and the right surgical expertise, even complex congenital heart conditions can be treated effectively, allowing children to return to a healthy, active life.