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A Hole In the Heart: When a Saying Becomes a Diagnosis

Written by Sarah Huang
Illustrated by Christine Cheng

Edited by Sandini Kodikara

The phrase “a hole in your heart” is often used to describe the pain of missing someone you love. But for some people, it isn’t just a metaphor — it’s a condition they’re born with. This was the case for Nora, a baby diagnosed with a septal defect, a literal hole in her heart, just two days after she was born¹.

Septal defects are abnormal holes in the septum, which is the wall that divides the left and right sides of the heart²⁻⁴. The heart can be divided into four chambers: the left and right atria (upper chambers) and the left and right ventricles (lower chambers)5. These chambers are essential to the heart’s main functions: pumping oxygen-rich blood around the body and sending oxygen-poor blood to the lungs⁵.

The septum keeps these chambers separate, ensuring that blood with and blood without oxygen don’t mix²,⁵. However, with a septal defect, blood can flow between chambers instead of throughout the body²⁻⁴. These defects are present at birth and are therefore considered a type of congenital heart disease². There are two types of septal defects that are classified by where the hole is: atrial septal defects (ASDs), which are abnormal openings in the septum between the atria, and ventricular septal defects (VSDs), or defects in the septum between the ventricles²⁻⁴.

ASDs are common congenital heart diseases, occuring in about 25% of children³. Since the hole is in the septum separating the left and right atria, oxygen-rich blood that normally enters the left atrium from the lungs mixes with oxygen-poor blood in the right atrium that is headed back to the lungs²,³. This leads to higher-than-normal volumes of blood in the right atrium, causing the heart to work harder to move this extra blood out to the lungs²,³.

VSDs on the other hand are the most common congenital heart disease in children, and the second most common heart defect in adults⁴. This was the condition that Nora was diagnosed with¹. VSDs lead to oxygen-rich blood flowing from the left ventricle to the right ventricle, causing it to be pumped back to the lungs instead of out to the body²,⁴. The blood being sent to the body is therefore not as oxygen-rich, since it mixes with oxygen-poor blood and becomes diluted⁴. Similar to ASDs, VSDs also increase the amount of work the heart needs to do to get the extra blood to the lungs²,⁴.

Both ASDs and VSDs can go unnoticed, and the defects can close spontaneously in childhood if they are small enough²⁻⁴. Larger defects, however, require intervention to close them and prevent further complications²⁻⁴. Closure is usually accomplished with open heart surgery or a procedure called percutaneous repair, where a thin tube called a catheter is guided through a vein to the heart so the doctor can close the hole with a patch²⁻⁴,⁶.  

For Nora, she had a VSD that after a month, still had not closed; this, coupled with the shape and location of the defect made surgery the best option for her¹. The surgeons at the Children’s Hospital of Philadelphia performed open heart surgery and closed her VSD using a synthetic patch that was stitched over the hole¹. After surgery, Nora had a smooth recovery¹. She now has a full life ahead of her, with no restrictions on what activities she can do¹.

However, not all cases go smoothly like Nora’s. If larger defects remain open, the heart can enlarge as blood flows between chambers, increasing the risk of conditions such as pneumonia, stroke, and arrhythmias (irregular heart rhythms) ³,⁴. The extra blood in the right atrium and ventricle can also raise heart and lung pressures, potentially leading to damaged lungs, reduced heart function, and a shorter lifespan⁶,⁷.

Thanks to our current understanding of septal defects, ASDs and VSDs generally have excellent outcomes once diagnosed and treated³,⁴,⁷. Most children with a septal defect only require one procedure to close the hole in their heart and often show improvements in their health almost immediately after their procedure⁷. For Nora, and the approximately 20,000 babies just like her seen each year in the United States, early diagnosis and modern treatments mean that a condition once capable of shortening lives can now often be repaired, allowing children to grow up healthy and live without limits⁸,⁹. For them, “a hole in the heart” may now be nothing more than a figure of speech.

Sources:

  1. Philadelphia TCH of. Ventricular Septal Defect: Nora’s Story [Internet]. www.chop.edu. 2013 [posted 2009 Jun; revised 2013 Nov; cited 2026 Mar 5]. Available from: https://www.chop.edu/stories/ventricular-septal-defect-noras-story
  2. Congenital heart disease [Internet]. Heart and Stroke Foundation of Canada. Available from: https://www.heartandstroke.ca/heart-disease/conditions/congenital-heart-disease
  3. Menillo AM, Alahmadi MH, Pearson-Shaver AL. Atrial Septal Defect [Internet]. Nih.gov. StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535440/#article-17967.s3
  4. Dakkak W, Oliver TI. Ventricular Septal Defect [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470330/#article-31090.s8
  5. Rehman I, Rehman A. Anatomy, Thorax, Heart [Internet]. Nih.gov. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470256/
  6. Percutaneous Atrial Septal Defect Closure (ASD & PFO) – Cardiac Sciences Manitoba [Internet]. Cardiac Sciences Manitoba – Serving Manitoba, Nunavut and Northwestern Ontario. 2021 [cited 2026 Mar 5]. Available from: https://cardiacsciencesmb.ca/health-professionals/tests-procedures/atrial-septal-defect-asd-closure/
  7. Atrial Septal Defect and Ventricular Septal Defect in Children [Internet]. www.hopkinsmedicine.org. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/atrial-septal-defect-and-ventricular-septal-defect-in-children
  8. CDC. About Atrial Septal Defect (ASD) [Internet]. Congenital Heart Defects (CHDs). 2024. Available from: https://www.cdc.gov/heart-defects/about/atrial-septal-defect.html
  9. CDC. About Ventricular Septal Defect [Internet]. Congenital Heart Defects (CHDs). 2024. Available from: https://www.cdc.gov/heart-defects/about/ventricular-septal-defect.html

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