If they are frequent or irregular, or come with shortness of breath, chest pain, dizziness or fainting. For severe chest pain or sudden fainting call 115 (Iran).

Yes. Even after childhood surgery or treatment, regular follow-up matters because arrhythmia, heart failure or valve problems can appear years later.

Previous ECGs, echo reports, lab results, angiography or surgery reports, and a list of your medications.

Depending on your symptoms: ECG, echocardiography, an exercise test or Holter monitoring. The doctor decides after the examination.

“Hole in the heart” is a lay term covering several different conditions:

• ASD (hole between the two upper chambers): secundum (most common, mid-septum), primum (low in the septum, often with a cleft mitral valve), sinus venosus (high in the septum, usually with anomalous pulmonary vein drainage) and coronary sinus (rare).
• PFO (patent foramen ovale): a fetal flap that stays slightly open in about one in four people. It is usually harmless and needs no treatment; closure is considered only in selected cases (for example, an unexplained stroke at a young age).
• VSD (hole between the two lower chambers): perimembranous (most common), muscular, outlet and inlet types. Small holes, especially muscular ones, often shrink or close on their own; large ones can cause heart failure and high lung pressure.
• PDA (patent ductus arteriosus): a fetal connection between the aorta and the pulmonary artery that stays open after birth.
• AVSD (atrioventricular septal defect): a combined atrial and ventricular hole with valve abnormalities; more common in Down syndrome.

Diagnosis: a murmur on examination, an ECG and echocardiography (the main test). In complex cases or in adults, a transesophageal echo, cardiac MRI or CT, and sometimes catheterization to measure lung pressure may be needed.

Treatment: small holes without symptoms or extra load on the heart are only monitored. If a hole enlarges the heart chambers, causes symptoms or raises lung pressure, closure is needed. Some secundum ASDs, PDAs and some VSDs can be closed with a device through a vein (no chest surgery); primum and sinus venosus ASDs, large VSDs and AVSDs usually need surgery. If lung pressure has become severely and permanently high (Eisenmenger syndrome), closure is generally not allowed and specialised medical treatment is used instead.

Follow-up: after closure, periodic echo and ECG are needed; atrial rhythm problems can appear years later, especially if closure was done at an older age. Antibiotic prevention before certain dental procedures is needed only in specific situations (for example, the first 6 months after closure with prosthetic material); your doctor will tell you.

It is the most common congenital heart defect with blue colour (cyanosis) and has four features: a hole between the lower chambers (VSD), narrowing of the right ventricular outflow and pulmonary valve, an aorta that overrides the hole, and a thickened right ventricle. A baby may look blue or have “tet spells” (sudden blueness and irritability during crying or feeding); severity varies.

Diagnosis: usually by echocardiography (sometimes before birth by fetal echo) and pulse oximetry.

Treatment: the main treatment is complete surgical repair, usually in the first months up to about one year of age; the exact timing depends on symptoms and anatomy. In some very symptomatic babies or those with unsuitable anatomy, a temporary procedure (shunt or stent) comes first, followed by complete repair later. Medicines alone are not a definitive treatment.

• Regular visits with a paediatric cardiologist: several in the first year, then usually once or twice a year depending on the child.
• Echo to check residual right ventricular outflow narrowing, pulmonary valve leak (very common after repair) and right ventricular size and function; ECG for rhythm and QRS width.
• Monitoring of growth, feeding, development and complete vaccination.
• Good dental hygiene, and prompt review of prolonged unexplained fever to prevent endocarditis.
• Guidance for the family about sport and school activity; genetic evaluation (including 22q11.2 deletion) when there are suggestive features.

Childhood repair is not “the end of treatment”. Lifelong follow-up, preferably in a specialised adult congenital heart disease (ACHD) centre, is needed at least once a year and sometimes more often.

• Pulmonary valve leak and right ventricular enlargement: the most common late problem, followed with echo and especially cardiac MRI. With symptoms, or with enlargement and weakening of the right ventricle, pulmonary valve replacement (surgical or through a vein) is considered; the ACHD team decides the timing.
• Rhythm problems: atrial flutter or fibrillation and ventricular arrhythmias, assessed with ECG, Holter and exercise testing. In higher-risk patients, ablation or an ICD may be considered. Report palpitations, fainting or falling exercise capacity early.
• Other issues: aortic root enlargement, a residual ventricular hole and narrowing of the pulmonary artery branches.
• Pregnancy: most women with a good repair tolerate pregnancy, but counselling is needed beforehand. The chance of heart disease in a child is higher than in the general population, and fetal echo is recommended.
• Regular, suitable physical activity, no smoking and good dental care.

Sources: Stout KK et al., 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease (Circulation 2019;139:e698). Baumgartner H et al., 2020 ESC Guidelines for the management of adult congenital heart disease (Eur Heart J 2021;42:563). Wilson WR et al., Prevention of Viridans Group Streptococcal Infective Endocarditis, AHA Scientific Statement (Circulation 2021;143:e963). PubMed. This is educational information and does not replace an examination or your doctor’s decision.