This is usually the real question behind every other question a parent asks after hearing the word murmur for the first time. So here's a straight answer: no, most of the time a heart murmur does not mean surgery. Most of the time it does not mean any treatment at all.

Around one or two children in every hundred with a murmur turn out to have something structural behind it. Of that smaller group, only some ever need treatment. And of those who do, many are treated with a simple catheter procedure rather than open surgery. It's easy to hear "murmur" and jump straight to "open-heart surgery," but that jump skips over a lot of steps in between.

Start with the innocent murmurs, because most murmurs are innocent. An innocent murmur means the heart is built normally. There's nothing to fix and nothing to watch over time. It might get quieter as your child grows, or disappear altogether, but either way there's no problem underneath it, so there's nothing for any treatment to do. For the smaller group where something structural is found, it still isn't one path for everyone. A small hole between two chambers of the heart, for example, might just be checked with an echocardiogram every so often, and often closes by itself with no procedure needed at all. A hole that's a bit bigger might eventually be closed, but this is frequently done through a catheter, not open surgery. That means a thin tube goes in through a blood vessel in the leg, a small device is placed to close the hole, your child stays in hospital one night, and is back to normal activity within a week or two. That's a very different experience to open-heart surgery, and mixing the two up in your head, even by accident, can cause a lot of needless worry.

Open surgery is kept for a smaller group still: larger holes causing symptoms, some valve problems that can't be fixed by catheter, and more complex heart conditions. Even here, it's worth saying clearly that results from these operations, done at experienced centres, are very good. The idea that surgery always means something catastrophic just doesn't match what most families actually go through.

Here's something that comes up again and again in clinic. A parent hears "murmur," searches online, reads about the rarest and most serious things a murmur can theoretically point to, and turns up to the appointment already bracing for the worst. Nearly every time, the conversation that follows is far more reassuring than what they'd spent the night before preparing for. That gap between what a search engine shows you and what actually applies to your child is exactly why seeing a specialist in person matters more than any amount of reading beforehand. So the full answer is this: a murmur on its own doesn't tell you whether your child will ever need treatment. What matters is the specific cause behind it, and that's found through an examination and, if needed, an echocardiogram. That cause is what decides whether the path ahead is nothing at all, some simple monitoring, a catheter procedure, or surgery.

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❓Frequently asked questions

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What percentage of children with a heart murmur end up needing surgery?

Only a small number. Of the one to two per cent of children with a murmur who have something structural, only some need treatment at all, and many of those are treated with a catheter procedure rather than open surgery.

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If my child needs a procedure, does that mean the murmur was more serious than I was told?

Not necessarily. Some conditions that need treatment have quite soft murmurs, and some completely innocent murmurs are loud. So how loud a murmur sounds doesn't tell you much about whether a procedure will be needed.

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What's the difference between a catheter procedure and open-heart surgery?

A catheter procedure closes or repairs certain problems using a thin tube passed through a blood vessel, without opening the chest. It usually means one night in hospital at the most and a quick recovery. Open surgery involves opening the chest to reach the heart directly, and is used for problems that can't be treated with a catheter.

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Could a condition that needs treatment be missed if the murmur sounds innocent?

It's rare, but it can happen. That's why any uncertainty at the examination is followed up with an echocardiogram rather than reassurance from listening alone. This step is what catches the small number of cases that don't sound the way you'd expect.

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If my child has a small hole that doesn't need treatment now, could that change later?

Yes, which is why small holes are monitored rather than just left alone. Most either close by themselves or stay small and cause no problems, but regular check-ups make sure any change is picked up early.

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Author: Dr. Alessandro Giardini, MD, PhD, Consultant Paediatric Cardiologist

Written 12/08/2026

Last reviewed 12/08/2026