A hole in the heart is created either in the septum between the atria or in the septum between the ventricles. The hole is usually congenital, in rare cases it arises as a result of a heart attack . Larger holes increase the risk of a stroke .
Table of Contents
- The most important facts
- How does a hole in the heart come about?
- The ventricular septal defect (VSD)
- The atrial septal defect (ASD)
- The persistent foramen ovale (PFO)
- What can you do?
- Symptoms
- therapy
- Hole in the heart in the elderly
- Treatment – catheter and double screen
- When is a closure recommended?
- diagnosis
- Complications
- Are you allowed to do sports?
- Preventing a Hole in the Heart?
The most important facts
- If there is a hole in the heart, the otherwise separate heart chambers or atria are connected by an opening. This is how the bloodflows through that doesn’t belong there.
- Most often, such holes are congenital because they did not close in the fetus.
- In rare cases, they are caused by heart attacks.
- Small holes are often left untreated if they aren’t causing discomfort.
- Smaller holes in the atria are now mostly closed using a minimally invasive catheter.
- However, closing holes in the heart chambers requires open heart surgery.
The hole in the heart is one of the clinical pictures in which an operation is not absolutely necessary. (Image: Siarhei / fotolia.com)
How does a hole in the heart come about?
The halves of the heart each consist of a heart chamber and an atrium. Oxygen-depleted blood brings the bloodstream through the right atrium to the right ventricle and from there to the lungs . The breathing air supplies it with fresh oxygen and the blood continues to flow through the left atrium into the left ventricle. The aorta then carries the blood back into the body. Partitions separate the atria and ventricles from one another. Toxins, infections during pregnancy, and genetic defects can prevent the septum from closing. The septum grows together from above and below in the embryo. If there is a hole in the septum, it will not close completely.
The ventricular septal defect (VSD)
Here is the hole in the septum between the right and left ventricle. If this opening is small, oxygen-rich blood can move from the left chamber into the right chamber and from there into the lungs. The lungs are supplied with more blood than normal.
Large holes increase the pressure in the right ventricle and thereby the pressure in the pulmonary arteries. Affected children suffer from shortness of breath due to this blood pressure and have to breathe faster.
The atrial septal defect (ASD)
The second most common congenital malformation of the heart is an atrial septal defect. There is a hole in the septum between the atria. The oxygen-rich blood now flows at a higher pressure from the left to the right atrium. The pressure in the lungs increases, the right atrium and the right ventricle can enlarge. With smaller holes there are usually no symptoms, but in the long term there is a risk of thrombosis or a cardiac arrhythmia.
A cardiac exam will determine what shape a hole in the heart is. (Image: ra2 studio / fotolia.com)
The persistent foramen ovale (PFO)
This creates a hole between the atria and thus a direct connection between the pulmonary and body circulation. The blood enters the aorta directly from the pulmonary veins. This opening usually closes in the first few days after birth. If not, this hole causes little problems for small children, because the pressure in the lungs is not yet high. However, this pressure increases with age. Activities with strong pressure fluctuations are life-threatening for young people and adults with a PFO. This is especially true for diving and mountaineering. Flying becomes risky too. Many diver deaths result from an unrecognized hole in the auricle.
What can you do?
Pregnant women can already have an ultrasound examined before the child is born to determine whether the fetus suffers from such a heart defect.
Symptoms
With larger holes, typical symptoms manifest in the infants. They hardly drink, gain little weight and suffer from shortness of breath. Cardiologists specializing in childhood diseases clarify whether it is a septal defect.
Children are more likely to be affected by the hole in the heart, the heart defect is usually congenital. (Image: seventyfour / fotolia.com)
therapy
The therapy depends on the severity of the defect, its size and its location. If the heart defect is enormous, it is surgically removed. However, in eight out of ten cases, an ASD can be resolved using minimally invasive methods. To do this, a small umbrella with a catheter is inserted and this umbrella then closes the hole. This is only possible if the hole is in the middle of the septum. If not, an open heart procedure must be performed.
Hole in the heart in the elderly
Such a heart defect is usually congenital, but in rare cases it also appears in old age. This is usually due to damage to the ventricular septum caused by a heart attack. If an infarct is detected too late, no oxygen reaches the heart and this leads to the death of the heart tissue. This can also affect the substance of the heart septum. The dead tissue scarred.
The heart wall can bulge and an opening sometimes forms in the septum between the right and left ventricles. Open heart surgery can also create a hole like this.
Sometimes, however, the
skin of older people also turns blue as a result of a hole in the heart or they suffer from shortness of breath. However, this is a late consequence of an innate opening in the heart. At a young age the heart’s performance is stronger and such a mistake can be better compensated for. In advanced years the cardiac output decreases and now the symptoms set in.
Treatment – catheter and double screen
Such a hole can be closed with a double screen made of nitrile. This screen is surgically inserted through the groin with a probe. Local anesthesia is usually sufficient, unless the patient insists on general anesthesia. There is no pain for those affected. The procedure takes about 30 minutes.
To close a septal defect in the atrium, a special catheter is inserted from the right atrium across the hole in the left atrium and a wire is pulled through the catheter into the left atrium. A measuring catheter is now inserted along the wire to determine the dimensions of the opening. The size of the closure depends on these dimensions.
The doctor removes the measuring catheter and pulls the locking tool into the guide catheter. The left part of the occluder opens by itself when it is pushed. As the guide catheter is withdrawn, the occluder nestles against the atrial septum. When the guide catheter is fully withdrawn, the right part of the occlusion will also open. In the following three months, the patient takes medication until the tissue has overgrown the umbrella.
In the cardiac practice, the need for an intervention is discussed. (Image: Elnur / fotolia.com)
When is a closure recommended?
An open foramen ovale that does not cause discomfort is usually not closed. The situation is different when blood clots from the leg or pelvis enter the large bloodstream through the opening. Then blood vessels in the brain or other organs can become blocked, with serious consequences such as a stroke. The very rare defects in the atrial septum are also usually not closed. However, as with an open foramen, if blood clots form, it is strongly recommended that the patient be closed.
diagnosis
Small defects in the atrium and the open foramen ovale can neither be detected with an EKG nor with an X-ray. Cardiologists, on the other hand, recognize larger holes in the atrium by abnormal heart sounds, an EKG or an X-ray. Heart holes are found much more effectively by heart ultrasound.
Complications
Complications with catheter occlusions are extremely rare. In the past, blood clots occurred about six percent of the time. However, this is hardly the case with today’s closures and these clots only develop in one in a hundred people treated. Theoretically, it is also possible that the umbrella washes into the circulation and damages the tissue. In practice, however, this almost never happens. Ten percent of those affected have disorders of the atrial rhythm in the weeks after the procedure. These arise because the atria are mechanically irritated. This does not cause any problems.
Even if competitive sports are out of the question, there are many sporting activities such as hiking that are definitely recommended for a hole in the heart. (Image: Janni / fotolia.com)
Are you allowed to do sports?
People with an unlocked hole in their heart can often do almost any sport if the hole is small. However, you should definitely discuss this with your doctor. If there is a small defect, you can do moderate sports such as golf, but also more strenuous sports such as football or cycling. This is not so easy with a larger hole – especially if the hole leads to an undersupply of oxygen. This can be seen when you literally turn blue, that is, your skin is discolored. In this case, you should not choose a sport that requires a high supply of oxygen, such as long-distance running. Competitive sport is not possible with severe heart defects, but recreational sport is. The first choice are easy hikes.
Preventing a Hole in the Heart?
You cannot prevent a hole in the heart as it is usually congenital. Acquired openings in the heart are a result of heart attacks. The best you can do to prevent a heart attack is through regular cardiological examinations, avoiding cigarettes and alcohol and getting enough exercise . (Dr. Utz Anhalt)
