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A hole in the heart is created either in the septum between the atria or in the septum between the ventricles. Most of the time the hole is congenital, in rare cases it arises as a result of a heart attack. With larger holes, the risk of stroke increases.
The most important facts
- If there is a hole in the heart, the otherwise separate heart chambers or auricles are connected by an opening. This is how the blood flows that does not belong there.
- Such holes are usually congenital because they have not closed in the fetus.
- In rare cases, they arise from heart attacks.
- Small holes are often not treated unless they cause discomfort.
- Smaller holes in the atria are now mostly closed minimally invasively using a catheter.
- However, closing holes in the ventricles requires open heart surgery.
How does a hole in the heart come about?
The halves of the heart each consist of a heart chamber and an atrium. Oxygen-poor blood brings the blood circulation through the right atrium into the right chamber and from there into the lungs. The breathing air supplies it with fresh oxygen and the blood continues to flow through the left atrium into the left chamber. The aorta then carries the blood back into the body. Partitions separate atria and ventricles. Poisons, infections during pregnancy and genetic defects can cause the partitions to not close. The septum grows together from above and below in the embryo. If there is a hole in the partition, it does not close completely.
The ventricular septal defect (VSD)
Here is the hole in the septum between the right and left ventricles. If this opening is small, oxygen-rich blood flows from the left into the right chamber and from there into the lungs. The lungs get 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 heart defect is an atrial septal defect. There is a hole in the septum between the atria. The oxygen-rich blood now flows from the left into the right atrium with higher pressure. 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 run there is a risk of thrombosis or cardiac arrhythmia.
The Persistent Foramen Oval (PFO)
This creates a hole between the atria and thus a direct connection between the lung and body circulation. The blood flows directly from the pulmonary veins into the aorta. This opening usually closes in the first few days after birth. If not, this hole is not a problem for toddlers, 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 adolescents and adults with a PFO. This is especially true for diving and mountaineering. Flying is also risky. Many divers' deaths are due to an undetected hole in the atria.
What can you do?
Pregnant women can have an ultrasound scan performed before the child is born to determine whether the fetus has such a heart defect.
With larger holes, typical symptoms manifest in the infants. They hardly drink, gain little weight and suffer from shortness of breath. Cardiologists specialized in teething problems clarify whether it is a septal defect.
Therapy depends on the severity of the defect, its size and location. If there is an enormous heart defect, then this is surgically removed. However, an ASD can be minimally invasively repaired in eight out of ten cases. 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 partition. If not, an open heart procedure must take place.
Hole in the heart in the elderly
Such a heart defect is usually congenital, but in rare cases it also appears in old age. Here it is usually due to damage to the chamber septum caused by a heart attack. If an infarction is detected too late, no oxygen gets into the heart and this leads to the death of the heart tissue. This can also affect the substance of the cardiac septum. The dead tissue scarred.
The heart wall can sag and an opening sometimes forms in the septum between the right and left ventricles. A hole can also arise during open heart surgery.
Sometimes, however, the color changes in older people as a result of a heart hole
Skin blue or suffering from shortness of breath. However, this is a late consequence of an innate opening in the heart. At a young age, the performance of the heart is stronger and such an error can be better compensated for. In advanced years the cardiac output weakens and now the symptoms start.
Treatment - catheter and double umbrella
Such a hole can be closed with a double umbrella made of nitrile. This umbrella is surgically inserted over the groin with a probe. Local anesthesia is usually sufficient, unless the patient insists on general anesthesia. There is no pain in those affected. The procedure takes about 30 minutes.
To close a septal defect in the atrium, insert a special catheter from the right atrium across the hole in the left atrium and pull a wire through the catheter into the left atrium. A measuring catheter is now inserted along the wire to identify the dimensions of the opening. The size of the closure is based on these dimensions.
The doctor removes the measuring catheter and pulls the closure tool into the guiding catheter. The left part of the closure opens automatically when pushed. By withdrawing the guide catheter, the closure clings to the atrial septum. When the guide catheter is completely withdrawn, the right part of the closure also opens. In the following three months, the patient takes medication until the tissue has grown over the screen.
When is a closure recommended?
An open oval foramen that does not cause any symptoms is usually not closed. It looks different when blood clots from the leg or from the pelvis enter the large bloodstream through the opening. Then blood vessels in the brain or other organs can become clogged, with serious consequences such as a stroke. The very rare defects in the atrial septum are also usually not closed. However, as with open foramen, closure is strongly recommended if blood clots form.
Small defects in the atrium and the open oval foramen can neither be detected with an EKG nor with an X-ray image. Cardiologists, on the other hand, recognize larger holes in the atrium from conspicuous heart murmurs, from an EKG or from an X-ray image. Heart holes are found much more effectively by cardiac ultrasound.
Complications are extremely rare with catheter closures. In the past, blood clots occurred in about six percent of cases. However, this is hardly the case with today's closures and these clots only occur in one out of a hundred people treated. In theory, it is also possible that the screen will wash into the circulation and damage the tissue. In practice, however, this almost never happens. Ten percent of those affected have disturbances in the atrial rhythm in the weeks after the procedure. These arise because the atria are mechanically irritated. There are no problems.
Are you allowed to play sports?
People with an unlocked hole in the heart can often do almost all sports when the hole is small. However, you should definitely discuss this with your doctor. With a small defect, you can do moderate sports such as golf, but also more strenuous sports such as soccer or cycling. This is not so easy with a larger hole - especially if the hole leads to an undersupply of oxygen. You can see this when you literally turn blue, that is, your skin changes color. In this case, you should not choose a sport that requires a high oxygen supply, such as long-distance running. Competitive sports are not possible with severe heart defects, but leisure sports are. The first choice are easy hikes.
Prevent a hole in the heart?
You cannot prevent a hole in the heart because it is mostly innate. Acquired openings in the heart are a result of heart attacks. At most, you can prevent a heart attack by regular examinations in cardiological practice, refraining from cigarettes and alcohol and adequate exercise. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Thomas Lambert, Clemens Steinwender: Cardiovascular Medicine, Trauner Verlag, 1st edition, 2019
- Jeanne Marie Baffa: Ventricular Septal Defect (VSD), MSD Manual, (accessed August 6, 2019), MSD
- S. Dittrich et al .: S2k Guideline Pediatric Cardiology: Ventricular septal defect in children and adolescents, German Society for Pediatric Cardiology, (accessed August 6, 2019), AWMF
- Jeanne Marie Baffa: Atrial Septal Defect (ASD), MSD Manual, (accessed August 6, 2019), MSD
- C. Jux et al .: S2k Guideline Pediatric Cardiology: Atrial Septal Defect (ASD) in childhood and adolescence, German Society for Pediatric Cardiology, (accessed August 6, 2019), AWMF
- Jeanne Marie Baffa: Overview of Congenital Heart Defects, MSD Manual, (accessed August 6, 2019), MSD