DEAR DR. GOTT: How dangerous is a hole in the heart? My daughter’s cardiologist says they have to open her chest to repair the hole. If she does not do that, her heart will keep enlarging. Please let me know your thoughts. Thank you.
DEAR READER: The heart is divided into four chambers – two upper and two lower. A hole in the heart refers to an atrial septal defect, a hole in the wall between the two upper chambers or a hole in the wall between the two lower chambers called a ventricular septal defect. If the condition was present since birth, your daughter would have what is known as a congenital defect. When an adult has one that may have gone undetected for years, the condition increases her risk for heart failure or pulmonary hypertension (high blood pressure in the lungs). This is because the defects allows oxygenated blood to flow from the left upper or lower chamber of the heart back into the right upper or lower chamber, mixing with deoxygenated blood. The oxygenated and deoxygenated blood mix together for its trip throughout the body, causing the heart to work harder than it already does. If the condition is not corrected, the right side of the heart will weaken and enlarge over time and, in some instances, pulmonary hypertension can occur. Also, as the right side enlarges, it can change the pressures in the heart so that blood starts to pass from right to left. Symptoms can include edema of the abdomen, legs or feet, heart palpitations, shortness of breath, frequent lung infections, and more.
A physician can often hear a murmur that resembles a whooshing sound when listening through a stethoscope. Other than hearing the abnormal rhythm through a stethoscope, your daughter’s physician or cardiologist may choose to order an echocardiogram, chest X-ray, electrocardiogram, MRI or pulse oximetry which will measure how well oxygen reaches the tissues of the skin.
If treatment is required as a result of the tests, it may be accomplished with medication that will not repair the hole, but may reduce the symptoms, lower a person’s risk of possible blood clots, and help the heart maintain a normal rhythm. Beyond that, surgery is commonly recommended. It can either be through cardiac catheterization that utilizes a catheter that is inserted into the groin and threaded to the heart with a mesh patch or plug to close the hole, or through open heart surgery that requires the use of a heart-lung machine. This form of repair will use sutures or patches to close the hole.
The long and short of it is, if your daughter’s cardiologist is recommending surgery, that is likely what should be done. She must have the confidence in the surgeon that will perform the procedure and should be guided by such activity as exercise, diet and follow-up once the defect is repaired.
Readers who would like related information can order my Health Report “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
