DEAR DR. GOTT: I’m a 61-year-old male with a 10-year history of heart problems. I’ve had two heart attacks, resulting in partial heart damage, had three stents put in, and a triple bypass operation. On my last visit to my cardiologist, he informed me that I have a hole on the front side of my heart in need of mending with a mesh-type patch. What causes a hole in the heart and might there be risks if I choose not to have the operation? I’m undecided.
DEAR READER: This is one issue that sounds terribly frightening, but may represent a congenital heart defect that has likely been present since birth. If this isn’t the case, your physician may be referring to a “hole in the front of the heart” which isn’t a true hole but rather a aneurysm of the left ventricle due to the damage caused by your heart attacks. For thoroughness’s sake I will discuss both.
The heart works in a similar manner as a pump, beating approximately 100,000 times a day. It has four chambers, two upper and two lower, is two-sided and has an inner wall separation known as the septum. The right side of the heart pumps blood to the lungs where it picks up oxygen. The left side of the heart then receives that oxygen-rich blood from the lungs and pumps it throughout the body. Each time the heart beats, the re-oxygenation circulating process begins. The septum prevents mixing of the blood that is both rich and deficient in oxygen.
A hole in that septum between the heart’s two upper chambers is known as an atrial septal defect, or ASD. A hole between the heart’s two lower chambers is referred to as a ventricular defect or VSD. The presence of a “hole” allows both bloods to mix and the oxygen-rich blood is incorrectly pumped back to the lungs where it just came from, rather than throughout the body. If an ASD isn’t repaired, the additional flood of blood can cause heart problems such as right sided heart failure, pulmonary hypertension, arrhythmias or stroke that commonly occur during adulthood. If a VSD isn’t repaired, problems might include heart failure, arrhythmias, and pulmonary hypertension. Exam results for an ASD are not often found until adulthood, whereas VSDs cause a distinct and recognizable murmur, making diagnosis easier — often in infancy. If this is the condition you have, it is extremely odd that it wasn’t discovered before now.
If the “hole” is on the front of your heart (left ventricle) as a result of your heart attacks, your physician is likely recommending repair to improve your heart function and prevent further damage. When the muscle becomes damaged, clots may form within the muscle. The area then bulges or balloons out as the heart beats putting pressure on the area but reducing the effectiveness and efficiency of the contraction. If it bursts a hole may form. Often the defect is found before this occurs, however.
This procedure, known as Dor, removed the damaged or dead tissue and then repairs the area followed by a patch to cover the site to prevent further bulging or ballooning of the muscle as the heart pumps.
In either case, my guess is that your cardiac surgeon will likely make an incision in your chest to reach the site. A heart-lung bypass machine will take over the heart’s pumping action while the procedure is being performed. I’m guessing you currently have an irregular heartbeat known as an arrhythmia that will likely remain following surgery. Your physician will then follow up with you on a regular basis and will tell you when you can drive, exercise and return to normal activities. He or she wouldn’t recommend repair if it weren’t necessary but you may feel more comfrtoable getting a second opinion first. Get your questions answered and proceed accordingly.
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 payable to Dr. Peter Gott, 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.
