A hole in the heart represents a congenital heart defect. There are many types of holes in the heart, and most of them are present at the time of birth. An anomaly scanning during the pregnancy period helps to detect most of the heart holes in a fetus. The exact cause of heart hole formation is not known, but healthcare providers believe genetics is a factor leading to it. According to the clinical data, almost 7 out of 10 infants born with a heart hole will survive into adulthood. Depending upon the type of hole, people may experience various symptoms. Some holes can be left untreated, while the heart hole that causes symptoms and complications requires surgery to treat it.
Types of Hole In The Heart:
Different types of holes can be raised in the heart including:- Patent Foramen Ovale (PFO): All fetuses have a natural hole in the heart during development that will close itself. But in some fetuses, the hole does not fuse even after birth, which is known as patent foramen ovale. 20-25% of adults have PFO.
- Atrial Septal Abnormalities: In this type, a hole is formed in between the upper chambers of the heart (atria). The hole is formed in the atrial septum. A hole can sometimes remain when the fetus’s heart forms and the septum does not close completely. There are different types of atrial septal abnormalities such as primum (heart hole is developed near the bottom of the septal wall, secondum (heart hole develops near the middle of the septal wall), multifenestrated( consists of multiple holes in the septal wall), and sinus venous (heart hole appears near the superior and inferior vena cava).
- Ventricular Septal Abnormalities: In this type, a hole is formed in the wall separating the ventricles of the heart. The different types of ventricular septal abnormalities are muscular (heart hole is seen in the muscular tissue between ventricles), perimembraneous (hole appears near the middle of the heart, outlet and supracristal (hole develops near the aorta or pulmonary arteries), post-infarction (a hole that develops after a heart attack).
Causes For Hole In The Heart:
The exact cause for the formation of a hole in the heart is not clear. The following factors may play a role in the cause of congenital heart diseases:- Genetics: a family history of chromosomal abnormalities may predispose to the development of a hole in the heart
- Environmental factors: These include exposure to certain chemicals or drugs during pregnancy
- Medical conditions: Pregnant people with medical conditions such as diabetes, rubella, maternal phenylketonuria, and lupus are at a higher risk of having a baby with congenital heart defects
- Certain medications: Taking some medicines during pregnancy may cause a heart hole. this includes angiotensin-converting-enzyme inhibitors to control high blood pressure, statins, thalidomide, lithium, isotretinoin
- Smoking: Cigarette smoking during pregnancy may cause a hole in the heart of fetus
- Alcohol misuse: Excess alcohol consumption may cause a hole in the fetal heart
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What Are The Symptoms of A Hole In The Heart?
All holes in the heart do not cause any symptoms. Some people experience the symptoms depending upon the type of hole they have. A hole in the heart leads to the mixing of both oxygenated and deoxygenated blood putting stress on the side of the heart that is getting more blood flow than expected, which may cause a condition called cyanosis. A baby born with atrial septal defect may not show early symptoms, often the symptoms appear in adulthood. Following are the symptoms of atrial septal defect:- Shortness of breath, especially when exercising
- Feeling tired, especially after performing activities
- Swelling in feet, legs, or belly area
- Irregular heartbeats (arrhythmias)
- Palpitations (feeling of a skipped heartbeat or feelings of a quick, pounding or fluttering heartbeat)
- Poor eating
- Slow or no physical growth rate
- Getting tired more often
- Breathlessness or fast breathing
- Heart murmur
- Shortness of breath, especially when exercising
- Severe headaches (migraine)
- Stroke
- Transient ischemic attack
Diagnosis Of A Hole In The Heart:
Some of the congenital heart defects such as holes in the heart are found before or soon after the baby is born. But the smaller holes will remain undetected till later stages of life. If you have a family history of heart disease, or if the doctor hears a heart murmur while examining, he or she will ask you to perform some tests to rule out the exact cause. These diagnostic tests include:- Echocardiogram: This is the main test used to diagnose both atrial septal defect and ventricular septal defect. A picture of the heart in motion is obtained using sound waves. It shows the structure of heart chambers and valves. Along with this how blood moves through the blood vessels is also seen in echocardiograms.
- Chest X-ray: A chest X-ray helps to see the structure of the heart and lungs
- Electrocardiogram (ECG):
- ECG helps to detect the electrical activity of the heart. It is a quick and painless test that discloses how fast and how slowly the heart beats.
- Pulse oximetry: A pulse oximeter is a sensor device attached to your fingertips to record the amount of oxygen in the blood. Too little oxygen values represent underlying heart or lung problem.
- Cardiac magnetic resonance imaging scan: Detailed images of the heart are disclosed with the help of radio waves and a strong magnetic field. It is performed if other tests don't provide a sure diagnosis.
- Computerized tomography scans: Detailed images of the heart are disclosed with the help of a series of X-rays, and are performed if other tests are not enough to come to a proper diagnosis.
- Cardiac catheterisation: This helps doctors to determine the function of the heart valves and chambers.
Treatment For A Hole In Heart:
Some types of holes in the heart do not need any treatments. They will close over some time. The treatment depends on the type of hole, number of holes, age of the patients, and the symptoms experienced by the patient. Evaluating these factors your doctor will prescribe medications, and in severe cases, they may recommend surgery for you.Treatment for atrial septal defect:
An atrial septal defect during birth time will close over a period of time. If it is not causing any symptoms, regular health checkups are only needed. Treatment includes:- Medications: medicines will not help to repair the hole in the heart, but they may help to reduce the symptoms. These medicines include beta blockers to control heartbeat, anticoagulants or blood thinners to lower the risk of blood clots, and diuretics to reduce fluid build ups.
- Surgery or other Procedures: It is done to repair a medium to large atrial septal defect to prevent complications. It involves closing the hole in the heart, which can be done in two ways.
- Catheter-Based Repair: This is done to fix the secundum type of atrial septal defects. Through the groin area, a thin, flexible tube called a catheter is put into a blood vessel. Then this tube is guided into the heart. A mesh patch or plug goes through the catheter. The patch is used to close the hole. Later heart tissue grows around the patch, closing the hole for life.
- Open Heart Surgery: this involves making a cut through the chest wall to get to the heart. The surgeon closes the holes using patches. Open-heart repair surgery is the only way to fix primum, sinus venosus and coronary sinus atrial defects.
Treatment for Ventricular Septal Defect:
The treatment includes regular checkups, medications and surgeries depending on the type and number of holes.- Medications: Medications will not help to repair the holes but help to prevent complications. Oxygen, and diuretics, are usually prescribed.
- Surgeries and other procedures: Surgeries are done to repair medium to large-sized holes. Most of the surgeries for babies with VSD are done in their first year. The surgery can be done in 2 ways.
- Open heart surgery: Most of the ventricular septal defects are repaired using open heart surgery. In this, the surgeon uses a patch or stitches to close the hole between the lower heart chambers.
- Catheter procedure: some types of VSD can be repaired using catheters without doing open heart surgeries.
FAQs:
Q1: Can a hole in the heart heal itself?A: A small hole in the heart may heal itself over some time. Some will not close, but will not increase in size and limit activities also. But medium to large-sized holes require medical treatments to heal.
Q2: What is the success rate of heart hole surgery?
A: Depending upon the disease severity, a 98% success rate is observed after heart hole surgery completion with only a few cases leading to complications.
Q3: How long can a patient live with a heart hole?
A: In some cases, patients with small holes such as ASD conditions live for 80 years without any treatment. However, the average life expectancy of an untreated ASD patient is 50 years.
Q4: What are the early symptoms of a hole in the heart?
A: Early symptoms include fatigue, shortness of breath, irregular heartbeat, swelling in legs, and frequent lung infections.
Q5: Can a hole in the heart be cured without surgery?
A: Small holes may close naturally, especially in children. Larger defects often require minimally invasive closure or surgery.
Q6: How much does hole in heart surgery cost in India?
A: The cost typically ranges between ₹2,00,000 – ₹5,00,000 depending on hospital, procedure, and patient condition.
