Types of Heart Holes and Their Treatments

Millions of babies around the world are born with a type of heart defect called a hole in the heart. These holes can occur in different walls of the heart and can vary in size. Some holes are small and cause no symptoms, while others can be large and get detected later on in adulthood and lead to serious health problems. This blog post will explore the different types of heart holes, including atrial septal defects (ASD), ventricular septal defects (VSD), and patent foramen ovale (PFO). Finally, we will explore the treatments for holes in the heart.


Types of Heart Holes

The term "heart hole" might sound alarming, but it refers to a group of congenital heart defects, where an opening exists in one of the heart's walls. These defects can develop during foetal development when the heart structures aren't fully formed. Some defects go undiagnosed and develop later in life. Thankfully, many heart holes are small and cause no symptoms. However, larger holes can disrupt blood flow within the heart, leading to various complications. In this section, we'll explore some of the different types of hole in heart and their potential impact.

Atrial Septal Defects (ASD)

ASD is the most common type of heart hole, occurring in the wall (septum) separating the heart's upper chambers (atria). Normally, oxygen-poor blood from the body flows through the right atrium to the right ventricle, then gets pumped to the lungs for oxygenation. Oxygen-rich blood from the lungs flows in the left atrium and then to the left ventricle, which pumps it out to the body. In ASD, blood can mix between the atria due to a hole, potentially reducing the amount of oxygen-rich blood reaching the body. There are three main types of ASD heart holes based on their location:

Atrial Septal Defect Secundum: This is the most common type of ASD hole in heart, occurring in the mid-portion of the septum.

Atrial Septal Defect Primum: This defect involves the lower part of the septum and may be associated with other heart abnormalities.

Atrial Septal Defect Sinus Venosus: This rare type occurs near the upper part of the septum, close to the major veins entering the heart.

Symptoms of ASD can vary depending on the size of the hole. Small ASD heart problems might cause no issues, while larger ones can lead to fatigue, shortness of breath, palpitations (irregular heartbeat), and exercise intolerance.

Ventricular Septal Defects (VSD)

A VSD is a hole in the septum separating the heart's lower chambers (ventricles). Similar to ASD, VSD can allow mixing of oxygen-rich and oxygen-poor blood. Here, the oxygen-rich blood from the left ventricle can flow back to the right ventricle through the hole, reducing the efficiency of blood circulation. VSDs can also be categorised by location:

Perimembranous VSD: This occurs near the base of the heart, close to the aortic valve.

Muscular VSD: This is the most common type, located within the muscular wall of the septum.

Outlet VSD: This rare type occurs near the outflow tract of the ventricles, close to the major arteries leaving the heart.

VSD symptoms can range from none in case of small defects to fatigue, shortness of breath, feeding difficulties in infants, and even heart failure in severe cases.

Patent Foramen Ovale (PFO)

During foetal development, a natural opening exists in the atrial septum called the foramen ovale. This allows blood to bypass the developing lungs and receive oxygen directly from the placenta. Normally, this opening closes shortly after birth. However, in some individuals, the foramen ovale remains open to some degree, creating a PFO. Most PFOs are small and cause no problems. However, in rare cases, a large PFO is linked to an increased risk of stroke, particularly if combined with other risk factors.

Heart Hole Treatment Options

The need for heart hole treatment depends on the type, size, and its impact on blood flow, as well as the patient's age and whether they are experiencing any symptoms. As mentioned earlier, many small defects require no intervention and can be monitored by a doctor and even close up on their own. However, for larger holes, those causing symptoms, or those developing in adults, various treatment options exist.


Medications

Medications might be used to manage symptoms associated with small heart holes, such as heart failure or arrhythmias (irregular heartbeat). Here are some examples of such medications:

Diuretics: These help remove excess fluid from the body, which can be beneficial in heart failure caused by a large heart hole.

ACE inhibitors (angiotensin-converting enzyme inhibitors): These medications relax blood vessels and can help reduce workload on the heart.

Beta-blockers: These medications slow down the heart rate and force of contraction, which can be helpful in managing arrhythmias.

It's important to note that medications don't directly close the hole itself, but rather address its associated complications.

Heart Hole Surgery

In some cases, surgical intervention might be necessary for heart hole treatment. Depending on the type and location of the defect and the age of the patient, two main approaches for heart hole surgery can be taken:

Open-heart surgery: This traditional method involves accessing the heart through an incision in the chest. The surgeon then repairs the hole with a patch or stitches.

Minimally invasive procedures: Technological advancements have led to the development of minimally invasive procedures for certain heart hole treatments. Here are two main approaches:

Catheter-based procedures (device closure): This technique utilises thin, flexible tubes called catheters inserted through a vein in the groyne or arm. These catheters are guided using X-ray fluoroscopy to reach the heart. Once positioned, a specialised closure device is deployed through the catheter and manoeuvred to plug the hole. This device can be a self-expanding plug, a double-disc occluder, or another type depending on the specific defect.

Robotic-assisted surgery: In some cases, robotic-assisted heart hole surgery might be employed for minimally invasive heart hole closure. Here, the surgeon operates from a console while manipulating the surgical laparoscopic instruments using robotic arms. This technique offers enhanced precision and visualisation compared to traditional minimally invasive surgery.

Conclusion

There are treatments available for heart murmurs. Early diagnosis and appropriate intervention can ensure a healthy and fulfilling life for most individuals with heart holes. Remember, knowledge is empowering. By understanding these conditions and the heart hole treatment options, patient’s families can make informed decisions.

Disclaimer:

This article has been written for information purposes only, and is not a substitute for professional medical advice by a qualified doctor or other health care professional. The author is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information in this article. Always consult a qualified healthcare provider for accurate diagnosis, personalised treatment, and recommendations tailored to your individual health needs.