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Hole in the heart causes, symptoms and therapy
contents
- The most important facts
- How does a hole in the heart come about??
- The ventricular septal defect (VSD)
- The atrial septal defect (ASD)
- The persistent foramen ovale (PFO)
- What can you do?
- symptoms
- therapy
- Hole in the heart in the elderly
- Treatment - catheter and double shield
- When is a closure recommended??
- diagnosis
- complications
- You are allowed to do sports?
- Prevent a hole in the heart?
The most important facts
- In the case of a hole in the heart, the otherwise separate ventricles or atria are connected through an opening. This is how the blood flows that does not belong there.
- Mostly, such holes are innate because they have not closed in the fetus.
- In rare cases, they are caused by heart attacks.
- Small holes are often left untreated if they cause no discomfort.
- The occlusion of smaller holes in the atria is now mostly minimally invasive by means of a catheter.
- However, closing holes in the heart chambers requires open heart surgery.
The hole in the heart belongs to the clinical pictures in which an operative procedure is not absolutely necessary. (Image: Siarhei / fotolia.com) How does a hole in the heart come about??
The halves of the heart each consist of a ventricle and an atrium. Low-oxygen blood brings the bloodstream through the right atrium into the right ventricle and from there into the lungs. The breathing air supplies it with fresh oxygen and the blood continues to flow via the left atrium into the left ventricle. The aorta then transports the blood back into the body. Partitions divide atria and ventricles from each other. Poisons, infections during pregnancy and genetic defects can cause the septa not close. The septum grows together in the embryo from above and below. When a hole in the septum, it does not close completely.
The ventricular septal defect (VSD)
Here lies the hole in the septum between right and left ventricle. If this opening is small, then oxygen-rich blood passes from the left into the right ventricle and from there into the lungs. The lungs get more blood than normal.
Large holes increase the pressure in the right ventricle and thereby increase the pressure in the pulmonary arteries. Affected children suffer from this blood pressure in shortness of breath and need to breathe faster.
The atrial septal defect (ASD)
The second most common congenital malformation of the heart is an atrial septal defect. Here 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 increase. Smaller holes usually show no symptoms, but for a long time there is a risk of thrombosis or cardiac arrhythmia.
A cardiological examination clarifies the shape of a hole in the heart. (Image: ra2 studio / fotolia.com) The persistent foramen ovale (PFO)
This creates a hole between the atria and thus a direct connection between the pulmonary and the systemic circulation. The blood passes directly from the pulmonary veins into the aorta. Usually, this opening closes in the first days after birth. If not, this hole causes little trouble for toddlers because the pressure in the lungs is still not high. With age, however, this pressure increases. For adolescents and adults with a PFO, activities with severe pressure fluctuations are life-threatening. This is especially true for diving and mountaineering. Even flying becomes risky. Many diver deaths are due to an unrecognized hole in the atria.
What can you do?
Pregnant women can be examined by ultrasound before the birth of a child, if the fetus suffers from such a heart defect.
symptoms
With larger holes, typical symptoms manifest themselves in infants. They barely drink, take little weight and suffer from shortness of breath. Cardiologists specialized in teething issues will clarify if it is a septal defect.
Children are more affected by the hole in the heart, the heart defect is usually innate. (Image: seventyfour / fotolia.com) therapy
The therapy depends on the severity of the defect, its size and its location. If it is a huge heart defect, then this is surgically removed. However, an ASD can be minimally-invasively corrected in eight out of ten cases. For this purpose, a small screen with a catheter is inserted and this Schirmchen then closes the hole. This only works if the hole is in the middle of the septum. If not, an open-heart surgery must take place.
Hole in the heart in the elderly
Such a heart defect is usually innate, but appears in rare cases even in old age. Here it is usually due to a damage of the ventricular septum, which was caused by a heart attack. If there is an infarct detected too late, no oxygen enters the heart and this leads to death from the heart tissue. This may also affect the substance of the heart septum. The dead tissue is scarring.
The wall of the heart can become loose and sometimes an opening is formed in the septum between the right and left ventricles. Even with an operation on the open heart, such a hole can arise.
Sometimes, in the elderly, but as a result of a heart hole also the
Skin is blue or you are 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 so a mistake can be better compensated. In advanced years, the cardiac output diminishes and now the discomfort sets in.
Treatment - catheter and double shield
Such a hole can be closed with a double screen made of nitrile. This shield is surgically inserted with a probe over the groin. Usually a local anesthesia is sufficient, unless the patient insists on general anesthesia. The sufferers do not experience any pain. 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 into the left atrium and pull a wire through the catheter into the left atrium. Along the wire, a measuring catheter is now inserted to detect the dimensions of the opening. According to these dimensions, the size of the closure depends.
The doctor removes the measuring catheter and pulls the sealing tool into the guiding catheter. The left part of the closure opens automatically when pushed. As the guide catheter is withdrawn, the closure conforms to the atrial septum. When the guide catheter is fully retracted, the right part of the closure will also open. Over the next three months, the patient takes medication until the tissue overgrows the screen.
Cardiac practice discusses the need for intervention. (Image: Elnur / fotolia.com) When is a closure recommended??
An open foramen ovale that causes no discomfort is usually not occluded. The situation is different when clots enter the bloodstream from the leg or pelvis through the opening. Then blood vessels in the brain or other organs can clog, with serious consequences such as a stroke. The very rare defects at the atrial septum are also usually not closed. However, a closure is strongly recommended, as in the open foramen, when blood clots form.
diagnosis
Small defects in the atrium and the patent foramen ovale can be detected neither with an ECG nor with an x-ray. On the other hand, cardiologists will notice larger holes in the atrium due to conspicuous heart murmurs, ECGs or X-rays. Heart holes are found much more effective by the heart ultrasound.
complications
With catheter closures, complications are extremely rare. In the past, circulating 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 every hundred people treated. Theoretically it is also possible that the screen floats into the circulation and damages the tissue. Practically, however, this hardly ever happens. Ten percent of sufferers have disturbances of the atrial rhythm in the weeks following the procedure. These arise because the atria are mechanically irritated. Problems do not arise as a result.
Even if competitive sports are not an option, there are many sporting activities, such as hiking, which are definitely recommended at the hole in the heart. (Image: Janni / fotolia.com)You are allowed to do sports?
People with an unlocked hole in their heart can often do almost all sports when the hole is small. In any case, you should discuss this with your doctor. With a small defect, you can do both moderate sports such as golf, but also more strenuous sport such as football or cycling. With a larger hole this is not so easy - especially if the hole leads to an undersupply of oxygen. This is recognizable if you start in the truest sense of the word blue, that is, your skin discolored. In this case, you should not choose a sport that requires high levels of oxygen, such as long-distance running. Competitive sports is not possible with severe heart defects, recreational sports already. The first choice are easy walks.
Prevent a hole in the heart?
You can not 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 therefore prevent a heart attack, through regular examinations in the cardiology practice, waiving cigarettes and alcohol and sufficient exercise. (Dr. Utz Anhalt)