Is a hole in the heart serious?

The heart is an important organ that ensures normal blood circulation in the human body. Because there are many blood vessels in the heart area, problems are very prone to occur. When it comes to heart diseases, the most common one is heart disease. But in fact, in addition to heart disease, there are many other diseases that are related to the heart, and some people have holes in their hearts. So, is a hole in the heart serious?

Atrial septal defect is one of the most common congenital heart diseases, and together with ventricular septal defect, it can be called a "hole" in the heart.

There is a consensus on timely treatment for larger holes in the heart, but as medical conditions improve, many smaller holes are discovered by doctors.

Unlike ventricular septal defects that usually cause heart murmurs, small atrial septal defects are often discovered through cardiac ultrasound examinations and are usually not found through a doctor's stethoscope. Even if there are repeated lung infections or other discomforts, these cannot be explained by this hole. Yang Mingfeng, Department of Cardiovascular Surgery, Dongyang People's Hospital

But once it is discovered, it will always bring a great psychological burden to parents or patients, and even unnecessary panic. At this time, they face two choices: one is treatment, and the other is no treatment.

Treatment methods, although small atrial septal defects can generally be treated with minimally invasive methods, such as percutaneous interventional closure or small incision closure. The former can be treated with an injection in the thigh without leaving any scars on the body surface, and the latter will only leave a very small surgical scar on the chest. Because both methods are not very invasive and the surgical risks are relatively small, many parents do not even understand why surgery is necessary. They just take it for granted that a hole in the heart is a big deal and must be treated.

Why should a disease be treated?

This sounds like a question that requires no answer. Of course you need to treat your illness! But in reality, it is not that simple. The goal of treatment is to live longer and live better. Will a small atrial septal defect shorten life expectancy? There is currently no clear answer to this question.

Atrial septal defect is a hole between the left and right atria of the heart. Because the pressure in the left atrium is greater than that in the right atrium, this hole causes part of the blood in the left atrium to flow into the right atrium through it. It is generally believed that this abnormal excessive flow will lead to adverse consequences.

These consequences include;

1. The right side of the heart is overloaded, causing the right ventricle and right atrium to enlarge, leading to right-sided heart failure and tricuspid regurgitation.

2. Right atrial enlargement can also lead to atrial arrhythmias.

3. Excessive blood flow in the pulmonary artery and repeated lung infections can lead to pulmonary hypertension after long-term effects.

4. Infective endocarditis.

5. Paradoxical embolism.

Generally, the first three are the main ones, and they are the result of slow and long-term influences, so you can rest assured and give yourself a few days to sort out your thoughts. The latter two are rare. It is also believed that it may be related to migraines and decompression sickness. However, these research results may have been obtained from studies on larger cases of atrial septal defects in an era when cardiac ultrasound was not available. Larger atrial septal defects led to clinical manifestations such as recurrent lung infections, heart failure, and arrhythmias, which were later discovered through auscultation of heart murmurs and cardiac catheterization. Therefore, it is questionable whether the conclusions drawn from these data can be extended to small atrial septal defects. However, years of clinical observations have shown that small atrial septal defects generally do not lead to adverse consequences.

At this point we have to clarify what kind of atrial septal defect is considered small. It is generally believed that if it is less than 5 mm (another term you may encounter is patent foramen ovale, which in most cases can be equated to a relatively small atrial septal defect), cardiac ultrasound examination shows no enlargement of the right ventricle or right atrium, or cardiac catheterization examination finds that the pulmonary circulation blood flow exceeds the systemic circulation blood volume by less than 1.5 times. Of course, in general, only cardiac ultrasound examination is required and there is no need for cardiac catheterization. The above standards are not absolute and require individualized analysis based on the case.