Avoiding the Need for Open Heart Surgery
Holes in the heart are often present at birth, but can also occur following heart surgery, heart attack, or infection. There are a number of different types of holes in the heart, such as:
- Atrial septal defects (ASD)
- Patent foramen ovale (PFO)
- Ventricular septal defect (VSD)
- Paravalvular leak
Our Structural Heart Disease Team can fix all types of heart holes with minimally invasive procedures that avoid the need for open heart surgery.
Atrial Septal Defect (ASD)
An Atrial Septal Defect is a rare heart defect that occurs in the wall between the two upper chambers of the heart. Extra blood is pushed from the left side of the heart to the right side through the hole in the upper chambers. Depending on the size of the hole, the right side can get too much blood flow, become enlarged, overworked, and eventually weaken or fail.
ASD is congenital (present at birth) and occurs when walls don’t properly develop when the baby is in the womb. Some small ASDs close spontaneously during infancy or early childhood, while larger ASDs can persist into adulthood and cause serious problems.
Larger ASDs can cause the right side of the heart to fail, arrhythmias, elevated blood pressure in the lungs (pulmonary hypertension), and a shorter lifespan. An ASD can also increase your stroke risk.
If your ASD hole is too large, you may experience:
- Fatigue
- Shortness of breath
- Swelling of the legs, feet, or abdomen
- Palpitations (fluttering or extra heartbeats)
Common ASD Questions
The most commonly used test is an echocardiogram (ultrasound of the heart), which uses sound waves to produce a video image of your heart. A transthoracic echocardiogram (TTE) is usually the first screening test that can determine if any abnormal blood flow is present or assess/detect a problem with your heart's size, function, and valves. If your TTE reveals a possible ASD, then a transesophageal echocardiogram (TEE) is also necessary. Both procedures require an IV for injecting bubbles (agitated saline) into the vein to see if a bubbles cross a hole, if present.
We may also need to perform additional tests, including CT scans, MRIs, or cardiac catheterization to fully assess your condition.
Depending on its size, ASDs can cause serious problems due to its effect on the right side of the heart. Larger defects can cause:
- the right side of the heart to fail
- arrhythmias
- elevated blood pressure in the lungs (called pulmonary hypertension)
- shorter lifespan
Yes, it can. Blood clots can form in your veins and can travel to your heart. If you have a hole in your heart, the clot can cross from the right side of the heart to the left side, and get pushed to the brain, causing a stroke. If you suffered a stroke for unknown reasons, your neurologist may look for an ASD.
We may recommend closure if you have:
- significant flow across the ASD that causes the right side of the heart to enlarge–with or without symptoms
- a history of stroke for unknown reasons
Decisions regarding closure can be complex and our Structural Heart Disease experts will guide you through this process.
Patent Foramen Ovale (PFO)
A patent foramen ovale (PFO) is a hole or a tunnel in your heart that didn't close properly after birth. Everyone has a PFO when they are developing in the womb, but it closes for most people. At birth, your lungs begin to function, and the pressures inside your heart change. This closes the hole (foramen ovale) and blood follows through normal circulatory route. PFOs are very common (25% of people have them), but most do not know it. If you have a PFO, it will remain open for life.
Common PFO Questions
In general, a PFO is hidden and does not cause any symptoms. Sometimes (rarely), it can cause someone to have lower blood oxygen levels.
A PFO does increase your risk of stroke. If a small clot forms in a vein and travels up to your heart, it could cross through the PFO to the brain, causing a stroke.
The most commonly used test is an echocardiogram (ultrasound of the heart), which uses sound waves to produce a video image of your heart. Additionally, a transthoracic echocardiogram (TTE) is a screening test which can determine if any abnormal blood flow is present or detect a problem with your heart's size, function, or valve. If your TTE reveals a possible ASD, then a transesophageal echocardiogram (TEE) is also necessary. Both procedures require an IV for injecting bubbles (agitated saline) into the vein to see if a bubbles cross a hole, if present.
We may also consider additional tests, including CT scans, MRIs, or cardiac catheterization.
Treatment Options
Observation
If the hole in your heart is small enough, you may not need treatment. If treatment is not required, then it may warrant additional monitoring to ensure it does not pose a risk to your health.
Percutaneous Closure
Percutaneous closure is a minimally invasive heart procedure that uses a small tube, inserted into the vein in your leg, to pass through the hole between the two chambers of the heart. The tube is used to deliver a closure device that seals the hole. The majority of holes can be closed using this method, but the size and location of your hole will determine if this treatment option is right for you.
Surgical Closure
If your hole cannot be closed percutaneously, then open-heart surgery can be performed. This requires general anesthesia and the use of a heart-lung machine. An incision will be made into your chest and a patch will be used to close your hole. The experienced Cardiac Surgery team at Rochester Regional Health will perform this surgical closure.
What to Expect with a Percutaneous Closure
One of our primary goals is to make every step of your heart hole closure process as efficient and compassionate as possible. We want you to feel comfortable during your appointments and will make every effort to answer questions throughout the process.
- Our team will provide you with specific instructions on preparing for your ASD/PFO Closure
- This will include any medications that we would like you to hold prior to the procedure
- In general, you should take all other medications as prescribed
- Activity
- It is OK to maintain your current level of activity including exercise
- If you develop any new symptoms, then please inform your physician
- Diet
- Continue to eat a healthy, low salt diet
- Make a Recovery Plan
- It is very important to plan for the following:
- Who will take me home?
- Who will stay with me the day I am discharged?
- Generally, we recommend that someone stay with you for the day you are discharged from the procedure
- Do I have help for preparing meals, driving, or other household chores during the first few days following the procedure?
- The day before the procedure
- You likely will be asked to have your blood drawn to have updated labs
- DO NOT EAT ANYTHING AFTER MIDNIGHT OR THE MORNING OF THE PROCEDURE
- It is ok to have small sips of water to take your morning medications
- It is very important to plan for the following:
- The procedure is performed at Rochester General Hospital
- You will be given specific instructions on where to go on the day of the procedure
- You will meet the anesthesiologist prior to the procedure
- The majority of patients undergo general anesthesia for the procedure but conscious sedation can also be used
- We will typically perform transesophageal echocardiography (TEE) during the procedure to visualize the hole and guide closure
- If conscious sedation is performed, then we will use a miniature ultrasound (intracardiac echocardiography or ICE) that is inserted through the a vein in the other groin
- The procedure takes about 30 minutes to perform
- As with any medical procedure, there are risks and anything can happen.
- The most serious risks are very rare but include: death, stroke, vascular complications, bleeding events requiring transfusion and/or immediate surgery, device erosion, and device embolization requiring retrieval (percutaneous or surgical)
- The most common complication is a 5 to 6% chance of developing atrial fibrillation or other rhythm problem from the top chambers (atria) of the heart
- If this occurs, then it is usually self-limited and goes away on its own after several months
- If you develop atrial fibrillation, a blood thinner is usually started to reduce your risk of stroke
- In some people, it may require additional medical therapy or procedures for management
- We will go over the risks with you in detail
- The recovery time is fast!
- Recovery occurs in our post-procedural recovery area
- You will ambulate within 2 hours of the procedure
- Most patients are discharged the same day
- If you stay overnight, then you will be assigned a bed on one of our cardiac hospital floors
- Our criteria for discharge is:
- You do not have any bleeding issues at the sites used for vascular access
- You can ambulate without any major limitations
- You feel well and have a recovery plan!
- We will give you detailed instructions about any restrictions and new medications following the procedure
- You will be on certain medications to prevent clot from forming on the device
- You will also need to take an antibiotic prior to any procedure (including dental work) to reduce the risk of infection
- Most patients can resume full activity including driving within 2 days after the procedure
- You will be on certain medications to prevent clot from forming on the device
- Follow-up
- You will undergo an transthoracic echocardiogram (TTE) with bubbles (agitated saline) study at 30 days following your procedure