For patients with heart conditions affecting the structure of their heart, either present from birth (congenital) or acquired later in life, many options for treatment exist. Medical therapy continues to improve and surgical repair can often be done minimally invasively. The following are some of the conditions which can be readily treated with contemporary technology.
ATRIAL SEPTAL DEFECT (ASD)
Atrial septal defects are a congenital opening or hole between the two filing chambers of the heart (the atria). This condition causes blood to move inappropriately from the left side of the heart to the right side. This results in the blood vessels of the lungs becoming overloaded with the extra circulation. Over time this can damage both the heart and the lungs.
Not all ASD’s need to be repaired. If the ASD is small the hole can usually be left alone. An atrial septal defect is usually diagnosed by a cardiologist based on the physical exam, EKG and an echocardiogram. While sometimes causing shortness of breath or palpitations, many patients have little or no symptoms. The condition can be difficult to diagnose because the findings are often subtle. Many patients are diagnosed as children but sometimes the condition is not detected until adulthood. There are different types of ASD. Some ASD’s can only be repaired with surgery, however the most common type of ASD called a secundum defect, can often be repaired non-surgically by using a small catheter to place a patch over the hole.
PATENT FORAMEN OVALE (PFO)
A patent foramen ovale is a form of an atrial septal defect. It has been associated with unexplained strokes especially but not exclusively in young patients. When closure is recommended this is typically done through a small catheter without surgery.
VENTRICULAR SEPTAL DEFECT (VSD)
A ventricular septal defect is a hole between the two pumping chambers of the heart. Most VSD’s are congenital but some can happen after the heart is damaged from a heart attack. A VSD is usually detected by physical exam. If the VSD is present from birth (congenital) and is small it sometimes will close over time as the child grows. Occasionally the defect persists but is small but is small and no repair is needed. If the VSD is larger it can it can cause heart failure and surgical repair is recommended as a child. VSD’s which occur after a heart attack usually need to be repaired. This often requires surgery but sometimes the hole can be closed with a patch placed through a catheter.
PATENT DUCTUS ARTERIOSUS (PDA)
A patent ductus arteriosus is a blood vessel that connects the aorta with the pulmonary artery. It is present in everyone when we are developing in the womb, but usually closes at birth or shortly thereafter. If this congenital abnormality does not close it creates a loud murmur easily detected on exam. It also causes the high pressure blood from the aorta to flow into the lungs causing eventual damage to the lungs and heart if uncorrected. In children this problem is usually corrected with surgery while in adults the defect is usually repaired non-surgically by means of catheter technology to close the blood vessel with a plug.
VALVUALR HEART DISEASE
When the aortic valve is narrowed and does not open well we call this stenosis. The diagnosis is usually made on physical exam and confirmed by echocardiogram. The condition typically produces shortness of breath. If this is congenital it usually is opened with a minimal invasive balloon procedure. If the valve narrows as an adult this usually requires surgery to replace the valve. Aortic stenosis in adults typically occurs in the elderly from a lifetime of wear and tear on the valve, although at times illnesses such as rheumatic
Fever or scarlet fever can cause the valve to deteriorate many years after the initial illness. For patients who are poor surgical candidates for traditional valve replacement, a new less invasive way to replace the valve using a catheter bases approach is now available. This approach is called Transcatheter Aortic Valve Replacement (TAVR).
When a heart valve is leaky (doesn’t close well) we call this insufficiency. While many times the problem is managed for years with medication, when repair is needed this usually requires surgery. However, when the patient has a prosthetic (artificial) heart valve that is leaking sometimes this can be repaired with a minimally invasive catheter based approach using a plug to close the area of the leak.
A narrowing of the mitral valve is called mitral stenosis. This is usually a result of prior rheumatic or scarlet fever which may have gone unrecognized by the patient. When this occurs the patient commonly experiences shortness of breath and sometimes palpitations or heart rhythm abnormalities (arrhythmia). Historically this problem was repaired surgically. Over the last twenty years many patient have had the valve opened less invasively by using a balloon placed through a catheter to stretch open the valve (valvuloplasty). The results have proven to be a durable as the surgical repair in the right patient.
A mitral valve that does not close well is referred to as insufficient. It can be well tolerated causing few symptoms for many years. It is diagnosed on exam and by echocardiography. When symptomatic, patients with mitral insufficiency often have shortness of breath and/or arrhythmias. Increasingly, when these patients need intervention, it is possible to repair rather than replace the valve in the majority of patients by a surgeon who is experienced in this technique. The technology is also on the horizon to allow some of these patient s to have the valve repaired minimally invasively via a catheter based approach.
A narrowing of the pulmonic valve is usually congenital. If severe it is typically repaired in childhood. At times the narrowing does not become severe until adulthood. Symptoms are typically shortness of breath and it is diagnosed based on findings at physical exam and on echocardiography. When an adult has significant pulmonic stenosis this can usually be relieved by a balloon valvuloplasty performed in the cardiac catheterization laboratory.
PERICARDIAL EFFUSION AND TAMPONADE
The heart lies in the sack or pouch we call the pericardium. If fluid accumulates in the heart sack it can potentially impair heart function or even be fatal. This condition can be caused by a variety of conditions from viruses to kidney failure or cancer. If treatment is needed the heart sack can be drained either by a small operation we call a “window procedure” or through a needle placed into the heat sack.
LEFT ATRIAL APPENDAGE CLOSURE
Patient with a heart rhythm disturbance (arrhythmia) we call atrial fibrillation are often treated with blood thinners (anticoagulants) because the condition predisposes the patient to a stroke. When the atria fibrillate they do not contract rhythmically and blood clots can form within them. This often occurs in an area of the left atrium we call the appendage. Blood clots forming in the left atrium can sometimes travel from the heart to the brain causing a stroke. Anticoagulants help prevent this possible cause of stroke. However some patient are unable to take anticoagulants because of anemia or abnormal bleeding problems. For these patients, it has become possible to close the left atrial appendage non-surgically in the cardiac catheterization laboratory and thus eliminate one possible cause of stroke.