Congenital or acquired heart defects are among the most common causes of impaired heart function. They can occur in newborns or develop over the course of a person’s life. Modern cardiac operations have made a variety of interventions to correct these malformations possible, including minimally invasive procedures and open-heart surgery.
1. right atrium
2. left atrium
3. right ventricle
4. left ventricle
5. pulmonary artery
6. aorta
7. superior and inferior vena cava
8. pulmonary veins (pulmonary vein)
9. sinus node
10. atrioventricular node (atrioventricular node)
11. tricuspid valve
12. pulmonary valve
13. aortic valve
14. mitral valve
Heart defects at a glance
In medicine, a distinction is made between congenital and acquired heart defects. The most common acquired heart deformities are heart valve defects. The treatment options for heart valve defects are described in the article Heart valves: operations and procedures. The spectrum of defects present at birth, referred to medically as congenital defects, is wide and ranges from insignificant defects with no major impacts to serious deformities that require heart surgery. Congenital heart defects are often only discovered in adulthood. The most common defects that are corrected with surgery include anomalous pulmonary venous return and atrial and ventricular septal defects. Depending on the heart defect, various procedures are used, such as cardiac catheterisation, minimally invasive surgery or an open heart operation.
Atrial and ventricular septal defects
The heart has a left and right side, which are separated by a wall of tissue (septum). Before birth, the heart septum has an opening, the foramen ovale, allowing blood to flow through it. After birth, the foramen ovale closes and blood flows through the lungs from the right to the left side of the heart. If the foramen ovale does not completely close after birth or if the heart septum is not completely closed for other reasons, this causes a septal defect. Depending on the location, this can be an atrial septal defect (ASD) – an opening between the two atria – or a ventricular septal defect (VSD), which affects both chambers of the heart. Over time, this can lead to heart failure, requiring surgery to close the septal defect. Depending on the location and size of the hole in the heart wall, it can be closed through surgery or by means of cardiac catheterisation.
Anomalous pulmonary venous return
Normally, the pulmonary veins, which carry the oxygenated blood from the lungs, flow into the left atrium. In the case of anomalous pulmonary venous return, at least one (partial anomalous pulmonary venous return) or all four pulmonary veins (total anomalous pulmonary venous return) flow to the right atrium.
Total anomalous pulmonary venous return (TAPVR), in which all pulmonary veins drain into the right atrium or connected vessels, is particularly serious. Without surgical correction, the oxygen-rich blood cannot enter into pulmonary circulation – a situation that, without surgery, can quickly lead to death. In general, TAPVR requires surgery within the first few days of the newborn’s life to restore normal blood flow. Partial anomalous pulmonary venous return (PAPVR) needs to be corrected only if it causes problems or is concomitant with another heart defect – often, there is also an atrial septal defect. Compared to atrial and ventricular septal defects, anomalous pulmonary venous return is a very rare cardiac abnormality.
Treatment goal
Operations for heart deformities or defects are performed to repair holes in the septum of the heart, such as atrial or ventricular septal defects, or to correct the incorrect entry of pulmonary veins into the heart. The goal is to restore normal blood flow to the heart, improve oxygen supply and prevent long-term damage to the heart muscle. Without treatment, a heart defect can lead in the long term to chronic overload of individual heart chambers, heart dilation and ultimately heart failure (cardiac insufficiency).
Surgical procedure
Operation for septal defects
Different methods are currently available for treating atrial and ventricular septal defects. Depending on the location, size and type of defect, cardiac catheterisation, an open heart operation or, under certain conditions, minimally invasive surgery may be considered.
Cardiac catheterisation
In cardiac catheterisation, the heart surgeon inserts a catheter equipped with a cardiac closure device through the femoral artery and pushes it up to the septal defect. There, the cardiac closure device is placed to close the defect. In the case of a ventricular septal defect, the catheter is sometimes inserted via a jugular vein. In addition, arterial access from the groin is necessary.
Open heart operation
In an open heart operation, the heart is accessed by cutting into the sternum. For this surgical treatment, the heart is stopped with the help of a special solution (cardioplegia) and circulation is maintained with a heart-lung machine. The defect is either sewn by the heart surgeon or sealed with a patch made from the pericardium or synthetic material. After the cardioplegic solution has been flushed out, the heart starts beating again by itself.
In recent years, under certain conditions, minimally invasive access via a minithoracotomy, done without severing the sternum and opening the ribcage, has become possible.
Surgery for anomalous pulmonary venous return
Surgical correction involves transplanting the pulmonary veins to their correct destination, the left atrium. The intervention is performed under general anaesthesia while connected to the heart-lung machine.
After treatment, patients can usually lead a normal life. However, they need regular heart check-ups and antibiotics to prevent endocarditis (inflammation of the heart).
Preparation and prevention
Before every cardiac operation, the individual heart defect is carefully assessed by the attending doctor. Modern imaging techniques such as echocardiography (cardiac ultrasound), heart catheter examinations or magnetic resonance tomography (MRI) can be used to precisely determine the location, size and effects of the deformity. This information is used to determine whether catheter-supported closure is possible in the case of septal defects, for example, or whether open heart surgery is necessary.
Open heart surgeries are always performed under general anaesthesia. For catheter-assisted interventions in adults, local anaesthetic for the injection site in the groin is usually sufficient. In children, however, cardiac catheter treatment is also carried out under general anaesthesia in most cases. If general anaesthesia is planned, patients must fast on the day of the procedure. This means that no solid food should be consumed at least six hours beforehand and no liquids for two hours beforehand.
Aftercare and recovery
During the healing phase after a cardiac operation, physical strain such as heavy lifting or strenuous exertion should be avoided if possible. After the surgery, heart function is regularly monitored over a longer period of time.
In order to prevent the formation of blood clots on implanted materials, follow-up treatment with blood-thinning medications is required in the first few months. In addition, antibiotics are initially administered to prevent infections. In the long term, antibiotics should also be given as a precaution in certain interventions with an increased risk of infection – such as dental treatments – in order to prevent bacterial inflammation of the heart (endocarditis prophylaxis).
Potential complications
Complications after heart surgery in cases of heart defects are generally rare. As with any surgical intervention, however, certain risks cannot be completely ruled out. Potential complications include:
- Bleeding or post-operative bleeding
- Infections
- Cardiac arrhythmia
- Stroke or embolism
- Reactions to anaesthesia
Modern cardiac surgery works with standardised procedures and the highest safety standards in order to keep these risks as low as possible.
Question about heart defects
Which heart defects need surgery?
Not all heart defects require treatment. Cardiac surgery is necessary if:
- Blood flow in the heart is impaired
- Oxygen supply is impaired
- The heart is overloaded
- Complications such as arrhythmias or pulmonary hypertension develop
Are heart defects always congenital?
No. Heart defects can start before birth (congenital heart defects) or develop in the course of life.
What causes heart defects?
Congenital heart defects usually develop during early embryonic development. The causes are often multifactorial – genetic influences, the use of certain medications, alcohol and drugs or viral infections (e.g. rubella) during pregnancy, or chronic diseases of the mother (such as diabetes) can play a role. Acquired heart defects are usually caused by a degenerative, inflammatory or structural change.
How dangerous is heart surgery?
Thanks to state-of-the-art medicine and specialised centres, the risks of heart surgery can now be significantly minimised. Nevertheless, it is a major surgical intervention whose risk varies depending on the surgical method, pre-existing conditions and the individual’s state of health.
