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There are many types of holes in the heart, some of which may develop before birth. Rarely, holes in the heart can form after birth. For example, they can develop during a heart attack or after a medical procedure. Atrial septal abnormalities, where a hole develops in the heart’s septum, are quite common in children. While experts do not know what causes holes in the heart, genetics can often be a factor. However, other factors may also influence the development of these heart abnormalities. People may experience symptoms according to the type of hole they have in the heart. While they may not necessarily require treatment, those causing symptoms or complications may require surgery. Keep reading to learn more about holes in the heart, including the different types, risk factors, symptoms, diagnosis, and treatments. Overview Share on PinterestSusanMcAnnally/Getty ImagesA hole in the heart is a congenital heart abnormality. Various kinds of holes can develop in the heart, including the below. Patent foramen ovale PFO During development, all fetuses have a natural hole in the heart. However, in some fetuses, the hole does not close until some time after birth. This is called a PFO, and about 20 to 25% of adults have it. Atrial septal abnormalities Atrial septal abnormalities refer to a hole between the atria, which are the upper chambers of the heart. The hole forms in the septum, the wall that separates the heart’s chambers. It can sometimes remain when the fetus’s heart forms and the septum does not close completely. There are a few different types of atrial septal abnormalities, including:primum, which develops near the bottom of the septal wall secondum, which occurs near the middle of the septal wall multifenestrated, which consists of several holes in the septal wall sinus venosus, which appears near the superior and inferior vena cava According to the Centers for Disease Control (CDC), about 1 in every 1,859 infants born in the U.S each year are born with atrial septal abnormalities. Ventricular septal abnormalities This abnormality refers to a hole in the wall separating the ventricles of the heart. There are several different types of ventricular septal abnormalities, including:muscular, where holes in the muscular tissue between ventricles cause a heart murmurperimembranous, which appear near the middle of the heart outlet and supracristal, which develop near the aorta or pulmonary arteries post-infarction, holes that develop after a heart attack Risk factors Experts do not know what causes most congenital heart abnormalities. However, genetics often play a role, and some may be more common in people with a family history of the condition or with chromosomal abnormalities. Environmental factors may also affect heart development. For example, pregnant people who have exposure to certain chemicals or drugs may be more likely to give birth to infants with heart abnormalities. Substances that may pose a risk include:medicines for high blood pressure called angiotensin-converting-enzyme inhibitorsstatinsthalidomide lithiumisotretinoinalcoholcigarettes Pregnant people with the following medical conditions may also be at higher risk of having a baby with a congenital heart abnormality:preexisting diabetesrubellamaternal phenylketonuria, where a pregnant individual’s body cannot process an amino acid called phenylalaninelupus Symptoms A hole in the heart can lead to the mixing of oxygenated and deoxygenated blood. This may put stress on the side of the heart that is getting more blood flow than expected, which may cause a condition called cyanosis. Cyanosis refers to skin discoloration resulting from circulation issues of oxygenated blood. Additionally, a stroke or a transient ischemic attack — known as a mini stroke — can occur if blood skips the lungs and moves straight to the arterial side through the atrial septal abnormality or PFO. However, not all holes in the heart cause apparent symptoms. Some people may experience them, depending on the type they have. Ventricular and atrial septal abnormalities A small or minor ventricular or atrial septal abnormality may not put excess strain on the heart and lungs, and a heart murmur may be the only detectable sign. However, a large hole may cause symptoms. Large holes will typically cause noticeable symptoms in infants and babies. Because they strain the heart, they can cause:rapid breathingfailure to thrive, which refers to issues with growing, gaining, or maintaining weight as individuals develophigh blood pressure Most of the time, doctors identify and treat large septal abnormalities during infancy. But if someone has a large septal abnormality as an adult, they may experience shortness of breath. Tetralogy of Fallot is a serious condition that refers to four structural abnormalities in the heart. It can cause episodes of cyanosis, where the skin turns blue or gray. PFOs Most PFOs do not cause noticeable symptoms or cause significant problems. Potential conditions relating to PFO include:severe migrainetransient ischemic attackstroke Diagnosis A doctor who suspects a hole in the heart may order one or more of the following tests to make a diagnosis:an echocardiogram of the chesta cardiac CTa cardiac MRIa chest X-rayan exercise stress test for adults transesophageal echocardiogram, which uses sound waves to take clear pictures of the heart Testing for congenital heart abnormalities is part of routine screening after birth. During pregnancy Doctors may also diagnose congenital heart abnormalities during pregnancy using a fetal echocardiogram. This test allows them to see the heart of the fetus. They may perform this test if the pregnant person:has a family history of congenital heart abnormalitieshas a health condition that puts the fetus at higher risk for heart abnormalitiestakes medications that can increase the risk of heart abnormalities They may also perform the test if they detect any abnormalities during a routine ultrasound. Treatment Treatment depends on: the type of holelocation of the holethe person’s agewhether the person is experiencing symptoms For example, a small ventricular septal abnormality may not require treatment if it causes no noticeable symptoms. Some may even close over time. For example, atrial septal abnormalities of under five millimeters tend to close on their own within the first year of an infant’s life. Large holes or holes causing symptoms may require surgery. In infants, surgeons may place a temporary patch before performing a more invasive heart surgery when the child becomes older. More invasive surgery may occur if the infant has serious symptoms. In some cases, surgeons can close the hole without a patch. For large holes, they may use a device to block the hole. For PFO, treatment usually involves closure with an amplatzer device, a mesh implant. Survival rate Survival rates depend largely on the severity of the hole in the heart. According to the Centers for Disease Control and Prevention (CDC), about 97% of infants with nonserious types of congenital heart abnormalities survive for at least a year. Additionally, health experts predict that around 95% of infants with these abnormalities will live to 18 years of age. However, 75% of those born with serious heart abnormalities tend to survive at least one year, with 69% expected to survive until adulthood. Generally, the survival and medical interventions for infants with serious congenital heart abnormalities are improving. One 2022 study involving 427 people with atrial septal abnormalities found that people tend to live longer following hole repair. Complications Complications may vary substantially, depending on the type of hole in the heart and its size. With atrial septal abnormalities, possible complications may include:arrhythmiahigh blood pressurestrokeheart failureEisenmenger syndrome, a life threatening condition that causes irregular blood flow in the heart and lungs With ventricular septal abnormalities, possible complications may include:heart infectionaortic valve leakageheart failure However, complications are generally rare with small and repaired holes. Summary A hole in the heart typically forms before birth and may close on its own afterward. However, some holes may remain and cause symptoms or lead to complications. Symptom severity can vary depending on the size and location of the hole. Doctors often detect holes in the heart during pregnancy or not long after birth. Some people only find out they have a hole in their heart when they are well into their adulthood. They may start experiencing symptoms, or their doctor may detect a murmur during a routine exam. Treatment may require surgery, but this depends mainly on the size of the hole and whether it is causing symptoms. Last medically reviewed on September 28, 2022ArrhythmiaHeart DiseasePublic Health 13 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.AMPLATZER™ PFO Occluder Patient Information Guide. (n.d.). https://www.fda.gov/media/97988/downloadAtrial septal defect (ASD). (2022). https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/atrial-septal-defect-asdClosing holes in the heart. (2017). https://www.secondscount.org/treatments/treatments-detail-2/closing-holes-in-heartCongenital heart defects and critical CHDS. (2019). https://www.marchofdimes.org/complications/congenital-heart-defects.aspxFacts about atrial septal defect. (2022). https://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.htmlData and statistics on congenital heart defects. (2022). https://www.cdc.gov/ncbddd/heartdefects/data.htmlMenillo, A, M., et al. (2021). Atrial septal defect. https://www.ncbi.nlm.nih.gov/books/NBK535440/Patent foramen ovale PFO . (2017). https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/patent-foramen-ovale-pfoPopelová, J. R., et al. (2022). Long-term survival of adult patients with atrial septal defect with regards to defect closure and pulmonary hypertension. https://www.frontiersin.org/articles/10.3389/fcvm.2022.867012/fullTetralogy of Fallot. (2022). https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/tetralogy-of-fallotTransesophageal echocardiogram (TEE). (n.d.). https://www.heartandstroke.ca/heart-disease/tests/transesophageal-echocardiogram-teeUnderstand your risk for congenital heart defects. (2022). https://www.heart.org/en/health-topics/congenital-heart-defects/understand-your-risk-for-congenital-heart-defectsVentricular septal defect (VSD). (2022).https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/ventricular-septal-defect-vsdFEEDBACK:Medically reviewed by Dr. Payal Kohli, M.D., FACC — By Steph Coelho on September 28, 2022 Latest newsWhat sets 'SuperAgers' apart? 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