Hole in the Heart: What Happens Next?

Hole in the Heart in Adults

Being told you have a hole in your heart as an adult can come as a surprise. However, this is more common than many people realise. The condition is a form of congenital heart disease, meaning it has been present since birth.

Smaller holes often go undetected for decades, though some larger atrial septal defects can also remain undiagnosed when symptoms are mild or attributed to other conditions. Some people are diagnosed in their twenties, while others find out much later in life. Larger defects tend to cause symptoms earlier, whereas smaller ones might not present obvious issues until the seventies or eighties.

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Why the Hole Exists

Most holes in the heart occur in the septum, the wall separating the two upper chambers called the atria. This type is known as an atrial septal defect.

Before birth, all babies have an opening in this location. The developing baby receives oxygen through the umbilical cord, and blood flows through the heart differently than it does after birth. Once a baby is born and begins breathing, the circulation changes and this opening normally closes on its own.

In some babies, the hole remains large and needs surgical repair early in life. In others, the hole closes almost completely but leaves a small gap. This minor defect often causes no symptoms and can go unnoticed for decades.

Your situation may be slightly different. ask a question below ↓ and our editorial team will reply with our advice.

What Happens After Diagnosis

A small hole that has caused no problems may still require careful assessment. The decision about treatment depends on several factors beyond symptoms alone, including how blood flow is affected, the risk of developing heart rhythm problems such as atrial fibrillation, and the possibility of paradoxical embolism.

Many people with tiny defects simply need monitoring through occasional echocardiograms. Others may be advised to have the hole closed. Transcatheter closure, a keyhole procedure through a blood vessel, is generally the preferred approach for suitable defects. Surgery is usually reserved for cases where catheter closure is not technically possible.

Your medical team should explain the size and location of the hole, whether treatment is recommended or if monitoring is sufficient, any lifestyle considerations, and what symptoms to watch for. Understanding your results fully is important, and it's reasonable to want answers. If you left your appointment with questions, contact your GP or cardiology department to arrange a follow up conversation.

Living with a Small Heart Defect

Many adults with small, unrepaired holes live without significant restrictions, though individual responses to the defect vary. Your consultant will advise whether any activities need adjusting based on your situation.

Some people with atrial septal defects have a higher risk of heart rhythm problems. In certain cases, your team may discuss whether antibiotic prophylaxis before dental procedures is appropriate, or whether monitoring for pulmonary hypertension is needed for larger untreated defects.

The British Heart Foundation offers detailed information on congenital heart conditions in adults. Your GP can refer you back to cardiology if new symptoms develop or you need reassurance about your diagnosis.

The Next Step

Now that you have read through the advice above, you might want to put it into practice. Our Heart Risk Checker lets you check your heart disease risk factors and get personalised guidance. Try it now →