Treatment for a hole in the heart depends on three things: where the hole is, how large it is, and whether it’s causing problems. Small holes often close on their own or never need treatment. Larger holes that strain the heart may require a catheter-based procedure or open-heart surgery, both of which have high success rates and relatively straightforward recoveries.
Types of Heart Holes
A hole in the heart means there’s an opening in the wall (septum) that separates the heart’s chambers. The three most common types are:
- Atrial septal defect (ASD): A hole between the two upper chambers. Blood leaks from the left side to the right, forcing the right side of the heart and the lungs to handle more blood than they should.
- Ventricular septal defect (VSD): A hole between the two lower chambers. This is the most common heart defect present at birth. Small VSDs often cause no symptoms and may be found only because a doctor hears a heart murmur. Medium and large VSDs can cause heart failure in early childhood due to severe overload on the left side of the heart.
- Patent foramen ovale (PFO): A small flap-like opening between the upper chambers that normally closes shortly after birth. About one in four people have a PFO that never fully seals. Most never know it’s there, but in rare cases it can allow a blood clot to cross into the brain and cause a stroke.
A fourth type, patent ductus arteriosus (PDA), involves a blood vessel rather than a hole in the septum. Before birth, a vessel connects the lung artery to the body’s main artery. It’s supposed to close within days of delivery, but in some premature infants it stays open and needs treatment.
When Treatment Is Needed
Not every heart hole requires repair. The key question is whether the hole is forcing the heart to work harder than it should. Doctors measure this with a ratio that compares blood flow through the lungs to blood flow through the body. According to the most recent 2025 guidelines from the American College of Cardiology and American Heart Association, an ASD is generally considered for closure when the ratio of lung-to-body blood flow reaches 1.5 to 1 or higher, especially if lung artery pressure is rising. For VSDs, closure is not recommended when that ratio is below 1.5 and there are no other concerning signs.
In adults, the most common reasons that push doctors toward closing a VSD are leaking of the aortic valve (present in about 28% of cases), enlargement of the heart’s pumping chamber (20%), and rising lung pressures (20%). About 39% of adults who undergo VSD closure also have other associated heart defects that make surgery worthwhile.
Small ASDs and VSDs that aren’t straining the heart are simply monitored with periodic check-ups and imaging. Many small VSDs close on their own during childhood.
Medication for Symptom Relief
Medications can’t close a hole in the heart, but they can manage the symptoms it causes while doctors decide whether repair is needed or while waiting for a child to grow large enough for a procedure.
If the hole is causing fluid buildup and heart strain, diuretics (water pills) help the body shed excess fluid and reduce the workload on the heart. When diuretics alone aren’t enough, doctors may add medications that block hormones driving fluid retention or that help the heart pump more efficiently. The goal is to keep the patient stable and comfortable, not to replace the need for repair if the hole is large.
For premature infants with a PDA, medication can sometimes close the vessel without any procedure at all. Anti-inflammatory drugs that block a specific enzyme involved in keeping the vessel open are the standard first-line treatment. A large review of over 1,500 infants found that oral and intravenous forms of ibuprofen work about as well as the older standard drug, indomethacin, but with fewer side effects on blood flow to other organs. The oral form appears to be more effective than the intravenous form, reducing the chance of treatment failure by roughly 60%.
Catheter-Based Closure
For many ASDs and some PFOs, the preferred treatment is a catheter-based procedure that avoids open-heart surgery entirely. A thin, flexible tube is threaded through a vein in the groin up to the heart. A small closure device, typically a double-disc structure made of a mesh material, is guided through the catheter and positioned across the hole. One disc opens on each side of the septum, sandwiching the tissue between them and sealing the defect.
Before the device is placed, doctors use a combination of real-time X-ray imaging and echocardiography (ultrasound of the heart) to map the hole’s exact size, shape, and relationship to nearby structures. In some cases, a small balloon is inflated across the hole to measure it precisely and to check whether the surrounding tissue is sturdy enough to hold a device. If the hole has an unusual shape or there are multiple openings, more than one device may be used, or a single larger device can cover adjacent holes that are close together.
Choosing the right device size matters. A device that’s too large relative to the hole raises the risk of erosion into nearby heart tissue, particularly when the rim of tissue near the aorta is thin. The current standard is to match the device to the measured “stop flow diameter” of the hole, selecting a device that is the same size or no more than 2 millimeters larger.
PFO closure follows a similar catheter approach and is typically offered to people who have had a stroke with no other identifiable cause. A major trial published in the New England Journal of Medicine found that closing a PFO with a device plus blood-thinning medication was more effective at preventing recurrent strokes than medication alone, specifically in patients whose stroke couldn’t be explained by clogged arteries, small-vessel disease, or common risk factors like uncontrolled diabetes or high blood pressure.
Open-Heart Surgery
Surgery is the standard approach for most VSDs and for ASDs that aren’t suitable for catheter closure (because of size, location, or insufficient surrounding tissue to anchor a device). The surgeon works through an incision in the chest, uses a heart-lung machine to take over circulation temporarily, and patches the hole with synthetic material or, in some cases, with the patient’s own tissue.
In a large study of patients who underwent surgical VSD closure, perioperative mortality was 2.5% for those who had the procedure later in life and 4.5% for those who had early closure, likely reflecting the greater complexity of cases that required urgent repair in infancy. Arrhythmias (irregular heart rhythms) occurred in about 7% of surgical patients. Overall, surgical closure of both ASDs and VSDs carries low mortality and morbidity in experienced centers.
Recovery After Repair
Recovery looks different depending on whether you had a catheter procedure or open surgery. After catheter-based ASD closure, most people go home the same day or the next morning. After minimally invasive surgery, expect three to five days in the hospital, with the first night possibly spent in the intensive care unit.
Regardless of the approach, most people return to their regular activities within six to eight weeks. In the early weeks, the focus is on gradually increasing movement. Walking is the single most important activity after heart repair. Start with short walks around the house, then work up to three or four walks a day, eventually adding distance before speed. A good rule of thumb: if you can carry on a conversation while walking, you’re at the right pace. If talking feels hard, slow down.
Some soreness in the chest or upper body is normal after surgery. Alternating heat and ice, gentle stretching, and over-the-counter pain relief all help. If the catheter was inserted through a leg vein, mild swelling at the site is expected. Walking frequently and elevating your legs when sitting will bring it down. Daytime naps are fine when you’re tired, but keeping them short helps you sleep better at night and build stamina faster.
After either type of repair, follow-up appointments with imaging will be scheduled to confirm the hole is fully sealed and the device (if one was used) is sitting properly. Blood-thinning medication is typically prescribed for several months after device closure to prevent clots from forming on the device while heart tissue grows over it.
What Happens If a Large Hole Goes Untreated
Leaving a significant hole untreated allows blood to flow where it shouldn’t for years or decades. The extra blood volume flowing through the lungs gradually stiffens and narrows the lung’s blood vessels, raising pressure inside them. Over time, this damages the smaller vessels in the lungs and thickens the walls of the right side of the heart as it works harder to push blood through.
If lung pressure rises high enough, the direction of blood flow through the hole can actually reverse, sending oxygen-poor blood from the right side of the heart into the left side and out to the body. This condition, called Eisenmenger syndrome, causes persistent low oxygen levels, bluish skin color, shortness of breath, fainting, and eventually heart failure. Once Eisenmenger syndrome develops, the hole can no longer be safely closed because the right side of the heart has become dependent on the opening as a pressure release valve. At that point, treatment shifts to managing symptoms and lung pressure rather than repairing the defect, which is why timely evaluation and, when appropriate, early closure of large defects is so important.