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Forum Name: Congenital Heart Disease in Adults

Question: Can an ASD disappear in adults?


 slc25 - Wed May 06, 2009 2:00 pm

I am a 26 y/o 125lb female previously diagnosed with a murmer/mitral valve prolapse and SVT in my teens. I saw an electrophysiologist in 2008 because even though I had been on Toprol for several years, I had become increasingly symptomatic: exercise intolerance, shortness of breath, fainting, fatigue. My heart rate rarely dropped below 100 and got worse when I laid down flat and relaxed at night. The Cardio recommended ablation and scheduled me for a stress test.

Six weeks later I had my treadmill test as scheduled with the Chief of the Cardiology Dept. (don't remember the exact title) and three other doctors and nurses presiding. I lasted three minutes on the treadmill with my heart rate at 240. They took me off and laid me on the table for the TTE and my heart rate was not coming down much and the right side of my heart was dilated, so the Department Head told me I had an inappropriate response to exercise and they would do a bubble study to check for a hole. During the bubble study, he and everyone else in the room saw the bubbles passing across the top part and he told me that I did have a hole in my heart and would be scheduled for a TEE and closure.

While I was still sedated from the TEE, the technician told my husband that he didn't find a hole. When I went back to the cardiologist, he said the TEE and cardiac MRI revealed no structural abnormality. He put me on Bystolic and told me to come back every few years for a check up. He didn't say anything about ablation.

My question is: Have you ever heard of a bubble study giving a false positive for an Atrial Septal Defect, or of a hole not showing up on TEE and MRI? How can I know for sure whether or not there is a hole when one Cardiologist gave one answer and another gave a different one? Did the ASD close on it's own in a matter of 6 weeks, or is it a flap that opens and closes based on my exertion level?

Please help, I am confused.
 John Kenyon, CNA - Mon May 11, 2009 9:52 pm

User avatar Hello --

First, looking at your history I find it's pretty typical of a certain subset of patient which has a common set of signs and symptoms which you have. That being said. the ASD (often a patent foramen ovale or PFO), can be so small and tight as to allow bubbles to pass after stress when the dynamics are very different than at rest (as with the TEE) and so essentially does, clinically at least, "disappear." This type is often undetected and when it is it is usually followed as per suggestion by the cardiologist. It may be frustrating to get two different stories from the same doctor, but the TEE doesn't lie. The bubble test can make things appear different than they are, especially after stress.

You may have dysautonomia (most people with this set of defects do) and the exercise response can be inappropriate withouth there being any significant defect. Neurocardiogenic syncope is common with this group, but is not dangerous assuming one is able to avoid bumps on the head due to falling. SVT is common with MVP anyway, so ablation is not always indicated, but you could perhaps undergo an electrophysiology study if this continues or becomes more frequent and bothersome. There may be an associated atrioventricular re-entry tract (AVNRT) causing the SVT, and ablation can eliminate this entirely.

To answer your last question more precisely, while the hole may clinically disappear, it is present, and rarely a flap, but often a very tiny, insignificant hole and often not the cause of exercise intolerance but can be exposed via exercise and can sometimes contribute somewhat to that intolerance. It can open more at those times and virtually disappear when at rest. It should just be followed. It's not precisely a false positive, but like MVP, it can often be visualized one time and not the next, a frustrating thing for everyone. The change to Bystolic is not unreasonable and may actually work better for you than Toprol, although the latter is one o fthe best known meta blockers. If it wasn't doing the job maybe Bystolic will work better for you.

I hope this is helfpul. Please follow up with us here as needed and keep us updated. Good luck to you.
 slc25 - Tue May 12, 2009 11:11 am

Wow, thank you for taking the time to give me all of that information. That really clears up a lot for me. So, does this mean I can SCUBA dive?

-Valerie
 John Kenyon, CNA - Sat May 16, 2009 9:49 am

User avatar You're very welcome! Glad it was helpful. As to your question re: SCUBA diving, that has certain considerations attached to it which would best be addressed by your personal doctor. There should be a fairly simple yes or no depending upon how he weighs all the factors. I'd be remiss to tell you it was okay from this distance. Wish I could, but that's one for the attending. :)

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