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What is Structural Heart Disease?

Structural heart disease is a defect or abnormality of the heart that is non-coronary, meaning that it does not affect the blood vessels in the heart. Many structural heart conditions are congenital (present at birth), but these abnormalities can also form later in life due to wear and tear from aging, infection or result from another underlying condition.

The University of Chicago Medicine Center for Structural Heart Disease has a multidisciplinary team that specializes in managing congenital conditions as well as diagnosing and treating acquired structural heart conditions. We use the latest technology and techniques to deliver the highest quality, patient-centric care. The Center for Structural Heart Disease also welcomes patient seeking second opinions on their treatment options.

What are the Symptoms of Heart Disease?

Symptoms will vary depending on the patient and the severity of the condition. The most common symptoms associated with structural heart conditions include:

  • Transient ischemic attack (TIA) also know as a mini-stroke
  • Migraines
  • Heart palpitations/irregular heart beats
  • Shortness of breath/Difficulty exercising
  • Stroke
  • Chest pain or tightening
  • High blood pressure
  • Coronary artery disease
  • Leg cramping
  • Kidney dysfunction
  • Fatigue

These symptoms may be a sign of a heart condition or of another medical condition. If you experience one or more of the above symptoms, contact your physician for further evaluation.

What are Common Structural Heart Conditions?

Atrial septal defect
Patent foramen ovale
Ventricular septal defect
Paravalvular leak
Arterial/venous fistulae
Congenital heart disease

Atrial septal defect

This is a congenital defect where a hole has formed in the wall of tissue that separates the right and left atria (upper chambers of the heart). ASDs cause oxygen-rich blood to mix with oxygen-poor blood, which can result in oxygen-poor blood being delivered to vital organs and to abnormal enlargement of the right atrium. Large ASDs can eventually lead to pulmonary hypertension or heart failure.

Common types of ASDs:

  1. Ostium secundum is the most common type of ASD and occurs when a portion of the atrial septum fails to develop normally.  This defect can most 
    often be closed using a minimally invasive transcatheter procedure.
  2. Ostium primumis is a defect in part of the atrioventricular canal and is associated with a split (cleft) in the mitral valve.  
  3. Sinus venosus is classified as a hole between the superior vena cava (main vein that is returning blood from the upper body) and the right atrium (right upper chamber of the heart). 
  4. Coronary sinus is the most rare ASD. This is characterized by a hole the coronary sinus, a major vein in the heart.

Patent foramen ovale (PFO)

Similar to ASDs, a patent foramen ovale also occurs when a hole forms in the septal tissue that separates the upper chambers of the heart. With a PFO, instead of an open hole, there is a flap-like structure that opens when there is pressure in the chest, such as during a cough of a sneeze. PFOs lead to abnormal blood flow and the mingling of oxygen-poor blood with oxygen-rich blood.

Ventricular septal defect (VSD)

A ventricular septal defect is an opening in the intraventricular septum, the wall between the left and right ventricles (lower chambers of the heart). VSDs can be congenital or develop later in life after experiencing a heart attack. The hole allows blood from the left ventricle to flow back into the right ventricle and can lead to low blood pressure, low oxygen content and even heart failure.

Types of VSD

  1. Perimembranous is an opening in the upper section of the septum and is most commonly repaired through open-heart surgery.
  2. Muscular is the most common type of VSD. Muscular VSD can close spontaneously without intervention or and can be treated using an interventional transcatheter procedure.
  3. Conal Septal VSD is the most rare, and can be found below the pulmonic valve.
  4. Infarct-Related VSD occurs when a portion of the heart is being deprived of blood, such as during a heart attack. When the heart experiencing prolonged deprivation, heart tissue may begin to die and develop a hole in what previously normally functioning heart tissue.

Paravalvular leak

Paravalvular leaks occur in patients who have undergone valve repairs or replacements. In some rare circumstances, the surgically implanted valve may become “loose” and allow blood to leak around the valve. Small leaks may be able to be treated with medication, but larger, symptomatic leaks may require a minimally invasive transcatheter approach.

Arterial/venous fistulae

When an abnormal connection between an artery and a vein occurs it forms a fistula. This connection reroutes blood from the artery to the vein, interrupting blood flow to the organ and instead bypasses it altogether. Fistulas vary in severity. Small fistulae can be treated with medical management or physical therapy. Larger fistulae can be closed with a specially designed vascular plug that is delivered to the fistula through catheterization, a process where a thin tube is guided to the heart through a blood vessel and is used to place the plug.


When the lining of the aorta (the largest artery in the heart) is damaged or begins to leak and blood pool outside the wall, creating a bulge in the artery, or a pseudoaneurysm (PSA). Treatment depends on the size and location of the defect. Smaller PSAs can be treated with medications if it is small.  Larger PSAs often require additional intervention. Some can be treated using catheterization, to place a small vascular plug to manage the PSA, but others may require surgical treatment.

Congenital heart disease

Many structural heart defects are conditions that are present at birth. With the evolution of modern medicine, many children born with congenital heart defects live well into adulthood. Read more about our congenital heart disease at the Center for Adults with Congenital Heart Disease.