A Doctor Writes: Strauss’s diagnosis not unprecedented for professional sportsman

It may seem strange that an athlete can perform to a high professional standard with a “hole in the heart” but in fact it is not uncommon for certain congenital cardiac problems to remain undetected until adulthood. At age 27, the diagnosis of Leinster and Ireland hooker Richardt Strauss is not unprecedented.

Perhaps the first professional sportsman to come under this particular medical spotlight was soccer player Asa Hartford, whose transfer from West Bromwich Albion to Leeds in 1971 was halted after a routine medical found he had a hitherto undetected hole in the heart. Not that it ended his career; he played for a number of professional clubs after the diagnosis with no ill-effects.

The medical terminology for the condition is septal defect. It occurs when the septum, which is the wall that divides the heart into chambers, develops with a gap. This gap exists when the baby is in the womb in order to facilitate circulation but usually closes after birth. If the gap is between the upper chambers of the heart it is called an atrial septal defect (ASD); a gap between the lower and larger chambers is called a ventricular septal defect (VSD).

Routine medical
How does the condition come to light in adults? Most remain asymptomatic and the finding is made on a routine medical examination or when a person undergoes an ultrasound examination of the heart (echocardiography) for some other reason. Others may notice increasing shortness of breath or unusual fatigue, the investigation of which reveals a septal defect.

What are the treatment options? For many years open heart surgery was the treatment of choice, during which a patch is placed over the defect.

Now there is an option to carry out the procedure by firstly inserting a long flexible tube via an incision in the groin which is then threaded up to the heart. The tube is guided to the defect and a small umbrella-like device is opened and placed over the defect. However not every patient will be suitable for the less invasive procedure.

Congenital heart defects occur in about eight infants per 1,000 live births and vary enormously in severity and complexity.The type of structural defect and its severity will determine how early in life a child is operated on.

Procedures
Children with a "hole in the heart" will be operated on between three and nine months of age if the defect is in the ventricles (the lower chambers of the heart). For those with holes in the upper part of the wall between chambers called the atria, it is usual to carry out surgical repair at two-four years.

From the reports emerging from the Leinster camp it seems that Strauss is being lined up for the less invasive procedure. Following an uncomplicated recovery he can expect to be playing professional rugby again after about six months.