Most people with a hole in their heart live a normal or near-normal lifespan, especially if the hole is small or gets repaired early. But the answer depends heavily on which type of hole you have, how large it is, and whether it’s treated. A small defect that closes on its own carries almost no long-term risk, while a large, unrepaired hole can shorten life by decades.
There are several types of holes that can occur in the heart’s walls. The most common are atrial septal defects (a hole between the upper chambers), ventricular septal defects (a hole between the lower chambers), and patent foramen ovale, or PFO (a small flap-like opening left over from fetal development). Each has a different trajectory.
Small Holes Often Close on Their Own
Ventricular septal defects are the most common heart defect present at birth. Most don’t cause symptoms and close on their own by age 6, though some take longer. A VSD is unlikely to close on its own after age 20. People whose small VSD closes naturally have the same life expectancy as someone without a heart defect at all.
A PFO is even more common. Roughly one in four adults has one and never knows it. A PFO on its own rarely causes problems, though it does carry a small increased risk of stroke. In people under 60 who’ve had an unexplained stroke, closing a high-risk PFO reduces the chance of another stroke, though it doesn’t affect overall mortality.
What Happens When a Hole Stays Open
When a hole between heart chambers doesn’t close, blood flows from the higher-pressure left side of the heart into the lower-pressure right side. This extra blood gets pumped to the lungs over and over again, gradually overloading the right side of the heart and the blood vessels in the lungs.
For atrial septal defects, this process is slow. Many people feel fine for decades. Symptoms typically creep in during the 30s, 40s, or later and include shortness of breath during activity, fatigue, swelling in the legs, and irregular heartbeats. Heart failure in people with an unrepaired ASD tends to occur in older adults and is usually linked to chronic irregular heart rhythms rather than lung damage alone. Population studies show that people with untreated ASDs have a reduced life expectancy compared to the general population, even if they feel well for years.
For ventricular septal defects, the timeline depends on size. A moderate or large VSD that isn’t repaired early tends to shorten life expectancy even after eventual repair. The lower chambers generate higher pressures than the upper chambers, so a VSD pushes more blood into the lungs more aggressively, and damage accumulates faster.
The Biggest Risk: Pulmonary Hypertension
The most serious complication of an unrepaired heart hole is high blood pressure in the lungs, known as pulmonary hypertension. About 14% of people with an untreated ASD develop this between ages 20 and 40. Once it takes hold, it can progress rapidly.
The damage to the lung blood vessels happens along a spectrum. Early on, it’s reversible: if you close the hole in time, the pressures come back down. But at some point the changes become permanent. That tipping point varies significantly between individuals, and there’s no simple test that pinpoints exactly when someone has crossed the line.
When pulmonary hypertension becomes severe enough, blood flow through the hole actually reverses direction. Instead of oxygen-rich blood leaking to the right side, oxygen-poor blood starts flowing to the left side and out to the body. This is called Eisenmenger syndrome, and it’s the most dangerous outcome of an unrepaired hole.
Life Expectancy With Eisenmenger Syndrome
Eisenmenger syndrome symptoms usually appear in adolescence or early adulthood, though they can show up in childhood. The hallmark sign is a bluish or grayish tint to the skin, lips, and fingernails caused by low oxygen levels in the blood.
Once Eisenmenger syndrome develops, the hole can no longer be safely closed. Surgical repair at this stage carries unacceptably high mortality. The outlook is significantly shortened: about 70 to 80% of people survive at least five years after diagnosis, and nearly 60% live at least 10 years. Only about 20% live to age 60. Many people survive into early or middle adulthood, but the condition limits activity, requires ongoing management, and carries a constant risk of serious complications.
Why Timing of Repair Matters So Much
Closing a heart hole before permanent lung damage sets in is the single most important factor for long-term survival. A large study published in Frontiers in Cardiovascular Medicine found that closing an ASD was a significant independent predictor of long-term survival, even after accounting for other risk factors. Every decade of delay in diagnosis roughly tripled the risk of death during follow-up.
For younger patients without pulmonary hypertension, closure (whether through a catheter-based procedure or surgery) typically restores a normal or near-normal life expectancy. The benefit is clearest when repair happens before age 25, but closing the defect later in life still improves outcomes compared to leaving it open.
The decision gets more complicated for older adults who already have elevated lung pressures. Repair in this group carries higher risk, and specialized centers often use targeted medications first to try to bring lung pressures down before attempting closure. If pressures can be reduced to a safe range, repair may still be worthwhile. If they can’t, the risks of surgery may outweigh the benefits.
Signs That a Hole Is Causing Problems
Many heart holes produce no symptoms at all for years. When symptoms do appear, they often develop so gradually that people attribute them to aging or being out of shape. Watch for shortness of breath that’s new or worsening, especially with physical activity. Fatigue that seems disproportionate to your effort level is another common early sign. Swelling in the ankles or legs, heart palpitations, and frequent respiratory infections can also signal that a defect is straining the heart.
Irregular heartbeats deserve particular attention. People with unrepaired ASDs are prone to atrial fibrillation and other rhythm disturbances as they age. These aren’t just uncomfortable. Some irregular rhythms increase stroke risk or, in rare cases, can cause sudden cardiac death if untreated.
The Bottom Line on Life Expectancy
A small hole that closes on its own or gets repaired early has virtually no impact on how long you live. A moderate to large hole that goes unrepaired into adulthood progressively raises the risk of heart failure, lung damage, and Eisenmenger syndrome, each of which shortens life. With modern catheter-based and surgical techniques, the vast majority of people diagnosed with a heart hole today can expect a normal lifespan, provided the defect is identified and managed before irreversible damage occurs.