Atrial septal defect w/mitral valve insufficiency

  : : Of course I know you can't offer medical advice without examing the patient but could you please give me some general information to answer the questions below.  First, my history, I have a congenital heart defect that includes an atrial septal defect of the ostium primum type with a cleft mitral valve and mild to moderate regurgitation.  I was diagnosed at age 5 with mild insufficiency, then recently (age 30) had an echo that showed moderate regurgitation.  I am sympton free and there is no enlargement of the heart.  My doctor has advised a heart cath be done to determine exact regurgitation. My last one was at age 5.  I have put off surgery because I feel that the technology is improving every day and perhaps one day this surgery will not be as invasive.  I see from your web page that you are doing remarkable things.  My questions are: (1) What is the danger of becoming pregnant, both to mother and child, with this condition?  (2) Are the defects I described above able to be fixed with a less invasive procedure than open heart surgery?  (3) At what mitral valve insufficiency rate is surgery recommended when the patient is symptom free?  (4) Is the ostium primum ASD harder to fix than other ASD's because of the location?  (5) Is there any evidence to suggest a correlation between these defects and migraine headaches, which I suffer from?  Thanks for any info you can provide.  Christy
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  : Dear  Christy,
  : Thank you for your questions.
  : Q: What is the danger of becoming pregnant, both to mother and child, with this condition?
  : A: Pregnancy increases the workload on the heart.  Depending on the type and severity of the valvular problems there may be no problem or significant difficulty.  The best thing is to consult with both your cardiologist and an ob/gyn who specializes in high risk pregnancies.
  : Q: Are the defects I described above able to be fixed with a less invasive procedure than open heart surgery?
  : A: No and doubtful that there will be such a technique in the near future.
  : Q:  At what mitral valve insufficiency rate is surgery recommended when the
  : patient is symptom free?
  : A: This is not a black and white issue.  If one waits until the patient develops symptoms it's too late.  The best thing is to have regular follow-up and if there is progression and severe regurgitation to proceed with surgery.
  : Q:  Is the ostium primum ASD harder to fix than other ASD's because of the location?
  : A: Yes.
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  : Q: Is there any evidence to suggest a correlation between these defects and migraine headaches, which I suffer from?
  : A: No.
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  : Hope this helps feel free to write back with any additional questions.
  : Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist
  Thanks for your answers.  You answered yes that the ostium primum ASD is harder to fix.  Why is this and what are the mortality rates for fixing this problem assuming I am an otherwise healthy 30 year old who will also be undergoing the mitral valve fix?  
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Dear Christy,
It is the location of the defect that makes it a little more technically chalenging.  This should not be a problem for a good surgeon however.  You would have to talk to the surgeon to get the exact mortality rates but it should be less than 1%.  If you are interested in coming to the Cleveland Clinic I would highly recommend Dr. Cosgrove.  To be evaluated you can call the number below and make an appointment with a cardiologist to be evaluated for surgery.  Hope this helps.  Feel free to write back with any additional questions.
  : Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist