What is an atrial septal defect?
An atrial septal defect (ASD) is a congenital heart defect in which there is an opening in the partition (the atrial septum) between the heart’s two upper chambers (the right and left atria). An ASD is one of the defects referred to as “a hole in the heart.”
An ASD ( hole in septum) allows the oxygenated blood to shunt from the left atrium into the right atrium. This leads to increased blood flow through the right side of the heart and lungs. Over time, this “extra” blood volume over loads the right side of heart and causes the right atrium, ventricle and pulmonary arteries to dilate (become wider). This can eventually lead to heart failure, pulmonary hypertension or heart rhythm abnormalities.
Signs and symptoms of atrial septal defect
Patients with ASD are generally asymptomatic. They are generally diagnosed when doctor hears murmur, or they have abnormal ECG or X ray done for some other reason. However, a large ASD can cause symptoms even in early infancy. These babies are generally underweight. Common symptoms of ASD are as follows
- Heart murmur: abnormal heart sounds when a doctor listens with a stethoscope
- Fatigue or shortness of breath
- Racing heartbeat (palpitations)
Testing and diagnosis
Your child’s primary care doctor may refer you to the Cardiac Center for evaluation. Diagnosis of atrial septal defect may require some or all of these tests:
- 2D Echocardiogram: It is diagnostic modality and gives clear idea about nature of defect and any other associated anomalies.
- Electrocardiogram (ECG): a record of the electrical activity of the heart
- Chest X-ray
Types of ASD
There are following varieties of ASDs
- Ostium secundum ASD: It is most common.
- Sinus venosus ASD: It is generally associated with abnormal pulmonary venous connections.
- Coronary sinus ASD
- Ostium primum ASD: This is generally associated with regurgitation ( leak) of left sided valve i.e. mitral valve.
Treatment for atrial septal defect
Some small ASDs close on their own. This often happens before a child turns 3 years old, so your doctor may decide to wait and see whether the atrial septal defect closes on its own.
If the ASD is large, or doesn’t close on its own, additional steps will be required to prevent complications from developing. Treatment options include:
Cardiac catheterization
In many cases, an ASD can be closed during a cardiac catheterization procedure. A paediatric interventional cardiologist will insert a thin tube (catheter) through a large vein in the leg, then guide it up into the heart. A device is then delivered through the catheter to close the hole.
Because each ASD is unique, cardiologists will choose a closure device that is best suited to your child based on the particular features of the hole (size, location, amount of tissue surrounding the hole, etc.). The device will be placed using both ultrasound and x-ray guidance to ensure proper positioning and stability.
Most children will spend one night in the hospital after this procedure. They will also need to rest for the next few days, but then can resume normal activity.
Open heart surgery
In cases where the hole is very large, or the heart anatomy is complex, surgery may be required. Surgeons use stitches or patches to close the hole. After surgery, patients initially in cardiac ICU.
Outlook
Because of enormous strides in medicine and technology, today nearly all children with atrial septal defects go on to lead healthy, productive lives as adults.
Follow-up care
After ASD repair, most children recover quickly and don’t experience additional cardiac problems. Children and adults with ASD must see a pediatric cardiologist for regular checkups. Rarely, additional surgery is required.
Children who have other heart abnormalities will require more extensive follow-up care.
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