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Definition

Atrial septal defect can be defined as a hole between the walls of the two upper chambers of the heart. Such a defect is congenital and may sometimes go away during early childhood itself.

This defect allows oxygen-rich blood to leak into the oxygen-poor blood chambers in the heart. ASD is a defect in the septum between the heart's two upper chambers (atria). The septum is a wall that separates the heart's left and right sides.

If the hole is small, it may have minimal effect on heart function. When a large defect exists between the atria, a large amount of oxygen-rich (red) blood leaks from the heart's left side back to the right side. Then this blood is pumped back to the lungs, despite already having been refreshed with oxygen. Unfortunately this creates more work for the right side of the heart. This extra amount of blood flow in the lung arteries can also cause gradual damage.

A large ASD is usually closed in early childhood, even in patients with few symptoms, to prevent complications later. The prognosis after ASD closure during childhood is excellent and late complications are uncommon.

If the opening is small, surgery or other treatments may not be needed.

Symptoms

Some patients with ASD have no symptoms. If the opening is small, it won't cause symptoms because the additional work done by the heart and lungs is minimal. If the opening is large, it may cause mild shortness of breath, especially with exercise. The increased blood in the lung may increase a patient's susceptibility to pneumonia and bronchitis. On physical examination, the only abnormal finding may be a murmur (noise heard with a stethoscope) and other abnormal heart sounds. However, with progressive damage to the lung vessels, the pressures in the lung may rise, and the patient can become more severely limited, eventually developing Eisenmenger's syndrome.

ASD may present as:

  • Stroke
  • Frequent lung infections
  • Fatigue
  • Heart murmurs
  • Shortness of breath
  • Swelling in legs or abdomen
  • Heart palpitations

Risk Factors

Your child may be at risk for atrial septal defects if either or both parents have existing heart conditions. Other risk factors may include:

  • Diabetes or Lupus
  • Drug tobacco or alcohol use
  • Obesity
  • Rubella infection
  • Phenylketonuria

Diagnosis

The diagnosis for atrial septal defect may include some or all of the following medical examinations and procedures:

  • Stress test
  • Basic ECG test
  • Electrophysiology
  • Chest X-Ray
  • Echocardiogram
  • Tilt table test
  • Cardiac Catheterization
  • Myocardial Biopsy
  • CT Heart Scan
  • Pericardiocentesis
  • Heart MRI

Treatment

In a lot of cases, atrial septal defects may go away on their own and without much treatment. In other cases, however, medication and surgery may also be necessary.

Medication

Medication given for atrial septal defects can help in reducing some of its symptoms and they are also given in the post-operation period, to reduce complications.

Surgery

Surgery for atrial septal defects for children and adults may include:

  • Cardiac Catheterization
  • Open heart surgery
 
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