Atrial septal defect (patient information)
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For WikiDoc information click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
What is an atrial septal defect?
Atrial septal defect or ASD is type of congenital heart defect in which the wall separating the upper chambers of the heart does not fuse completely. During fetal development, the opening between the two atria is needed to allow blood to bypass the lungs. Eventually, as the fetus becomes more developed, the lungs can support circulation and the opening fuses shut. An ASD can result in shunting of blood disproportionately between the right and left sides of the heart. Symptoms include shortness of breath, difficulty breathing, frequenty respiratory infections in children, and heart palpitations in adults. Associated conditions include atrial fibrillation, congestive heart failure, infective endocarditis, pulmonary hypertension and stroke. Tests to determine ASD include cardiac catheterization, a chest x ray, coronary angiography, trans-cranial doppler ultrasound, an electrocardiogram, echocardiography and MRI. Treatment may not be needed if the defect is small. Larger defects require surgical closure. Prognosis depends on the severity of ASD with more severe cases causing disability later in life.
How do I know if I have an atrial septal defect and what are the symptoms of an atrial septal defect?
Symptoms may not be present at birth and can develop later in life. Symptoms may include:
Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.
Who is at risk for an atrial septal defect?
Like other congenital heart diseases, the cause of an atrial septal defect is not clear.
How to know you have an atrial septal defect?
- Auscultation: Using a stethoscope, a doctor can listen to the beating of the heart. A doctor may hear abnormal heart sounds called a murmur. If the defect is large enough, the increase in blood flow across the heart valves may create a secondary murmur between beats.
- Echocardiography: This kind of non-invasive, painless sonar test can help the doctor closely examine an atrial septal defect. It uses sound waves to produce an image of the ventricles, atrium and great vessels. An echocardiogram can determine if blood is flowing properly from the right to the left systems. Furthermore, the doctor can measure the speed of blood flow through patient's heart and the pulmonary blood pressure using the echocardiogram. This is important to determine if there is excess flow through the lungs and if there is damage to the vessels in the lung.
- Chest x-ray: An x-ray image of chest allows the doctor to check the size and shape of your heart. A chest x ray also helps the doctor check the condition of your lungs. Patients with an atrial septal defect may show enlarged right atrial border on an x -ray.
- Chest CT or MRI: A chest CT or MRI can demonstrate the details of the heart extremely well, such as the positions of valvular, vascular, atrial and ventricular structures and their relationships to one another.
- Electrocardiogram (ECG): Electrocardiogram determine if there are abnormal electric activities of the heart as a result of an ASD. The ECG can provide information about the heart rhythm and the size of the heart chambers.
When to seek urgent medical care?
Call your health care provider if your baby has the following symptoms as soon as possible:
- Heart failure
- Shortness of breath (Dyspnea)
- Cyanosis
- Failure to thrive
Call your health care provider if you are an adult experiencing the following symptoms:
Treatment options
The classification of the atrial septal defect must be assessed. Potential tests include:
- MRI
- Chest x-ray
- Echocardiogram
If the atrial septal defect is determined to be an ostium secundum defect, patients have the option of percutaneous transcatheter closure or surgical closure. Percutaneous closure is minimally invasive, traveling through the femoral artery up to the heart. It involves the usage of a guide wire catheter to close the septal hole. Surgical closure is more invasive and involves the usage of sutures to close the septal hole. The purpose of both procedures is to close the septal hole and restore normal circulation from the right to left sides of the heart.
If the atrial septal defect is determined to be any other type, the only option is surgical closure. This invasive procedure varies in execution depending on the gender and age of the patient, as certain incisions are more appropriate for specific genders and specific age groups. Recovery time is difficult to generalize and depends largely on the type of incision, the age of the patient, and the severity of symptoms.
Where to find medical care for an atrial septal defect?
Directions to hospitals treating atrial septal defects
What to expect (Outook/Prognosis)?
In general, the mortality rate of surgical repair is less than 1% for patients younger than 45 years. The morbidity rate is low. Overall, surgical closure has been observed to have a positive role in improving the health of atrial septal defect patients. Without intervention, atrial septal defect patients may suffer a severe decline in health. Treatment is always recommended.