©️ Mayo Clinic & Cincinnati Children's
Atrial Septal Defect (ASD)
Essentially, a common congenital heart defect involving a hole between the heart's atrial chambers (in the septum—wall that decides these chambers). This increases the amount of blood flowing through to the lungs.
When there is an ASD present, blood flows primarily from the left atrium to the right atrium, therefore increasing the volume in the right atrium, and in turn, increasing the blood flow to the lungs.
The increased volume load causes enlargement of both atria, and right ventricle and the pulmonary artery.
Untreated, ASD can cause pulmonary hypertension, congestive heart failure (weakening heart muscle) atrial arrhythmias, and an increased risk of stroke.
Signs & Symptoms
Primarily, there are no symptoms. However most often, ASD presents and is diagnosed after hearing a heart murmur during physical examination. Heart murmurs on examination are the most common reason ASD is suspected, and echocardiography is the primary method to conform the existence of ASD.
Larger defects that allow more blood flow can cause congestive heart failure, which is associated with:
☞ shortness of breath,
☞ becoming easily tired,
☞ and more uncommonly, poor growth.
Electrocardiography (EKG) can show thickening of the heart muscle, and a chest x-ray can show enlargement of the heart and increased blood flow to the lungs.
Treatment
ASD may close on its own without treatment, and small defects have a possibility of closing on its own of as much as 80% in the first 18 months of life. ASD present by 3 years of age will never close on their own.
Invasive treatments include:
Open-heart surgery
This is less common nowadays, but if necessary, an ASD may be closed by stitches, or with a patch. This is effective and low risk.
Transcatheter Device Closure
Depending on the area and size of the septal defect, it may be closed by cardiac catheterisation, that covers the defect by attaching to the atrial septum. Patches are used in larger defects.
Results & Management
ASD closure is without problems in 99% of cases, and after ASD closure in childhood, the heart size returns to normal over 4-6 months. After ASD is closed, there should be no problems with activity restrictions, however there should be follow-up appointments should be made with a cardiologist.
ECHOs should be done every 5 years follow up to monitor for complications in those who have undergone ASD device closure treatment.
Graphics:
Normal:
Atrial Septal Defect:
ASD Close-up:
ASD Patched:
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