Atrial septal defect

The atrial septal defect (ASD) is an opening within the wall (septum) between the two chambers that make up the heart (atria). The condition can be present from the time of birth (congenital).

A few small defects may be discovered in the course of a random search and will not cause any problems. Small atrial septal defects are discovered in the early years of childhood.

The hole boosts the quantity of blood that circulates through the lungs. A large, long-standing atrial septal defect can damage your heart and lungs. A procedure or closure of the device could be required to correct atrial septal defect to prevent complications¹.

 

Symptoms

Many infants who are born atrial septal defect show no symptoms or signs. The signs or symptoms may begin at any time in adulthood.

The symptoms and signs could be:

• A shortness of breath, in particular during exercise
• Fatigue
• Swelling of feet, legs or the abdomen
• Heart palpitations or skip beats
• Stroke
• A heart murmur or loud sound that is detected by an device called a stethoscope.

When is the best time to visit a doctor?

Consult your physician if you or your child is suffering from

• Shortness of breathing 
• The fatigue can be quite intense, particularly following an activity.
• Swelling of feet, legs or the abdomen
• Heart palpitations or skip beats

Causes

It is split into 4 chambers: two on the right side and two left. To circulate circulation of blood through the entire body, it makes use of the right and left sides for various functions.

The heart’s left side transports blood to the lung. Within the lung, blood soaks oxygen, and then is returned to left side. Its left-side pump the oxygenated blood into the aorta, and out to the rest of the body.

Why do heart defects develop?

Doctors have learned that heart problems found in the womb (congenital) result from mistakes at an early stage of the development of the heart and there’s typically no specific root. Genetics and environmental factors may be involved.

The heart’s function is affected by an atrial septal defect

A massive atrial septal defect could cause an increase in blood flow to the lungs and overload that side of the body. If left untreated the right side of the heart will eventually expand and becomes weaker. The blood pressure of your lungs could also increase and cause the condition known as pulmonary hypertension.

There are a variety of atrial septal defects such as:

• Secundum. The most commonly used kind of ASD and is located and occurs in the middle of wall that connects the and the atria (atrial septum).
• Primum. This defect occurs in the lower region of the septum atrial. It could be associated in conjunction with other heart conditions that are congenital.
• Sinus Venosus. This rare defect typically occurs in the upper portion of the septum atrial. It is frequently associated with other heart conditions that can be caused by congenital birth.
• The coronary sinus. In this rare defect, a portion of the wall that connects the coronary sinus an integral part of the blood vessel system in the heart along with the left atrium is absent.

Risk factors

It’s unclear the reason why atrial septal defects happen however, certain congenital heart problems are known to be prevalent in families and can be found alongside other genetic disorders like Down syndrome. If you’re suffering from a heart defect or have a child who has an issue with the heart or genetic disorder, a genetic counselor will calculate the probability that your the next generation will suffer from one.

Certain conditions that you suffer from during pregnancy may increase your chances of having a child who has a defect in the heart such as:

• Rubella disease. Becoming infected with rubella (German measles) in the early months of pregnancy could increase the risk of fetal cardiac problems.
• Alcohol, tobacco, or alcohol consumption, or the exposure of certain chemicals. Use of certain drugs, alcohol, tobacco or even drugs, such as cocaine during pregnancy could affect the development of the fetus.
• Lupus or diabetes. Having diabetes or Lupus could increase the risk of having a baby born with heart defects.

Complications

A tiny atrial septal defect may not cause any complications. A small atrial septal defect is likely to occur during the first few months of life.

Larger defects can cause serious problems, including:

• Heart failure of the right side
• Heart rhythm abnormalities (arrhythmias)
• Risk of strokes is increased
• Life spans are shorter

The less frequent serious complications be:

• Hypertension in the lungs. If a large atrial septal defect remains untreated, the increased flow of blood to the lungs can increase blood pressure in your lung’s arteries (pulmonary hypertension).
• Eisenmenger syndrome. Pulmonary hypertension can cause lung damage that is permanent. The complication, known as Eisenmenger syndrome, is usually developed over time and can be seen typically in patients with large atrial septal deformities.

Treatment is a way to prevent or treat many of these problems.

Arial septal defect and pregnancies

A majority of women with an atrial septal defect be pregnant without issues due to the defect. However, having a more significant defect or having complications like arrhythmias, heart failure, or pulmonary hypertension could increase the chance of complications occurring during pregnancy.

Doctors advise women suffering from Eisenmenger syndrome to avoid becoming pregnant, as it may put their lives in danger.

The risk of developing congenital heart disease is more prevalent in children of parents suffering from congenital heart diseases. Anyone who has a congenital heart defect that has been repaired or not, thinking of starting a family must speak with a doctor. The doctor could suggest repair prior to conception.

Prevention

Most of the time atrial septal problems can’t be avoided. If you’re planning on becoming pregnant, make an appointment with your physician. This appointment should include:

• Tests for the presence of immunity for rubella. If you’re not immune, consult your physician to get vaccination.
• Examining your health issues and medication. You’ll need to keep an eye on certain health issues while pregnant. Your physician may also suggest changing or stopping certain medications prior to you becoming pregnant.
• Examining your medical history as a family member. If you have a history of family members with heart defects or other genetic diseases you should talk to an expert on genetics to assess what your risk is.

 

Diagnosis

A heart murmur heard during a routine checkup could lead your doctor or the doctor of your child to believe that an atrial septal deficiency, or another heart defect. In the event of a possible heart defect, your physician might recommend some or all of the tests below:

• Echocardiogram. It is the most frequently performed test to detect the presence of an atrial septal defect. The use of sound waves to create a video that shows the inside of the heart. This allows your doctor to view the heart’s chambers and determine their strength of pumping.
  The test also tests the heart valves and will look for signs of heart defect. Doctors may also use this test to determine the condition of your body and establish a treatment strategy.
• Chest Xray. This helps your doctor determine the health of your lungs and your heart. A X-ray may reveal conditions that are not heart-related that could cause the symptoms or signs you are experiencing.
• Electrocardiogram (ECG). This test monitors how your heart beats electrically. It assists in diagnosing heart rhythm problems.
• Cardiac catheterization. A thin elastic tubing (catheter) is placed through a vein located at the groin or arm, and then guided towards your heart. By using catheterization, doctors are able to detect heart defects that are congenital check how well your heart pumps to check the heart valve’s function and assess the pressure of blood in your lung. But, it usually isn’t required to determine an atrial septal problem. Doctors can also utilize procedures to fix heart defects.
• MRI. This uses a magnetic field and radio waves to generate 3-dimensional pictures of your heart as well as other bodily organs and tissues. Your physician may suggest an MRI when echocardiography cannot conclusively identify an atrial septal deficiency, or related disorders.
• CT scan. This uses a sequence of X-rays to produce high-quality photographs of your heart. It is a method to determine if you have the presence of an atrial septal defect as well as congenital heart defects that are related in the event that echocardiography isn’t able to definitively identify the atrial septal deformity.

 

Treatment

A number of atrial septal defects heal at a whim during the early years of childhood. If they don’t the septal defects may not require intervention. However, many atrial septal deformities eventually require surgery.

Medical monitoring

In the event that you suspect your child is suffering from an atrial septal problem your cardiologist may suggest keeping an eye on it for a while to determine if it heals by itself. The doctor will decide if the child or you requires treatment, based on the condition of your child and whether your child have other heart defects congenital to the child.

Medications

Medicines won’t fix the hole However, they could be used to lessen certain symptoms and signs that be associated with an atrial septal hole. They can also be used to lower the risk of complications following surgery. The medications may be used to ensure that the heart beat is regular (beta-blockers) as well as to lower the chance for blood clots (anticoagulants).

Surgery

Many doctors suggest repairing an atrial septal defect that is discovered in the teen years or in adulthood to avoid the possibility of complications in the future. Surgery isn’t advised when you suffer from an extreme pulmonary hypertension since it can make the problem worse.

Children and adults alike the procedure involves sewing shut or patching the gap between the atria. The doctor will examine your health and decide which procedure to choose from:

• Cardiac catheterization. Doctors insert a flexible, thin tubing (catheter) into the blood vessel of the groin, and then guide it towards the heart by with imaging techniques. With the help of the catheter put the mesh patch or plug to seal the wound. The heart tissue develops within the mesh closing the hole. This procedure is intended to repair only the secundum variety of atrial septal deformities. Some large secundum atrial septal defects, however, might require open-heart surgery.
• Open-heart surgery. This kind of procedure is carried out under general anesthesia and involves the use of the heart-lung machine. Through an incision on the chest area, doctors make patches to seal the gap. This is the only method to fix the primum, sinus venosus, and coronary sinus atrial deformities. The procedure is performed with tiny incisions (minimally surgically) as well as a robot for certain kinds of atrial septal defect.

Follow-up care

Care for follow-up depends on the nature of the defect, the suggested treatment and if other problems are present. Echocardiograms are repeated after the discharge from hospital after one year and thereafter as directed by you or your child’s physician. For atrial septal defects that are simple and which are repaired during the child’s childhood just a few times, follow-up care typically is required.

Adults who’ve undergone repair of the atrial septal defect need to be monitored throughout their lives to detect any potential complications, like pulmonary hypertension, heart failure, arrhythmias or valve issues. Regular follow-up tests are conducted every year.

 

Lifestyle Changes

If you’re suffering from an abnormal heart condition that is congenital or have had surgery to rectify it, you could be wondering about restrictions on your activities , as well as other issues.

• Exercise. A heart septal defect typically doesn’t stop your activities or workout. If you’re suffering from problems, such as heart failure, arrhythmias or hypertension in the lungs, then you could be advised against certain actions or workouts. Your cardiologist will help you determine what is appropriate for you. If you’re suffering from an uncorrected problem, your doctor will likely recommend that you avoid high-altitude climbing.
• Infection prevention. A few heart defects and treatment of these defects can cause changes on surfaces of your heart which increase the risk of infections (infective endocarditis). Arial septal problems are generally not connected to infective heart disease, although your physician may suggest preventive antibiotics for around six months following closure if you’re having dental work done. If you’re suffering from other heart conditions other than the atrial septal deficiency or if you’ve undergone an atrial septal defect repairs in the past 6 months, then you could require antibiotics prior to certain procedures, whether surgical or dental.