Atrial septal defect

Atrial septal defect, also called as “hole in the heart” is a congenital (from birth) heart defect in which the wall separating upper chambers of the heart (atrial septum) does not close completely. The hole may be of smaller or larger size. Smaller holes may not cause symptoms or problems. But if it is large, the blood flows from the heart’s upper left side through the hole to right side and out into the lung arteries. The “extra” blood increases pressure in the lungs that makes the heart and lungs to work harder and eventually results in increased blood pressure, and sometimes heart failure.

ASD’s can be present at different places and can be of different sizes. The symptoms and treatment often depend on these two factors. ASD is more common in girls than in boys. However, the reason is unknown.

About 4.2% of all neonatal deaths are due to congenital heart defects.

Smaller defects, less than 5 millimeters may not show any symptoms or not until middle age or later. In adults, the signs and symptoms usually begin from the age of 30. The symptoms include:

  • Shortness of breath, with activity
  • Poor appetite
  • Swelling of legs, feet, and abdomen
  • Irregular heart beat or skipped beats
  • Stroke
  • Frequent lung infections
  • Heart murmur or “whooshing” sound that can be heard through stethoscope

Inform the doctor immediately when you or your child has the following symptoms. These signs could be the sign of a heart failure or other congenital heart problems.

  • Shortness of breath
  • Getting tired easily, especially during any activity
  • Skipped beats
  • Swelling of legs, feet, and abdomen

Most of the ASD occur by chance with no clear cause. Scientists are still working on that part. ASD mainly occurs when the partitioning process of the heart does not complete during the first few weeks of conception, thus leaving a hole in the atrial septum. The reason behind this is unknown. Heredity and environmental factors play a major role in congenital defects like ASD.

Atrial defects are often defined as primum, or secundum.

  • The primum defects are present in the lower side of the atrial septum and are linked to other defects of the heart such as a ventricular septum or mitral valve.
  • Secundum is the most common type of ASD, and it occurs in the middle of the atrial septal wall.

The defect may also occur in the upper part of the atrial septum (sinus vinosus) or between the coronary sinus.

The following conditions during pregnancy may increase the risk of developing ASD in your baby.

  • Obesity
  • Rubella infection
  • Drug abuse
  • Exposure to certain substances like tobacco, alcohol
  • Phenylketonuria - error of metabolism
  • Eisenmenger syndrome - permanent lung damage; doctors usually recommend not to get pregnant if you have this condition because it can endanger your baby’s life

Smaller defects never cause any problems, but larger defects may cause life-threatening problems like:

  • Right-sided heart failure
  • Arrhythmias
  • Increased risk of stroke
  • High blood pressure in the arteries of the lungs (pulmonary hypertension)
  • Eisenmenger syndrome-permanent lung damage

During the physical examination, if your doctor hears a heart murmur caused by ASD, he or she may recommend the following tests:

Chest X-ray: The X-ray images help your doctor to identify the condition of your heart and lungs.

Echocardiogram: This is the commonly used test to diagnose an ASD. This test that helps the doctor to see the heart chambers through video image produced by the sound waves.

Electrocardiogram: Heart rhythm problems are detected through this test.

Heart MRI: This test creates a 3-D image of your heart that helps in definitive diagnosis of the disease.

CT scan: Detailed images of the heart are created using a series of X-rays that help in the definitive diagnosis of the heart defects.

Atrial Septal Defect Treatment

Most of the defects close on their own during childhood. The defects that do not close are treated. Once the condition is diagnosed, your doctor recommends suitable treatment option depending on the age size location, and severity of the disease.

The doctors prescribe medicines to manage the symptoms as they do not close the hole completely. The commonly prescribed medicines are beta-blockers (keep the heart beat regular) and anticoagulants (prevent the formation of blood clots).

The doctors usually recommend atrial septal defect surgery for the closing of the ASD in childhood to prevent complications in life. Atrial septal defect repair may not be possible if you have pulmonary hypertension.

Cardiac catheterization: In this technique, the doctor inserts a catheter into the blood vessel in the groin and plugs a mash patch to close the hole. The heart tissue grows around the mesh permanently closing the hole.

Open-heart surgery: This surgery is recommended if you have other heart defects including ASD. The doctor makes an incision in the chest and uses patches to close the hole. ASD defect closure surgery may also be performed with minimally invasive technique.

If you are diagnosed with ASD or have undergone surgery to correct the condition, do not worry about your daily activities and lifestyle changes. Try to adopt these habits to have a healthy life:

  • Exercise regularly to improve your heart beat
  • Follow a healthy diet plan. Try to add fruits vegetables whole grains to your diet.
  • Avoid infections that may affect your health condition.