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A congenital heart defect known as an atrial septal defect (ASD) causes a hole between the upper chambers of the heart (atria) and causes blood from the left atrium to flow into right atrium in the wrong direction, causing an increase of blood flow to the lungs as a result of the hole. It may have presented as an incidental finding without causing any problem. Some small atrial septal defect close on their own over time, usually during infancy or early childhood. The likelihood of experiencing symptoms and need of treatment increases with the size of an ASD. The heart and lungs can be harmed by a large, long-lasting atrial septal defect. To repair an atrial septal defect and avoid consequences, surgery may be required.
Different types of atrial septal defects include:
- Secundum: It appears at the middle of the wall separating the upper heart chambers (atrial septum). The most common type of ASD.
- Primum: Other congenital heart disorders may coexist with this kind of ASD, which affects the lower portion of the atrial septum.
- Sinus venosus: The upper portion of the atrial septum is where this rare type of ASD typically manifests. It is linked to other birth-related changes in the heart’s structure.
- Coronary sinus: The wall separating the coronary sinus, a venous system component of the heart, and the left atrium is partially absent in this rare form of ASD.
Symptoms
Many infants with atrial septal defects are born without any symptoms. The signs and symptoms may be present in the adulthood.
Signs and symptoms of an atrial septal defect can include:
- Shortness of breath or difficulty in breathing with exercise
- Fatigue
- Swelling of legs, feet or abdomen
- Arrhythmias
- Rapid heartbeat (heart palpitations) or skipped beats
- Heart murmur
Before or shortly after a child is born, serious congenital heart problems, such as large atrial septal defects, are frequently identified. If the child exhibits any symptoms, get medical attention right away.
Causes
There is no known what cause atrial septal defects, but they usually come from an abnormal development of the heart that occurs while the infant is in the womb. However, there may be a connection between genetics, specific medical disorders, the usage of specific drugs, and environmental or lifestyle variables like smoking or excessive alcohol consumption.
The large atrial septal defect causes the right side of the heart may pump too hard and the lungs may become overfilled with blood. The right side of the heart ultimately enlarges and weakens if untreated. Pulmonary hypertension can also develop as a result of elevated blood pressure in the arteries that supply the lungs.
Risk factors
As the baby’s heart develops throughout pregnancy, an atrial septal defect (ASD) can develop. The likelihood of an atrial septal defect or another congenital heart defect in a fetus may be increased by specific medical conditions or drug use during pregnancy. These include the following:
- German measles (rubella) during early stages of pregnancy
- Diabetes
- Lupus
- Alcohol consumption
- Tobacco use
- Usage of drugs such as cocaine
- Taking some pharmaceuticals, such as some anti-seizure meds and those for treating mood problems
A genetic counselor’s screening can assist in the prediction of the likelihood of heart problems will occur in future children if you or a family member has congenital heart disease, including ASD.
Diagnosis
There are cases that ASD could be diagnosed before or shortly after a child is born. Smaller atrial septal defects, however, might not be found until much later in life.
The patient with ASD will have heart murmur (whooshing sound) during the physical assessment of the healthcare professional.
The following tests are used to identify an atrial septal defect:
- Echocardiogram: Sound waves can be utilized to visualize the beating heart in action. How well blood is flowing through the heart and heart valves can be seen on an echocardiography.
- Electrocardiogram (ECG or EKG). Used to monitor the heart’s electrical activity. It can detect if you have heart arrhythmia.
- Chest X-ray: Heart and lung condition can be seen on a chest X-ray.
- Cardiac magnetic resonance imaging (MRI) scan: If echocardiography failed to make a clear diagnosis, a doctor might order this kind of MRI. During this imaging procedure, the heart is captured in fine detail using magnetic fields and radio waves.
- Computed tomography (CT) scan: This produces finely detailed images of your heart using a sequence of X-rays. It can be utilized to identify one as well as associated congenital heart defects.
Treatment
The size of the hole at the heart or other congenital heart defects will determine by the healthcare professional on how the ASD will be treated.
Even though most of atrial septal defects close during childhood on their own, this is not always the case. No additional need for treatment for small atrial septal defects. The medical expert can advise routine checkups to track the progression of the condition.
Surgery is necessary for many atrial septal defects that remain unclosed. Closure is not advised in cases of severe pulmonary hypertension. When the child requires medical attention, the healthcare practitioner will discuss the necessary treatment.
Medications
Medications to regulate the heartbeat (beta blockers) or to lower the risk of blood clots (anticoagulants) may be prescribed for atrial septal defects. The signs and symptoms of an atrial septal defect can be lessened with medication, but the defect cannot be corrected.
Surgery
When a child or adult is identified with a medium to large-sized atrial septal defect, many cardiologists advise surgery to fix it in order to avoid further complications.
Atrial septal defect repair surgery involves patching up the heart hole in both adults and children. There are two ways to do this:
- Open-heart surgery: is used for primum, sinus venosus, and coronary sinus atrial defects. An incision through the chest wall is made in order to directly reach the heart. To close the hole, the surgeons apply patches.
Atrial septal defect correction can occasionally be carried out using a robot-assisted heart surgery and minimally invasive surgery.
- Catheter-based repair: Using imaging methods, a thin, flexible tube (catheter) is placed into a blood vessel, typically in the groin, and directed to the heart. To plug the hole, a mesh patch or plug is inserted through the catheter. The hole is permanently sealed as heart tissue develops around the seal.
Only the secundum kind of atrial septal defects are repaired using a catheter. However, open heart surgery may be necessary for some large secundum atrial septal defects.
Regular checkup and echocardiogram are needed for people who had undergone surgery, to further assess for any complications after the surgery. Heart valve problems, arrhythmias, pulmonary hypertension and heart failure are some of the complications.
Long-term outcomes are often worse for people with large atrial septal defects who do not have surgery to repair the hole. They may have lower functional capacity making it harder to carry out daily tasks. They also run a higher risk of developing pulmonary hypertension and arrhythmias.
