Overview

Atrial Septal Defect (ASD)

An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of your heart. The condition is present from birth (congenital). Smaller atrial septal defects may close on their own during infancy or early childhood.

Large and long-standing atrial septal defects can damage your heart and lungs. An adult who has had an undetected atrial septal defect for decades may have a shortened life span from heart failure or high blood pressure in the lungs. Surgery is usually necessary to repair atrial septal defects to prevent complications.

ASD is not very common. When the person has no other congenital defect, symptoms may be absent, particularly in children. Symptoms may begin any time after birth through childhood.


There are three major types of atrial septal defects:

Secundum Atrial Septal Defect :

This is the most common atrial septal defect. It is caused when a part of the atrial septum fails to close completely while the heart is developing. This causes an opening to develop between the atria.

Primum Atrial Septal Defect :

This defect is part of the AV canals, and is often found at a split in the leaflet of the valve.

Sinus Venosus Atrial Septal Defect :

This defect occurs at the superior vena cava and right atrium juncture. In this defect, one or more of the pulmonary veins enter the right atrium instead of correctly entering the left atrium.


Individuals with ASD are at an increased risk for developing a number of complications including:

Atrial fibrillation (in adults)
Heart failure
Pulmonary overcirculation
Pulmonary hypertension
Stroke

Signs And Tests :

The doctor may heart abnormal heart sounds when listening to the chest with a stethoscope. A murmur may be heard only in certain body positions, and sometimes a murmur may not be heard at all. The physical exam may also reveal signs of heart failure in some adults. If the shunt is large, increased blood flow across the tricuspid valve may create an additional murmur when the heart relaxes between beats.

Causes of Atrial Septal Defect (ASD)

Doctors know that heart defects present at birth (congenital) arise from errors early in the heart's development, but there's often no clear cause. Genetics and environmental factors may play a role.

ASDs are a common type of congenital heart disease, though their precise incidence is not well understood. An isolated ASD may present at any age, since the resulting murmur is often overlooked. In children with congenital heart disease, it is estimated that as many as 33-50% will have an associated ASD as part of their complex of disease.

An atrial septal defect allows freshly oxygenated blood to flow from the left upper chamber of the heart (left atrium) into the right upper chamber of the heart (right atrium). There it mixes with deoxygenated blood and is pumped to the lungs, even though it's already refreshed with oxygen. If the atrial septal defect is large, this extra blood volume can overfill the lungs and overwork the heart. If not treated, the right side of the heart eventually enlarges and weakens. In some cases, the blood pressure in your lungs increases as well, leading to pulmonary hypertension. When to seek medical advice for Atrial Septal Defect (ASD)


Contact your doctor if you or your child has any of these

signs or symptoms : -

Tests that may done include:

What are the types of atrial septal defects ?

There are three major types of atrial septal defects : -

Secundum Atrial Septal Defect -

This is the most common atrial septal defect, affecting 80 percent of people with this defect. It is caused when a part of the atrial septum fails to close completely while the heart is developing. This causes an opening to develop between the atria.

Ostium Primum Atrial Septal Defect -

This defect is part of the AV canal defects, and is often found with a split (cleft) in the leaflet of the mitral valve.

Sinus Venosus Atrial Septal Defect -

This defect occurs at the superior vena cava and right atrium junction. In this defect, one or more of the pulmonary veins enter the right atrium instead of correctly entering the left atrium.

Treatment :

ASD may not require treatment if there are few or no symptoms, or if the defect is small. Surgical closure of the defect is recommended if the defect is large, the heart is swollen, or symptoms occur.

A procedure has been developed to close the defect without surgery. The procedure involves placing an ASD closure device into the heart through tubes called catheters. The health care provider makes a tiny surgical cut in the groin, then inserts the catheters into a blood vessel and up into the heart. The closure device is then placed across the ASD and the defect is closed.

An atrial septal defect (ASD) is an opening in the atrial septum allowing blood to shunt between left and right atria. When the defect involves tissue of the septum primum at or around the area of the foramen ovale, it is a secundum ASD. Defects of the sinus venosus - the embryological origin of the junction of superior and inferior vena cava into the right atrium - are known as sinoseptal defects or sinus venosus ASDs. The latter defects are often associated with partial anomalous pulmonary venous return. When the defect involves endocardial cushion tissue, it is referred to as a primum ASD.


How does an ASD affect the body?

Atrial septal defects result in blood flowing from the left atrium to the right atrium, causing the right ventricle and lungs to work extra hard to handle the flow. Usually, children with ASD's lead normal, healthy lives. Over time, however, the right ventricle may get larger, and the pressure in the main arteries of the lungs can increase. It is also common for abnormal heart rhythms to occur as a long-term consequence of this defect. All of these conditions can lead to a decrease in exercise tolerance, and if left untreated, ASD is known to shorten average life expectancy.

Occasionally, blood will flow from the right atrium to the left atrium, resulting in an increased risk of a stroke from the debris that is normally filtered out by the lungs.

An ASD can cause lung problems if not repaired. A small opening in the atrial septum allows a small amount of blood to pass through from the left atrium to the right atrium. A large opening allows more blood to pass through and mix with the normal blood flow in the right side of the heart. When blood passes through the ASD from the left atrium to the right atrium, a larger volume of blood than normal must be handled by the right side of the heart. Extra blood then passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood vessels in the lungs.

The larger the volume of blood that goes to the lungs, the higher the pressure. The lungs are able to cope with this extra pressure for a while, depending on how high the pressure is. In time, however, the blood vessels in the lungs become diseased by the extra pressure.

Many people have no symptoms and seem healthy. However, if the ASD is large, permitting a large amount of blood to pass through to the right side of the heart, the right atrium, right ventricle, and lungs will become overworked, and symptoms may be noted. The following are the most common symptoms of atrial septal defect.


The symptoms of an atrial septal defect may resemble other medical conditions or heart problems.

For these reasons, the current standard of care is to close atrial septal defects to reduce the shunt to a level which allows the right heart size and blood flow into the lungs to return to normal.

Complications :

Prevention :

There is no known way to prevent the defect, but some of the complications can be prevented with early detection.

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