Overview
Atrial Septal Defect :
An atrial septal defect is an opening in the atrial septum, or dividing wall between the two upper chambers of the heart known as the right and left atria. ASD is a congenital (present at birth) heart defect. As the fetus is growing, something occurs to affect heart development during the first eight weeks of pregnancy, resulting in an ASD.
When there is a large defect between the atria, a large amount of oxygen-rich (red) blood leaks from the heart's left side back to the right side. Then this blood is pumped back to the lungs, despite already having been refreshed with oxygen. This is inefficient, because already-oxygenated blood displaces blood that needs oxygen.
An atrial septal defect allows oxygen-rich blood to pass from the left atrium, through the opening in the septum, and then mix with oxygen-poor blood in the right atrium. Atrial septal defects occur in 4 percent to 10 percent of all children born with congenital heart disease.
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.
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. Symptoms may include:
FatigueSweatingRapid breathingShortness of breathPoor growth in childrenThe 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.
What are the treatment options for an ASD?
There are several options available depending upon the size of the defect and effect on the patients quality of life.
Some individuals may need to take medications to help the heart work better, since the right side is under strain from the extra blood passing through the ASD. Medications that may be prescribed include the following: digoxin (a medication that helps strengthen the heart muscle, enabling it to pump more efficiently) and/or diuretics (the body's water balance can be affected when the heart is not working as well as it could). These medications help the kidneys remove excess fluid from the body.
One option for repair if medical therapy fails is the percutaneous placement of a septal repair implant. This procedure is done in the cardiac cath lab. The third option is having the defect closed with stitches or a special patch during an open heart procedure.
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