Atrial Septal Defect (ASD) An atrial septal defect is one of the most common forms of congenital heart dise

ase found in adults. Although there are at least three different forms of atrial septal defect, they all have in common a communication between the right and le ft atrium. If the ASD is large enough, it produces enlargement of the right side of the heart, arrhythmias and sometimes pulmonary hypertension. In some patient s, an ASD is discovered incidentally. In others, it can be suspected because of an abnormal cardiac exam, palpitations or shortness of breath. The diagnosis is generally confirmed with an echocardiogram. The three most common forms of ASD a re: secundum, sinus venosus and primum defects. Secundum ASD: The secundum defect is the most common form of ASD and generally occurs as an is olated defect. It results from failure of a part of the atrial septum to close c ompletely during fetal development. In the past, surgery was required to close a secundum ASD. However, following the approval of the Amplatzer ASD closure devi ce in 2002, most secundum defects can be closed with the catheter-based procedur e. Click here for video. The ASD closure device is inserted during a cardiac catheterization under echoca rdiographic guidance. Patients are discharged the following day on anti-platelet medications for six months. Unlike cardiac surgery, there is little or no recup eration associated with this procedure. Primum ASD: The primum ASD is a part of a larger spectrum of cardiac abnormalities known as an endocardial cushion defect. Endocardial cushion defects result in abnormaliti es of the atrioventricular valves, and both atrial and ventricular septum. A pri mum ASD refers to the hole in the inferior and posterior portions of the atrial septum adjacent to the AV valves. It is also associated with a cleft in the mitr al valve which may result in a valve leak, known as mitral regurgitation. These defects require surgical repair which consists of patch closure of the ASD and r epair of the mitral valve cleft. Greater surgical expertise is required to repai r this defect because of the proximity to the electrical system of the heart and the mitral valve abnormality. Sinus venosus ASD: The sinus venosus ASD is located in the superior and posterior portion of the at rial septum. As a result, it can be more difficult to visualize with routine ech ocardiography. The defect is associated with abnormal drainage of one or more ri ght sided pulmonary veins. Surgical repair involves patch closure of the ASD and redirection of the abnormal pulmonary vein back to the left atrium. Related defects: There are other less common forms of congenital heart disease that can cause sim ilar symptoms and include partial anomalous pulmonary venous return and coronary sinus ASD. In both of these abnormalities, the clinical manifestations are rela ted to the degree of excess blood flow into the right heart. Surgical repair is recommended when there are signs and symptoms of a significant increase of blood flow into the right heart Outcome: ASD closure eliminates the excess blood flow which produced enlargement of the r ight side of the heart. Pulmonary artery pressure may or may not be elevated in an adult with unrepaired ASD. Patients with mild or moderate degrees of pulmonar y hypertension often experience improvement in pulmonary artery pressure followi ng ASD closure. If pulmonary hypertension is severe, then ASD closure may not be advisable. Careful evaluation of patients with pulmonary hypertension should be

performed to determine optimal management. ASD closure also eliminates the potential for paradoxical embolization, a situat ion in which a blood clot can enter the systemic circulation from the right side of the heart and produce a stroke or damage to other organ systems. While exerc ise capacity is improved in many patients after ASD closure, arrhythmias, if pre sent, may persist when surgery is carried out in older patients.