Atrial Septal Defect

Atrial septal defect is a defect in the interatrial

septum allowing pulmonary venous return from the left atrium to pass directly to the right atrium. Depending on the size of the defect and associated anomalies, this can result in a spectrum of disease from no significant cardiac sequelae to right-sided volume overload, pulmonary arterial hypertension, and even atrial arrhythmias

Ostium secundum

Ostium primum

Sinus venosus

 ASD may not need treatment if there are few or

no symptoms, or if the defect is small. Surgery to close the defect is recommended if the defect causes a large amount of shunting, the heart is swollen, or symptoms occur. The decision to repair any kind of atrial septal defect (ASD) is based on clinical and echocardiographic information, including the size and location of the ASD, the magnitude and hemodynamic impact of the left-to-right shunt, and the presence and degree of pulmonary arterial hypertension.

 In childhood, spontaneous closure of secundum

ASD may occur. However, in adulthood, spontaneous closure is unlikely. In infants, small ASDs (less than 5 mm) will often close on their own or cause no problems. Larger ASDs (8 to 10 mm) most often do not close and may need a procedure.

 Open heart surgery for larger ASDs

Cardiac catheterization for smaller ASDs : A

thin tube (catheter) is inserted into a blood vessel in the groin and guided to the heart. Through the catheter, a mesh patch or plug is put into place to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.

 ASD closure devices cannot be used:

If the ASD is too large to be adequately closed by a

catheter-based closure device If the particular patients heart structure will not allow an ASD closure device to be used (for example, if there is not enough atrial septal tissue left to secure the device) If the particular patients blood vessels are too narrow to allow the catheter-based delivery system to be used If the patient has blood clots in his/her heart If the patient needs surgery to fix other heart defects If the patient has a bleeding disorder, untreated ulcer, or is unable to take aspirin If the patient has an active infection anywhere in the body (the device can be implanted after the infection is completely gone)

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