Professional Documents
Culture Documents
Definition
An atrial septal defect is an abnormal opening in the wall separating the left and right upper chambers (atria) of the heart.
Description
During the normal development of the fetal heart, there is an opening in the wall (the septum) separating the left and right upper chambers of the heart. Normally, this opening closes before birth, but if it does not, the child is born with a hole between the left and right atria. This abnormal opening is called an atrial septal defect and causes blood from the left atrium to flow into the right atrium. Different types of atrial septal defects can occur, and they are classified according to where in the separating wall they are found. The most commonly found atrial septal defect occurs in the middle of the atrial septum and accounts for about 70% of all atrial septal defects. Abnormal openings can form in the upper and lower parts of the atrial septum as well.
Diagnosis
Atrial septal defects can be identified by various methods. Abnormal changes in the sound of the heart beats can be heard when a doctor listens to the heart with a stethoscope. In addition, a chest x ray, an electrocardiogram (ECG, an electrical printout of the heartbeats), and an echocardiogram (a test that uses sound waves to form a detailed image of the heart) can also be used to identify this condition. An atrial septal defect can also be diagnosed by using a test called cardiac catheterization. This test involves inserting a very thin tube (catheter) into the heart's chambers to measure the amount of oxygen present in the blood within the heart. If the heart has an opening between the atria, oxygen-rich blood from the left atrium enters the right atrium. Through cardiac catheterization, doctors can detect the higher-than-normal amount of oxygen in the heart's right atrium, right ventricle, and the large blood vessels that carry blood to the lungs, where the blood would normally subsequently get its oxygen.
Treatment
Atrial septal defects often correct themselves without medical treatments by the age of two. If this dose not happen, surgery is done by sewing the hole closed, or by sewing a patch of Dacron material or a piece of the sac that surrounds the heart (the pericardium), over the opening. Some patients can have the defect fixed by having an clam-shaped plug placed over the opening. This plug is a manmade device that is put in place through a catheter inserted into the heart.
Prognosis
Individuals with small defects can live a normal life, but larger defects require surgical correction. Less than 1% of people younger than 45 years of age die from corrective surgery. Five to ten percent of patients can die from the surgery if they are older than 40 and have other heart-related problems. When an atrial septal defect is corrected within the first 20 years of life, there is an excellent chance for the individual to live normally.
Key terms
Cardiac catheterization A test that involves having a tiny tube inserted into the heart through a blood vessel. Dacron A synthetic polyester fiber used to surgically repair damaged sections of heart muscle and blood vessel walls. Echocardiogram A test that uses sound waves to generate an image of the heart, its valves, and chambers.
Resources
Organizations American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
Click Image to Enlarge 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. Normally, oxygen-poor (blue) blood returns to the right atrium from the body, travels to the right ventricle, then is pumped into the lungs where it receives oxygen. Oxygen-rich (red) blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped out to the body through the aorta. An atrial septal defect allows oxygen-rich (red) blood to pass from the left atrium, through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right atrium. Illustration of the anatomy of a heart with an atrial septal defect
Click Image to Enlarge Atrial septal defects occur in 6 percent to 8 percent of all children born with congenital heart disease. For unknown reasons, girls have atrial septal defects twice as often as boys.
ostium secundum atrial septal defect This is the most common atrial septal defect, affecting 80 percent of people with atrial septal defects. 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 in the center of the wall separating the two atria. ostium primum atrial septal defect This defect is part of the atrioventricular canal defects, and is associated with a split (cleft) in one of the leaflets of the mitral valve. sinus venosus atrial septal defect This defect occurs at the superior vena cava and right atrium junction, in the area where the pulmonary veins enter the heart. As a result, the drainage of one or more of the pulmonary veins may be abnormal in that the pulmonary veins enter the right atrium rather than the left atrium.
coronary sinus atrial septal defect This defect is located within the coronary sinus, which is the structure in the right atrium where all the heart's own veins drain into the right atrium. It is the rarest of all atrial septal defects.
child tires easily when playing fatigue sweating rapid breathing shortness of breath poor growth frequent respiratory infections The symptoms of an atrial septal defect may resemble other medical conditions or heart problems. Always consult your child's physician for a diagnosis.
chest X-ray - a diagnostic test which uses invisible X-ray beams to produce images of internal tissues, bones, and organs onto film. With an ASD, the heart may be enlarged because the right atrium and ventricle have to handle larger amounts of blood flow than normal. Also, there may be changes that take place in the lungs due to extra blood flow that can be seen on an X-ray. electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress. echocardiogram (echo) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves. An echo can show the pattern of blood flow through the atrial septal opening, and determine how large the opening is, as well as how much blood is passing through it. cardiac catheterization - a cardiac catheterization is an invasive procedure that gives very detailed information about the structures inside the heart. Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin, and guided to the inside of the heart. Blood pressure and oxygen measurements are taken in the four chambers of the heart, as well as the pulmonary artery and aorta. Contrast dye is also injected to more clearly visualize the structures inside the heart. Although an echocardiogram often provides enough diagnostic information, device closure of the ASD can be performed at the time of the catheterization.
your child's age, overall health, and medical history extent of the disease your child's tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference
Secundum atrial septal defects may close spontaneously as a child grows. Once an atrial septal defect is diagnosed, your child's cardiologist will evaluate your child periodically to see whether it is closing on its own. Usually, an ASD will be repaired if it has not closed on its own by the time your child starts school - to prevent lung problems that will develop from long-time exposure to extra blood flow. The decision to close the ASD may also depend on the size of the defect. Individuals who have their atrial septal defects repaired in childhood can prevent problems later in life.
medical management Many children have no symptoms, and require no medications. However, some children 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:
o o
digoxin - a medication that helps strengthen the heart muscle, enabling it to pump more efficiently. 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.
infection control Children with certain heart defects are at risk for developing an infection of the inner surfaces of the heart known as bacterial endocarditis. It is important that you inform all medical personnel that your child has an ASD so they may determine if the antibiotics are necessary before a procedure. surgical repair Your child's ASD may be repaired surgically in the operating room. The surgical repair is performed under general anesthesia. The defect may be closed with stitches or a special patch. device closure Device closure is frequently performed for secundum ASD, depending on the size of the defect and the weight of the child. During the cardiac catheterization procedure, the child is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided to the inside of the heart. Once the catheter is in the heart, the cardiologist will pass a special device, called a septal occluder, into the open ASD, preventing blood from flowing through it.
device closure procedure When the procedure is complete, the catheter(s) will be withdrawn. Several gauze pads and a large piece of medical tape will be placed on the site where the catheter was inserted to prevent bleeding. In some cases, a small, flat weight or sandbag may be used to help keep pressure on the catheterization site and decrease the chance of bleeding. If blood vessels in the leg were used, your child will be told to keep the leg straight for a few hours after the procedure to minimize the chance of bleeding at the catheterization site. Your child will be taken to a unit in the hospital where he/she will be monitored by nursing staff for several hours after the test. The length of time it takes for your child to wake up after the procedure will depend on the type of medicine given to your child for relaxation prior to the test, and also on your child's reaction to the medication. After the procedure, your child's nurse will monitor the pulses and skin temperature in the leg or arm that was used for the procedure. Your child may be able to go home after a specified period of time, providing he/she does not need further treatment or monitoring. You will receive written instructions regarding care of the catheterization site, bathing, activity restrictions, and any new medications your child may need to take at home.
surgical repair In most cases, children will spend time in the intensive care unit (ICU) for several hours, or overnight, after an ASD repair. During the first several hours after surgery, your child will most likely be drowsy from the anesthesia that was used during the operation, and from medications given to relax him/her and to help with pain. As time goes by, your child will become more alert. While your child is in the ICU, special equipment will be used to help him/her recover, and may include the following:
ventilator - a machine that helps your child breathe while he/she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he/she is too sleepy to breathe effectively on his/her own. Many children have the ventilator tube removed right after surgery, but some other children will benefit from remaining on the ventilator for a few hours afterwards so they can rest. intravenous (IV) catheters - small, plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medications that help your child recover from the operation. arterial line - a specialized IV placed in the wrist, or other area of the body where a pulse can be felt, that measures blood pressure continuously during surgery and while your child is in the ICU. nasogastric (NG) tube - a small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery. urinary catheter - a small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. After surgery, the heart will be a little weaker than it was before, and, therefore, the body may start to hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys remove excess fluids from the body.
o o o o
o o
chest tube - a drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours, or even a few days after surgery. heart monitor - a machine that constantly displays a picture of your child's heart rhythm, and monitors heart rate, arterial blood pressure, and other values.
Your child may need other equipment, not mentioned here, to provide support while in the ICU, or afterwards. The hospital staff will explain all of the necessary equipment to you. Your child will be kept as comfortable as possible with several different medications; some of which relieve pain and some of which relieve anxiety. The staff may also ask for your input as to how best to soothe and comfort your child. After discharge from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while and these will be explained to you. The staff will provide instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged.
Topic Home Page | Return to Full List of Topics The information on this Web page is provided for educational purposes. You understand and agree that this information is not intended to be, and should not be used as, a substitute for medical treatment by a health care professional. You agree that Lucile Salter Packard Children's Hospital is not making a diagnosis of your condition or a recommendation about the course of treatment for your particular circumstances through the use of this Web page. You agree to be solely responsible for your use of this Web page and the information contained on this page. Lucile Salter Packard Children's Hospital, its officers, directors, employees, agents, and information providers shall not be liable for any damages you may suffer or cause through your use of this page even if advised of the possibility of such damages.