Atrial Septal Defect

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.

Causes and symptoms
Abnormal openings in the atrial septum occur during fetal development and are twice as common in females as in males. These abnormalities can go unnoticed if the opening is small, producing no abnormal symptoms. If the defect is big, large amounts of blood flowing from the left to the right atrium will cause the right atrium to swell to hold the extra blood. People born with an atrial septal defect can have no symptoms through their twenties, but by age 40, most people with this condition have symptoms that can include shortness of breath, rapid abnormal beating of the atria (atrial fibrillation), and eventually heart failure.

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.

As a result. through the opening in the septum.   . a chromosome abnormality. passes into the left ventricle. What causes an atrial septal defect? The heart is forming during the first eight weeks of fetal development. with no clear reason for their development. then partitions within the tube develop that eventually become the septa (or walls) dividing the right side of the heart from the left. affecting 80 percent of people with atrial septal defects. For unknown reasons. normal Click Image to Enlarge An atrial septal defect is an opening in the atrial septum. As the fetus is growing. oxygen-poor (blue) blood returns to the right atrium from the body. girls have atrial septal defects twice as often as boys. What are the types of atrial septal defects? There are four types of atrial septal defects:  ostium secundum atrial septal defect This is the most common atrial septal defect.Atrial Septal Defect (ASD) What is an atrial septal defect? Anatomy of the heart. and then is pumped out to the body through the aorta. This causes an opening to develop in the center of the wall separating the two atria. something occurs to affect heart development during the first eight weeks of pregnancy. travels to the right ventricle. resulting in an ASD. Atrial septal defects occur when the partitioning process does not occur completely. It is caused when a part of the atrial septum fails to close completely while the heart is developing. It begins as a hollow tube. and then mix with oxygen-poor (blue) blood in the right atrium. ASD is a congenital (present at birth) heart defect. either occurring due to a defect in a gene. Most atrial septal defects occur sporadically (by chance). ostium primum atrial septal defect This defect is part of the atrioventricular canal defects. in the area where the pulmonary veins enter the heart. 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. 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. or dividing wall between the two upper chambers of the heart known as the right and left atria. Oxygen-rich (red) blood returns to the left atrium from the lungs. causing heart problems to occur more often in certain families. sinus venosus atrial septal defect This defect occurs at the superior vena cava and right atrium junction. leaving an opening in the atrial septum. An atrial septal defect allows oxygen-rich (red) blood to pass from the left atrium. and is associated with a split (cleft) in one of the leaflets of the mitral valve. then is pumped into the lungs where it receives oxygen. or environmental exposure. Some congenital heart defects may have a genetic link. Normally.

the extra blood flow eventually raises the blood pressure in the lungs. clinical condition. as well as heart problems that may develop later in childhood. and detects heart muscle stress. and institutional preferences. causing them to be diseased. shows abnormal rhythms (arrhythmias or dysrhythmias). and symptoms may be noted. and make other observations that help in the diagnosis. usually after several decades. It is the rarest of all atrial septal defects. and referred your child to a pediatric cardiologist for a diagnosis. and guided to the inside of the heart.. as well as the pulmonary artery and aorta. The location within the chest that the murmur is heard best. as well as the loudness and quality of the murmur (harsh. a small. Diagnostic testing for congenital heart disease varies by the child's age. Under sedation. Always consult your child's physician for a diagnosis. In some patients. With an ASD. Why is an atrial septal defect a concern? This heart defect can over time cause lung problems if not repaired. blowing. and organs onto film. flexible tube (catheter) is inserted into a blood vessel in the groin. A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects.a cardiac catheterization is an invasive procedure that gives very detailed information about the structures inside the heart. cardiac catheterization . The following are the most common symptoms of atrial septal defect.) will give the cardiologist an initial idea of which heart problem your child may have. echocardiogram (echo) . This then hardens the blood vessels in the lungs. Blood pressure and oxygen measurements are taken in the four chambers of the heart. as well as how much blood is passing through it. 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 test that records the electrical activity of the heart. The lungs are able to cope with this blood flow for a long period of time. the heart may be enlarged because the right atrium and ventricle have to handle larger amounts of blood flow than normal. and lungs will become overworked. A large opening allows more blood to pass through and mix with the normal blood flow in the right heart. listening to the heart and lungs. etc. This extra blood passes through the pulmonary artery into the lungs. However. An echo can show the pattern of blood flow through the atrial septal opening. and determine how large the opening is. causing higher amounts of blood flow than normal in the vessels in the lungs. overall health. right ventricle. Symptoms may include: 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. which is the structure in the right atrium where all the heart's own veins drain into the right atrium. Although an echocardiogram often provides enough diagnostic information. the right atrium. if the ASD is large.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.        How is an atrial septal defect diagnosed? Your child's physician may have heard a heart murmur during a physical examination. When blood passes through the ASD from the left atrium to the right atrium. resulting in irreversible changes in the lungs. bones. or therapies expectations for the course of the disease your opinion or preference . Contrast dye is also injected to more clearly visualize the structures inside the heart. permitting a large amount of blood to pass through to the right side of the heart. What are the symptoms of an atrial septal defect? Many children have no symptoms and seem healthy. device closure of the ASD can be performed at the time of the catheterization.    Treatment for atrial septal defect: Specific treatment for ASD will be determined by your child's physician based on:      your child's age. However. procedures. coronary sinus atrial septal defect This defect is located within the coronary sinus. Some tests that may be recommended include the following:  chest X-ray . and medical history extent of the disease your child's tolerance for specific medications.a diagnostic test which uses invisible X-ray beams to produce images of internal tissues. electrocardiogram (ECG or EKG) . A heart murmur is simply a noise caused by the turbulence of blood flowing through the opening from the left side of the heart to the right. a larger volume of blood than normal must be handled by the right side of the heart. Also. The cardiologist will perform a physical examination. there may be changes that take place in the lungs due to extra blood flow that can be seen on an X-ray. each child may experience symptoms differently. thin.

nasogastric (NG) tube . Once an atrial septal defect is diagnosed. since the right side is under strain from the extra blood passing through the ASD. and also on your child's reaction to the medication. Medications that may be prescribed include the following: o o  digoxin . As time goes by.a specialized IV placed in the wrist. called a septal occluder.a small. You will receive written instructions regarding care of the catheterization site. after an ASD repair. therefore. Individuals who have their atrial septal defects repaired in childhood can prevent problems later in life. providing he/she does not need further treatment or monitoring. into the open ASD. the child is sedated and a small. 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. enabling it to pump more efficiently. diuretics . Treatment may include:  medical management Many children have no symptoms.the body's water balance can be affected when the heart is not working as well as it could. the body may start to hold onto fluid. or overnight. and from medications given to relax him/her and to help with pain. your child will become more alert. These medications help the kidneys remove excess fluid from the body. A small.Secundum atrial septal defects may close spontaneously as a child grows. causing swelling and puffiness. During the cardiac catheterization procedure. If blood vessels in the leg were used. and require no medications. However. Many children have the ventilator tube removed right after surgery. and may include the following: o ventilator .a machine that helps your child breathe while he/she is under anesthesia during the operation.  surgical repair In most cases. The surgical repair is performed under general anesthesia. but some other children will benefit from remaining on the ventilator for a few hours afterwards so they can rest. o o o o . plastic tube is guided into the windpipe and attached to the ventilator. surgical repair Your child's ASD may be repaired surgically in the operating room. special equipment will be used to help him/her recover. The defect may be closed with stitches or a special patch. that measures blood pressure continuously during surgery and while your child is in the ICU. Usually. 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. 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. flexible tube (catheter) is inserted into a blood vessel in the groin and guided to the inside of the heart. After surgery. your child's nurse will monitor the pulses and skin temperature in the leg or arm that was used for the procedure.   Post-procedure care for your child:  device closure procedure When the procedure is complete. an ASD will be repaired if it has not closed on its own by the time your child starts school . arterial line . the catheter(s) will be withdrawn. 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. and any new medications your child may need to take at home. bathing. which helps determine how well the heart is functioning. After the procedure.a medication that helps strengthen the heart muscle. some children may need to take medications to help the heart work better. intravenous (IV) catheters . preventing blood from flowing through it.to prevent lung problems that will develop from long-time exposure to extra blood flow. Diuretics may be given to help the kidneys remove excess fluids from the body. the heart will be a little weaker than it was before. which breathes for your child while he/she is too sleepy to breathe effectively on his/her own. your child will most likely be drowsy from the anesthesia that was used during the operation. urinary catheter . and. In some cases. children will spend time in the intensive care unit (ICU) for several hours. activity restrictions. thin. or other area of the body where a pulse can be felt. 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's cardiologist will evaluate your child periodically to see whether it is closing on its own. Several gauze pads and a large piece of medical tape will be placed on the site where the catheter was inserted to prevent bleeding.small. Your child may be able to go home after a specified period of time. depending on the size of the defect and the weight of the child. Once the catheter is in the heart. During the first several hours after surgery.a small. flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery. flat weight or sandbag may be used to help keep pressure on the catheterization site and decrease the chance of bleeding. flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes. the cardiologist will pass a special device. While your child is in the ICU. plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medications that help your child recover from the operation. device closure Device closure is frequently performed for secundum ASD. a small. The decision to close the ASD may also depend on the size of the defect.

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. There is a risk of developing pulmonary hypertension (high blood pressure in the blood vessels of the lungs) or Eisenmenger's syndrome. directors. your child should be fully recovered and able to participate in normal activity. You agree to be solely responsible for your use of this Web page and the information contained on this page. The staff may also ask for your input as to how best to soothe and comfort your child. may be recommended to keep your child comfortable at home. Your child's cardiologist may recommend that your child take antibiotics to prevent bacterial endocarditis for a specific time period after discharge from the hospital. Topic Home Page | Return to Full List of Topics The information on this Web page is provided for educational purposes.a drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. and follow-up appointments before your child is discharged. or even a few days after surgery. Your child's physician will discuss pain control before your child is discharged from the hospital. Bleeding may occur for several hours. but usually will be allowed to play with supervision. Consult your child's physician regarding the specific outlook for your child. employees. When an ASD is diagnosed later in life. such as acetaminophen or ibuprofen. Care for your child at home following ASD repair: Most children feel fairly comfortable when they go home. as well as how early in life the ASD was diagnosed and whether or not it was repaired. heart monitor . You understand and agree that this information is not intended to be. With early diagnosis and repair of an ASD. the outcome is generally excellent. or afterwards. not mentioned here. Your child may become tired quicker than before the repair. the outlook may be worse than normal. Lucile Salter Packard Children's Hospital. The staff will provide instructions regarding medications. You will learn how to care for your child at home before your child is discharged. and monitors heart rate. some of which relieve pain and some of which relieve anxiety. Within a few weeks. a substitute for medical treatment by a health care professional. your child will recuperate on another hospital unit for a few days before going home.o o chest tube . and minimal follow-up is necessary. and other values. 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. Your child will be kept as comfortable as possible with several different medications. Pain medications. The hospital staff will explain all of the necessary equipment to you. arterial blood pressure. and have a fair tolerance for activity. to provide support while in the ICU. activity limitations. while avoiding blows to the chest that might cause injury to the incision or breastbone. or the ASD is never repaired. . Outcomes also depend on the type of ASD. Your child may need other equipment. Long-term outlook after ASD repair: The majority of children who have had an atrial septal defect repair will live healthy lives. and should not be used as. Your child may need to take medications for a while and these will be explained to you. its officers. agents. if complications occur after surgical closure. These individuals should receive follow-up care at a center that specializes in congenital heart disease.a machine that constantly displays a picture of your child's heart rhythm. After discharge from the ICU.

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