Atrial Septal Defects

The heart has four chambers. The two upper chambers are called the atria. An ASD is a defect or hole in the wall between these chambers. The hole allows blood to flow abnormally between the chambers. ASD is a relatively common cause of congenital heart disease.

Symptoms of an ASD depend on how large the defect is and where it is located. People with small defects may have no symptoms. If there is a large defect, symptoms may appear during infancy or childhood, but often the manifestation is delayed until adolescence or adulthood.

Someone with an ASD may have the following signs or symptoms:

• delays in a child's development, including thinking and motor functions
• difficulty breathing and shortness of breath, often made worse by activity
• fatigue
• failure to thrive, which is a slow growth rate in infants
• heart murmurs that a healthcare provider can hear with a stethoscope

The exact cause of ASD is often unknown. The heart develops abnormally before the person is born. Some factors that increase the risk of ASD are:

• alcohol ingested by the mother during her pregnancy
• chromosomal abnormalities, such as Down syndrome or Turner''s syndrome
• an infection, such as rubella, within the womb
• medicines and drugs, such as retinoic acid, taken by the mother during pregnancy

An atrial septal defect is often not preventable. Pregnant women should avoid alcohol. A woman who may get pregnant should make sure all her vaccines are up to date, to lower her risk of contracting an infection that can be passed on to her unborn child.

Diagnosis of ASD begins with a medical history and physical exam. An ECG (heart tracing), may show certain abnormalities. A chest X-ray may show enlargement of the heart or certain blood vessels. Often, an echocardiogram, or ultrasound of the heart, is used to diagnose the defect. A special X-ray test called a cardiac catheterization is generally used to confirm the diagnosis.

The effects of an ASD depend on the size and location of the defect. Breathing problems and congestive heart failure can occur with serious unrepaired defects. An ASD may also cause arrhythmias and infections of the heart or lungs. The ASD may occur together with other congenital heart defects, such as ventricular septal defect. This combination is more serious than ASD alone.

An ASD is not contagious and poses no risk to others.

If the ASD is small, the person may not need treatment. Congestive heart failure and arrhythmias may be treated with medicines.

Large defects must usually be repaired using open heart surgery. This helps prevent further heart and lung problems. As open heart procedures go, ASD repair is simple, effective, and quite safe.

People with heart and lung problems from their defect may need medical treatment before they can have surgery.

Sometimes ASD's can be repaired using a device delivered on a catheter.

Surgery carries a risk of bleeding, infection, and allergic reaction to the anesthetic. Rarely, arrhythmias or death occur because of the surgery. Medicines used for congestive heart failure or arrhythmias may cause allergic reactions or salt imbalances.

In uncomplicated cases, people can usually return to normal activity after recovery. Some people may require further treatment if heart or lung damage was severe before surgery.

In some cases, the individual may need regular visits to the healthcare provider. Periodic ECGs and echocardiograms may be ordered. Any new or worsening symptoms should be reported to the healthcare provider.