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Atrial septal defect (ASD) is a form of congenital heart defect that enables blood flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria. Without this septum, or if there is a defect in this septum, it is possible for blood to travel from the left side of the heart to the right side of the heart, or vice versa. Irrespective of interatrial communication bi-directions, this results in the mixing of arterial and venous blood. The mixing of arterial and venous blood may or may not be hemodynamically significant, if even clinically significant. This mixture of blood may or may not result in what is known as a "shunt". The amount of shunting present, if any, dictates hemodynamic significance. A "right-to-left-shunt" typically poses the more dangerous scenario.
Atrial Septal Defect Closure
Pediatric cardiologists at the University of Maryland Hospital for Children/University of Maryland Heart Center are now offering a minimally invasive treatment for atrial septal defects (ASD), a congenital heart defect. Until recently, children with atrial septal defects would often require open-heart surgery to repair a hole in their heart.
Now, pediatric cardiologists are avoiding surgery by using a new mesh device, delivered through a catheter, to treat this common congenital heart defect. This state-of-the-art technology closes the hole in the upper chambers of the heart.
What is ASD?
Atrial septal defect, or ASD, is an abnormal hole in the wall of the upper chambers of the heart where the wall between the right and left atria does not close completely. The size of the hole and its exact location vary from patient to patient.
An ASD can increase the amount of blood that flows to the lungs. During childhood, there may be no symptoms, but over time the condition can lead to pulmonary hypertension or congestive heart failure.
An ASD can close by itself, but more often than not needs repairing. It is typically repaired in children between 3 and 5 years of age, but infants and older children may also undergo the treatment when necessary.
Causes
In fetal circulation, there is normally an opening between the two atria (the upper chambers of the heart) to allow blood to bypass the lungs. This opening usually closes around the time the baby is born.
If the ASD is persistent, blood continues to flow from the left to the right atria. This is called a shunt. If too much blood moves to the right side of the heart, pressures in the lungs build up. The shunt can be reversed so that blood flows from right to left. Many problems can occur if the shunt is large, but small atrial septal defects often cause very few problems and may be found much later in life.
ASD is not very common. When the person has no other congenital defect, symptoms may be absent, particularly in children. Symptoms may begin any time after birth through childhood.
Individuals with ASD are at an increased risk for developing a number of complications including : -
Atrial fibrillation (in adults)
Heart failure
Pulmonary overcirculation
Pulmonary hypertension
Stroke
Symptoms
Small to moderate sized defects may produce no symptoms, or not until middle age or later.
Symptoms that may occur can include : -
Difficulty breathing (dyspnea)
Frequent respiratory infections in children
Sensation of feeling the heart beat (palpitations) in adults
Shortness of breath with activity
Exams and Tests
The doctor may hear abnormal heart sounds when listening to the chest with a stethoscope. A murmur may be heard only in certain body positions, and sometimes a murmur may not be heard at all. The physical exam may also reveal signs of heart failure in some adults.
If the shunt is large, increased blood flow across the tricuspid valve may create an additional murmur when the heart relaxes between beats.
Tests that may done include : -
Cardiac catheterization
Chest x-ray
Coronary angiography (for patients over 35 years old)
Doppler study of the heart
ECG
Echocardiography
Heart MRI
Transesophageal echocardiography (TEE)
Treatment
ASD may not require treatment if there are few or no symptoms, or if the defect is small. Surgical closure of the defect is recommended if the defect is large, the heart is swollen, or symptoms occur.
A procedure has been developed to close the defect without surgery. The procedure involves placing an ASD closure device into the heart through tubes called catheters. The health care provider makes a tiny surgical cut in the groin, then inserts the catheters into a blood vessel and up into the heart. The closure device is then placed across the ASD and the defect is closed.
Not all patients with atrial septal defects can have this procedure.
Prophylactic (preventive) antibiotics should be given prior to dental procedures to reduce the risk of developing infective endocarditis immediately after surgery for the ASD, but they are not required later on.
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Atrial septal defect (ASD) is a form of congenital heart defect that enables blood flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria. Without this septum, or if there is a defect in this septum, it is possible for blood to travel from the left side of the heart to the right side of the heart, or vice versa. Irrespective of interatrial communication bi-directions, this results in the mixing of arterial and venous blood. The mixing of arterial and venous blood may or may not be hemodynamically significant, if even clinically significant. This mixture of blood may or may not result in what is known as a "shunt". The amount of shunting present, if any, dictates hemodynamic significance. A "right-to-left-shunt" typically poses the more dangerous scenario.
