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An Atrial Septal Defect (ASD) : - sometimes referred to as a hole in the heart is a type of congenital heart defect in which there is an abnormal opening in the dividing wall between the upper filling chambers of the heart (the atria). In most cases ASDs are diagnosed and treated successfully with few or no complications
To understand this defect, it first helps to review some basics about the way a healthy heart typically works.
The heart has four chambers: The two lower pumping chambers are called the ventricles, and the two upper filling chambers are the atria.
In a healthy heart, blood that returns from the body to the right-sided filling chamber (right atrium) is low in oxygen. This blood passes to the right-sided pumping chamber (right ventricle), and then to the lungs to receive oxygen. The blood that has been enriched with oxygen returns to the left atrium, and then to the left ventricle. It's then pumped out to the body through the aorta, a large blood vessel that carries the blood to the smaller blood vessels in the body. The right and left filling chambers are separated by a thin shared wall, called the atrial septum.
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
Signs and Symptoms
The size of an ASD and its location in the heart will determine what kinds of symptoms a child experiences. Most children who have ASDs seem healthy and appear to have no symptoms. Generally, kids with an ASD feel well and grow and gain weight normally.
Infants and children with larger, more severe ASDs, however, may possibly show some of the following signs or symptoms : -
poor appetite
poor growth
fatigue
shortness of breath
lung problems and infections, such as pneumonia
Tests
Tests that may be performed in the diagnosis of ASD include : -
Chest x-ray
Echocardiography (ultrasound of the heart)
Doppler study of the heart
Transesophageal echocardiography (TEE)
Cardiac catheterization
Coronary angiography (for patients over 35 years old)
MRI of chest
ECG - may show atrial fibrillation, right atrial enlargement, or a pattern of delayed electrical conduction in the heart.
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.
Complications
Pulmonary hypertension
Arrhythmias, particularly atrial fibrillation
Heart failure
Infective endocarditis
Prevention
There is no known way to prevent the defect, but some of the complications can be prevented with early detection.
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An Atrial Septal Defect (ASD) : - sometimes referred to as a hole in the heart is a type of congenital heart defect in which there is an abnormal opening in the dividing wall between the upper filling chambers of the heart (the atria). In most cases ASDs are diagnosed and treated successfully with few or no complications
