Atrial Septal Defect

What is an atrial septal defect?

An atrial (A-tree-ull) septal (SEP-tull) defect is a hole in a wall inside the heart. This is also called an ASD. ASD is a common heart defect that babies are born with.

Where is an ASD?

The heart has 4 chambers or rooms. The two upper chambers are called the right and left atria (A-tree-uh). The two lower chambers are the right and left ventricles (VEN-trik-ulls). With an ASD, there is a hole in the septum (wall) between the right and left atria. This hole may be small or large.

How does the heart normally work?

Veins bring blood from your body to your heart. The blood enters the right atrium first, then flows down into the right ventricle. This ventricle pumps the blood into the lungs where oxygen is added. The lungs also clean the blood by taking out waste, such as carbon dioxide. The blood then goes back to the heart into the left atrium and down into the left ventricle. The left ventricle pumps the blood out to the body where the oxygen can be used.

What happens if you have an atrial septal defect?

• With an ASD, blood does not flow through the heart in the normal way. All of the blood coming back into the left atrium from the lungs does not go into left ventricle as it should. Some of the blood flows through the ASD and into the right atrium. This blood, which has already been to the lungs to get oxygen, returns to the lungs. Because of this, your heart and lungs must work harder to pump more blood.
  
  
• As time passes, the pressure inside the lungs gets too high. When this happens, the blood starts to move through the hole in the other direction. Blood that has not yet received any oxygen from the lungs is sent out to the body. This makes your fingers, toes, and lips turn blue. The right side of the heart cannot keep working so hard and finally begins to fail.

Causes:

It is not known what causes an ASD. Women who have an illness called rubella (rew-BELL-uh) early in their pregnancy often have babies with ASD. A baby who is born too early has a greater risk of having an ASD. A family history of ASD may also increase the risk of having an ASD.

Signs and Symptoms:

The signs and symptoms caused by an ASD can be different for each person. Some people have no symptoms because their ASD is very small. Many people do not start having symptoms until they are teenagers or young adults. You may have one or more of the following signs and symptoms.

• Fatigue (tiredness).
  
  
• Frequent colds or lung infections.
  
  
• Heart murmur (extra sound) when caregivers listen to your heartbeat.
  
  
• Lips and fingernails turn blue with activity.
  
  
• Palpitations (heartbeat that is not regular).
  
  
• Shortness of breath during exercise or activities like climbing stairs.
  
  
• Shortness of breath when you lie down.
  
  
• Some children with ASD may grow slowly and have problems gaining weight.
  
  
• Stroke.

Tests:

Usually an ASD is found when a child is young. Sometimes the ASD is very small and is not noticed until the person has grown. The following tests may be done to learn if you have an ASD. Some of the test results may be normal if the ASD is small.

• Cardiac Catheterization (kath-uh-ter-ih-ZA-shun): This is a test used to see how well your heart is working. This test may be done to show how much oxygen is in the blood in the right atrium. With an ASD, there is more oxygen than normal in the blood in the right atrium. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen. Your caregiver may also measure the pressure inside your heart.
  
  
• Chest X-ray: This is a picture of your heart and lungs. X-rays can show if the right atrium and ventricle are larger than the left atrium and ventricle. They can also show if the pulmonary arteries are larger than they should be.
  
  
• Echocardiogram (eh-ko-KAR-d-o-gram): An echocardiogram is often called an "echo". Sound waves are used to show pictures of the size and shape of your heart on a TV-like screen. An echo can show caregivers the type and size of an ASD. The echo and color flow Doppler can tell how your heart moves when it is beating and how blood flows through the heart. It can tell if your heart is pumping well. An echo can find problems with the valves of your heart.
  
  
• 12 Lead EKG:
  
  
  • This test makes a recording of the electrical activity of the heart. An EKG can show if it takes too long for the right ventricle to contract (pump). This is normal for someone with an ASD. Sometimes, the EKG can show signs of other problems that may happen with ASD.
    
    
  • Sticky pads (10) are placed on your chest, arms, and legs. Each pad has a wire that is hooked to a machine. This machine prints a paper tracing of your heart working. This test is painless and takes about 5 to 10 minutes.

Treatment:

One or more of the following treatments may be used to treat your ASD.

• Medicines: You may need one or more of these medicines to treat or prevent problems of your ASD.
  
  
  • Antibiotic (an-ti-bi-AH-tik) medicine.
    
    
  • Blood pressure medicine.
    
    
  • Blood thinning medicine.
    
    
  • Diuretics (di-u-REH-tiks) or "water pills".
    
    
  • Heart medicine.
  
  
• Surgery: Your doctor's ASD repair plan may depend upon the type of ASD you have. It also may depend on where the ASD is in the heart wall. Even if you are having no symptoms, closing an ASD early in life may prevent heart problems in later life. If an ASD is repaired early enough in life, you may not need any more surgeries for the ASD.
  
  
  • Surgery to close the ASD with stitches (thread) is open heart surgery. Sometimes a man- made patch or piece of the heart is used to help close the ASD. If a person with ASD has no symptoms, the ASD may be repaired by age 4 or 5. If there are symptoms, the ASD may be repaired by age 1 or 2.
    
    
  
  
• Treatment Without Surgery: Sometimes a man-made umbrella-like patch or plug may be put in place to close the hole. This is done during cardiac catheterization so the person does not need surgery.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Atrial Septal Defect