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Atrial Septal Defect in Children

Medically reviewed by Last updated on May 1, 2023.

What is an atrial septal defect (ASD)?

An ASD is a hole in the septum (wall) between the upper chambers (atria) of your child's heart. The hole may be small or large. An ASD causes a problem with the way blood moves through your child's heart. This makes his or her heart work harder to pump blood. An ASD can also lead to a stroke if a blood clot is pumped out to a blood vessel in your child's brain.

Atrial Septal Defect

What causes an ASD?

The cause of an ASD is not known. An ASD happens during your child's development before birth. Any of the following can increase your child's risk for an ASD:

  • A family history of ASD
  • Being born early
  • Mother's age during pregnancy was 35 years or older, or she had rubella early in her pregnancy
  • Mother's use of alcohol or cigarettes during pregnancy
  • Having another heart defect
  • A high blood glucose (sugar) level

What are the signs and symptoms of an ASD?

Your child may not have any symptoms, even if the ASD is large. Instead, your child may start having symptoms when he or she gets older. He or she may have any of the following:

  • Feeling his or her heartbeat skip or flutter in his or her chest
  • Colds or lung infections that happen often
  • Chest pain
  • Lips and fingernails that turn blue with long periods of crying
  • Shortness of breath that is worse during activity
  • Slow growth or problems gaining weight
  • Tiring easily, especially while feeding or eating

How is an ASD diagnosed?

Your child's healthcare provider will listen to his or her heartbeat and check for a murmur. A murmur is an abnormal heart sound. Your child may need any of the following:

  • An EKG test records your child's heart rhythm and how fast his or her heart beats. It is used to check for abnormal heartbeats and other heart problems.
  • X-ray, CT, or MRI pictures will show the size and location of your child's ASD. It may also show problems in his or her heart or lungs, such as enlarged heart. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if he or she has any metal in or on his or her body.
  • An echocardiogram is a type of ultrasound. Sound waves are used to show the size of the ASD and how blood flows through your child's heart. It can also show how well his or her heart is pumping. Your child may need a transthoracic or transesophageal echocardiogram. Ask his or her healthcare provider about these types of echocardiogram.
  • A cardiac catheterization is a test used to show how well your child's heart is working or to measure pressure. A tube is guided into his or her heart through a blood vessel in his or her leg or arm. He or she may be given contrast liquid to help his or her heart show up better in pictures. Tell his or her healthcare provider if he or she has ever had an allergic reaction to contrast liquid.

How is an ASD treated?

Your child may not need treatment if the ASD is small and he or she does not have any symptoms. A small ASD may close on its own within the first year of life. Your child may need any of the following:

  • Medicine may be given to strengthen your child's heart or control his or her heartbeat. Medicine may also be given to lower pressure in your child's lungs, prevent blood clots, or remove extra fluid.
  • Open heart surgery may be needed to close the ASD with stitches or a patch.
  • Cardiac catheterization is a procedure that is used to close the ASD through a catheter (thin tube). The catheter is placed into an artery in your child's groin and guided up to his or her heart. A small stitch or patch is used to close the hole.

What can I do to care for my child?

  • Do not smoke near your child. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Ask your healthcare provider for information if you or your older child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you or your older child use these products.
  • Feed your child heart-healthy foods. Feed your child more fresh fruits and vegetables. Feed him fewer canned and processed foods. Replace butter and margarine with heart-healthy oils such as olive oil and canola oil. Other heart-healthy foods include walnuts, whole-grain breads, low-fat dairy products, beans, and lean meats. Fatty fish such as salmon and tuna are also heart healthy.
  • Ask your child's healthcare provider if you need to limit his or her activity. Your child may need to avoid strenuous activities to decrease his or her symptoms. Examples include running, lifting, and swimming. Your child may also need to avoid scuba diving or hiking in high altitudes. These activities may put too much stress on his or her heart.
  • Ask about vaccines your child needs. Vaccines help decrease your child's risk for infections. Infections can make your child's condition worse. The influenza (flu) vaccine is given yearly, starting at age 6 months. Your child's healthcare provider will tell you which vaccines your child needs and when to get them.
    Recommended Immunization Schedule 2022

Call your local emergency number (911 in the US) for any of the following:

  • Your child has severe chest pain.
  • Your child has trouble breathing or sudden shortness of breath.
  • Your child coughs up blood.
  • Your child loses consciousness or stops breathing.
  • Your child has any of the following signs of a stroke:
    • Part of his or her face droops or is numb
    • Weakness in an arm or leg
    • Confusion or difficulty speaking
    • Dizziness, a severe headache, or vision loss

When should I seek immediate care?

  • Your child is more short of breath than usual.
  • Your child's heart is beating faster than usual.
  • Your child has swelling in his or her legs or ankles.
  • Your child has severe abdominal pain or his or her abdomen is larger than usual.

When should I call my child's cardiologist?

  • Your child has a fever.
  • Your child has chills, a cough, or feels weak and achy.
  • Your child is not gaining weight as he or she should.
  • You have questions or concerns about your child's condition or care.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

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