Atrial septal defect (ASD) is an unusual hole in the wall between the two upper chambers of the heart, known as the right and left atria. When this hole occurs, much blood flows from the left atrium to the right atrium and from the right side of the heart. This surplus blood flows through the right ventricle, pulmonary artery and into the lungs causing the heart work harder. The extra blood flowing to the lungs makes a noise called a murmur.
Small holes may close by itself by the time a child is 2 years old. In some cases, the defect doesn't cause symptoms until middle age.
Most babies that are born with atrial septal defects (ASDs) have no signs or symptoms. When signs and symptoms do appear, heart murmur is the very common one. A heart murmur is an extra or abnormal sound heard during a heartbeat.
Usually, a heart murmur is the only sign of an ASD. However, not all murmurs are symptoms of congenital heart defects. Many healthy children experience heart murmurs. Doctors can listen to heart murmurs and tell if they're harmless or signs of heart issues.
Over time, if a large ASD isn't treated, the extra blood flow to the right side of the heart can damage the heart and lungs and lead to heart failure. This doesn't happen until adulthood.
• Fatigue (tiredness)
• Easily getting tired during physical activity
• Shortness of breath
• A collection of blood and fluid in the lungs
• A collection of fluid in the feet, ankles, and legs
Regular checkups are performed to see if an Atrial Septal Defect (ASD) closes on its own. About half of all ASDs close on their own with time, and about 20 percent close within the first year of life.
Your child's doctor will tell you how often your child should have checkups. For an ASD, frequent checkups aren't required.
When treatment of an ASD is required, it involves catheter or surgical processes to close the hole. Doctors usually decide to close an ASD in children who still have medium to large holes by the time they're 2 to 5 years old.
Until the early 1990s, surgery was the normal method for closing all ASDs. Now, thanks to medical advances, doctors can now use catheter technique to close secundum ASDs, the most common type of ASD. For this measure, your child is given medicine so he or she will sleep through it and not feel any pain.
In the course of the procedure, the doctor inserts a catheter (a thin, flexible tube) into a vein in the groin (upper thigh) and threads it to the heart's septum. The catheter has a tiny umbrella-like device folded up within it.
When the catheter gets to the septum, the device is pushed out of the catheter and placed so that it plugs the hole between the atria. The device is secured in place and the catheter is removed from the body.
Within 6 months, normal tissue grows in and about the device. There will be no need to replace the closure device as the child grows.
Doctors normally make use of echocardiography (echo) or transesophageal echo (TEE) as well as angiography to direct them in threading the catheter to the heart and closing the defect. TEE is a unique type of echo that takes pictures of the heart through the esophagus (the passage leading from the mouth to the stomach).
Catheter procedures are very easy on patients than surgery because they involve just one needle puncture in the skin where the catheter is inserted. This implies that recovery is faster and easier.
The outlook for children having this procedure is great. Closures are successful in more than 9 out of 10 patients, with no considerable leakage. Rarely, a defect is too big for catheter closure and surgery is needed.
Open-heart surgery generally is performed to repair primum or sinus venosus ASDs. Your child is been administered some medicine so that he or she will sleep through out the surgery and not feel any pain.
At the course of the surgery, the cardiac surgeon makes an incision (cut) in the chest to reach the ASD. He or she then repairs the defect with a particular patch that covers the hole. Your child is placed on a heart-lung bypass machine in order to open heart for the surgery.
The outlook for children after ASD procedure is excellent. Typically, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, from ASD surgery are very uncommon.
Some children may notice inflammation of the outer lining of the heart, a condition called pericarditis (PER-i-kar-DI-tis). This leads to fluid collection around the heart in the weeks after surgery. This complication of heart surgery normally resolves with medicine.
While in the hospital, your child will be given medicines as required to reduce pain or anxiety. The doctors and nurses at the hospital will show you how to care for your child at home.
They will discuss about preventing blows to the chest as the incision heals, reducing activity while your child recovers, bathing, scheduling followup medical appointments, and deciding when your child can return to his or her normal activities.
The outlook for children who have atrial septal defects (ASDs) is excellent. Advances in treatment let most children who have these heart defects to live normal, active, and productive lives with no decrease in lifespan.
Most children who have these defects need no special care or only periodically checkups with a cardiologist (a heart specialist) as they go through life.
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