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Atrial septal defect

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Atrial septal defect is a hole located in the wall between the two upper chambers called atria of the heart.

Atrial septal defect
Atrial septal defect

Pronunciation

It is pronounced EY-tree-uhl SEP-tuhl DEE-fekt

What is Atrial Septal Defect?

  • An atrial septal defect is a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart.
  • A hole can vary in size and may close on its own or may require surgery.
Atrial septal defect
Atrial septal defect

Embryology

As a baby’s heart develops during pregnancy, there are normally several openings in the wall dividing the upper chambers of the heart (atria). These usually close during pregnancy or shortly after birth.

  • If one of these openings does not close, a hole is left, and it is called an atrial septal defect.
  • The hole increases the amount of blood that flows through the lungs and over time, it may cause damage to the blood vessels in the lungs.
  • Damage to the blood vessels in the lungs may cause problems in adulthood, such as high blood pressure in the lungs and heart failure.
  • Other problems may include abnormal heartbeat, and increased risk of stroke.

Incidence in the United States

One in 1 in every 1,859 babies born in the United States each year are born with Atrial Septal Defect.

Causes and Risk Factors

  • The causes of heart defects such as atrial septal defect among most babies are unknown.
  • Some babies have heart defects because of changes in their genes or chromosomes.
  • These types of heart defects also are thought to be caused by a combination of genes and other risk factors, such as things the mother comes in contact with in the environment or what the mother eats or drinks or the medicines the mother uses.

Diagnosis

  • An atrial septal defect may be diagnosed during pregnancy or after the baby is born.
  • In many cases, it may not be diagnosed until adulthood.
During Pregnancy
  • During pregnancy, there are screening tests (prenatal tests) to check for birth defects and other conditions.
  • An atrial septal defect might be seen during an ultrasound (which creates pictures of the body), but it depends on the size of the hole and its location.
  • If an atrial septal defect is suspected, a specialist will need to confirm the diagnosis.
Ostium secundum
Ostium secundum
After the Baby is Born

An atrial septal defect is present at birth, but many babies do not have any signs or symptoms. Signs and symptoms of a large or untreated atrial septal defect may include the following:

  • Frequent respiratory or lung infections
  • Difficulty breathing
  • Tiring when feeding (infants)
  • Shortness of breath when being active or exercising
  • Skipped heartbeats or a sense of feeling the heartbeat
  • A heart murmur, or a whooshing sound that can be heard with a stethoscope
  • Swelling of legs, feet, or stomach area
  • Stroke
ASD repair with Pericardial patch
ASD repair with Pericardial patch

Tests

  • It is possible that an atrial septal defect might not be diagnosed until adulthood.
  • One of the most common ways an atrial septal defect is found is by detecting a murmur when listening to a person’s heart with a stethoscope.
  • The most common test is an echocardiogram  which is an ultrasound of the heart.

Treatments

Treatment for an atrial septal defect depends on the age of diagnosis, the number of or seriousness of symptoms, size of the hole, and presence of other conditions. Sometimes surgery is needed to repair the hole. Sometimes medications are prescribed to help treat symptoms. There are no known medications that can repair the hole. A health care provider may recommend the atrial septal defect be closed for a child with a large atrial septal defect, even if there are few symptoms, to prevent problems later in life. Closure may also be recommended for an adult who has many or severe symptoms. Closure of the hole may be done during cardiac catheterization or open-heart surgery.


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