The atrial septal defect belongs to the group of shunts. These are short circuits between the arterial and venous circulatory systems. The atrial septal defect accounts for around 10 percent of congenital heart defects.
Atrial septal defect (ASD) is a hole in the septum between the atria @ Dee-sign /AdobeStock
In general, the severity of the symptoms of an atrial septal defect depends on the size of the "hole". Smaller shunts can remain without symptoms for a lifetime. With most larger defects, symptoms appear between the ages of two and 20.
In half of the patients, cardiac arrhythmias occur, and later signs of heart failure may develop. Patients with atrial septal defects usually have a pale skin color and a peripheral lack of oxygen (cyanosis). Large defects lead to exertional dyspnoea (shortness of breath) and reduced performance even in infancy.
Recovery is better the earlier children or adults with heart symptoms consult a doctor and receive the correct diagnosis. If the atrial septal defect persists untreated, it can lead to severe right heart strain and heart failure. This limits the quality of life and life expectancy of those affected.
The doctor usually discovers the heart defect by listening (auscultation). Typical heart murmurs and a usually visible heartbeat are an indication of a right heart strain. Characteristic symptom complexes can also be seen in the medical history. If there are no symptoms, the findings are usually accidental.
Heart examination with stethoscope @ Klaus Eppele /AdobeStock
The doctor's imaging provides evidence of an atrial septal defect. An ultrasound examination or echocardiography can visualize the blood flows in the heart. In particular, those that run through the atrial septal defect and through the hole in the heart.
Doctors may also be able to see the enlarged right atrium of the heart in the X-ray image, which is caused by overloading of the pulmonary circulation.
The specialist decides whether an operation is necessary for each patient individually.
It is favorable for the course of the operation and also for recovery:
- The patient is still at an early stage of the disease
- There is no high blood pressure in the pulmonary circulation (pulmonary hypertension). A possible threshold value for complications is a blood pressure of 40 mmHg and above.
Surgical closure of an atrial septal defect before the age of 25 offers the best chance of a normal life expectancy. The complication rate is low. In older patients who are asymptomatic, doctors are controversial about surgical closure of the septum.
The operation can be performed in two ways:
- Doctors close the atrial septal defect using a piece of tissue from the pericardium or suture it directly. This method is used for larger defects or when patients complain of significant symptoms and limitations.
- The operation is significantly less invasive for smaller atrial septal defects. It can be performed using a catheter that doctors insert from the groin into the heart. At the end of the catheter is a small umbrella that doctors stretch over the hole to close it.
After surgical correction of an atrial septal defect, patients spend some time in the intensive care unit. This is where they are put on blood thinners and followed up.
Blood thinning with heparin or Marcumar is necessary to prevent dangerous blood clots. These can enter the pulmonary circulation and lead to a pulmonary embolism. The same can happen in the brain, whereby the arterial blockage in the brain caused by a blood clot triggers a stroke.
Specialists for atrial septal defects are experts in the field of cardiac surgery and cardiology and, if necessary, pediatrics (pediatrics).
You can find suitable centers and specialists on this page, among others.
