What is an Atrial Septal Defect (ASD)?

An atrial septal defect is a congenital abnormality or a “birth defect” where the wall or septum separating the right and left sides of the heart is not fully formed. This creates a “hole” that connects these two sides of the heart and allows oxygen-rich blood from the lungs to mix with oxygen-poor blood from the veins. This can potentially lead to different issues, such as low oxygen levels in the body, high pressures in the lungs, congestive heart failure, and a blood clot causing strokes.

Signs and Symptoms

People with an atrial septal defect usually do not have any symptoms for many years and may not be diagnosed at birth. Regular check-ups are important to screen for potential symptoms including:

• Breathlessness
• Leg swelling
• Stroke or TIA symptoms, such focal weakness or slurring speech
• Low oxygen levels

Diagnosis

Timely intervention is important for patients with atrial septal defect who have developed symptoms or who have a large defect and are at risk for future problems. To diagnose an atrial septal defect, we ask questions about your medical history and do a physical exam. We then use advanced technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray video is taken to show how the heart functions and to look for heart blockages.

Chest X-ray: A common imaging test of your heart and aorta.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves. 

Transesophageal Echocardiogram: A small transducer attached to the end of a tube inserted down the esophagus allows a closer look at intra-atrial septum than a regular echocardiogram does.

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Causes

Atrial septal defect is the failure of a normal structure to develop properly and a connection remains between the right and left sides of the heart.

Prevention

While there are no preventative measures for an atrial septal defect, there are ways you can help manage your atrial septal defect:

Practice good heart health: Watch what you eat, exercise and avoid smoking.

Take your medications as prescribed: If you have high blood pressure or high cholesterol, be certain to take your prescribed medications as directed.

Prevent infections: See your doctor when you have a sore throat. Sore throats can mean strep and strep can develop into rheumatic fever, which weakens your aortic valve. Similarly, take good care of your teeth and gums. Infected gums can lead to heart infection.

Prognosis

Prognosis is usually good when an atrial septal defect is treated.

Treatment and Recovery

Atrial septal defect treatment depends upon the anatomy of the intra-atrial septum and size of the defect. Sometimes medication is prescribed to help manage your symptoms. Regular follow-up with your physician is an important part of your care.

Minimally Invasive Procedures

Minimally invasive techniques and procedures can be used to close an atrial septal defect when deemed appropriate. Atrial septal defect closure is procedure done in the cath lab using fluoroscopy and intracardiac echocardiography to help guide the procedure. A catheter is inserted into the leg vein to then used to cross the ASD. Through this catheter, a closure device is deployed to cover the defect and block blood flow.  Two device types are the GORE Cardioform Septal Occluder and the St. Jude Amplatzer ASD Occluder devices.

Surgery

Sometimes, due to the size of the defect or anatomy of the septum, closure must be done through traditional open surgery. During open surgery, the atrial septal defect is fixed by placing a patch over the hole.

Recovery After Surgery

Recovery depends upon how your body heals and the type of surgery. After open surgery, you will be in the hospital for up to 10 days and it may be three to six months before you feel able to fully resume normal activities. After minimally invasive atrial septal defect closure, you will be in the hospital for a day and it may be a week before full recovery.

Complications

If an atrial septal defect is left untreated, there can be a risk of developing worsening heart failure, worsening oxygenation, pulmonary hypertension, or recurrent stroke if not addressed by other methods such as anticoagulation.