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A hole in the heart between the upper chambers is known as an atrial septal defect (ASD). The hole boosts the flow of blood through the lungs. The condition exists from birth (congenital heart defect).
Small atrial septal defects may be discovered by chance and never create a problem. Others form attachments during infancy or early childhood.
Long-term atrial septal defects can harm the heart and lungs. To fix an atrial septal defect and avoid complications, surgery may be required.
WHAT ARE THE TYPES OF ASD?
Atrial septal defects are classified as follows:
- Secundum: This is the most prevalent kind of ASD. It happens at the middle of the wall between the upper and lower heart chambers (atrial septum).
- Primum: This ASD affects the lower half of the atrial septum and may be associated with other congenital heart abnormalities.
- Sinus venosus: This uncommon kind of ASD typically arises in the upper portion of the wall that separates the heart chambers. It's also linked to other cardiac structural alterations that occur during birth.
- Coronary sinus: Part of the wall between the coronary sinus, which is part of the heart's venous system, and the left upper heart chamber (left atrium) is absent in this unusual kind of ASD.
WHAT ARE THE SYMPTOMS OF ASD?
Many infants with atrial septal abnormalities are born with no indications or symptoms. Adults can develop signs or symptoms.
Among the signs and symptoms of an atrial septal defect are:
- Breathing difficulties, particularly when exercising
- Fatigue
- Leg, foot, or abdominal swelling (abdomen)
- Heartbeat irregularities (arrhythmias)
- A fast, pounding heartbeat (palpitations) or missed beats
- A whooshing sound heard through a stethoscope (heart murmur)
WHAT ARE THE CAUSES OF ASD?
The exact cause of atrial septal defect is unknown. A structural abnormality that occurs during heart development while a newborn is still in the womb is known as an atrial septal defect.
Genetics, specific medical disorders, medication use, and environmental or lifestyle factors such as smoking or alcohol abuse may all play a role.
How the heart works
The left and right atria, as well as the left and right ventricles
Understanding the etiology of atrial septal defect may help you understand how the heart normally works.
The average heart has four chambers: two upper chambers (atria) and two lower chambers (ventricles).
The right side of the heart is in charge of transporting blood to the lungs. Blood picks up oxygen in the lungs and returns it to the heart's left side. The blood is then pumped by the left side of the heart through the body's main artery (aorta) and out to the rest of the body.
A big atrial septal defect can overload the lungs and overwork the right side of the heart. If left untreated, the right side of the heart grows bigger and weaker. Blood pressure in the lungs' arteries can also rise, resulting in pulmonary hypertension.
WHAT ARE THE RISK FACTORS FOR ASD?
During pregnancy, the baby's heart develops an atrial septal defect (ASD). Certain health issues or medication usage during pregnancy may raise the likelihood of an atrial septal defect or other congenital heart abnormality in a baby. Among these are:
- Infection with German measles (rubella) during the first few months of pregnancy
- Diabetes
- Lupus
- Using alcohol or tobacco
- Cocaine and other illegal drugs
- Use of certain medications, including several anti-seizure medications and those used to treat mood disorders
Some congenital cardiac abnormalities run in families (inherited). If you or a family member has congenital heart disease, including ASD, genetic counseling can assist evaluate the risk of certain heart problems in future children.
WHAT ARE THE COMPLICATIONS OF ASD?
A little atrial septal defect may never cause concern. Small atrial septal abnormalities frequently close during childhood.
Larger atrial septal defects can result in significant consequences, such as:
- Heart failure on the right side
- Irregular heartbeats (arrhythmias)
- Stroke
- Early death
- High blood pressure in the arteries of the lungs (pulmonary hypertension)
Pulmonary hypertension can permanently harm the lungs. This condition, known as Eisenmenger syndrome, typically develops over time and is more common in persons with extensive atrial septal defects.
Many of these issues can be avoided or managed with treatment.
Pregnancy and atrial septal defect
If you have an atrial septal defect and are pregnant or want to become pregnant, you should consult your doctor and obtain proper prenatal care. Before conceiving, a health care practitioner may advise ASD repair. A big atrial septal defect or its sequelae can put a pregnancy at danger.
HOW IS ASD DIAGNOSED?
Some atrial septal abnormalities are detected before or shortly after birth. Smaller atrial septal abnormalities, on the other hand, may not be detected until later in life.
When a health care professional listens to the heart with a stethoscope and detects an atrial septal defect, he or she may hear a whooshing sound (heart murmur).
The following tests are used to help detect an atrial septal defect:
- Echocardiogram: This is the most common test for detecting an atrial septal defect. Sound waves are employed to produce images of the beating heart. An echocardiography can reveal how well blood flows through the heart and its valves.
- Chest X-ray: A chest X-ray reveals the health of the heart and lungs.
- Electrocardiogram (ECG or EKG): The electrical activity of the heart is recorded during this short and painless test. An ECG can aid in the detection of irregular heartbeats (arrhythmias).
- Cardiac magnetic resonance imaging (MRI) scan: This imaging technique creates comprehensive images of the heart using magnetic fields and radio waves. If echocardiography does not provide a conclusive diagnosis, a health care professional may order this sort of MRI.
- CT (computed tomography) scan: This procedure employs a succession of X-rays to produce detailed images of your heart. If echocardiography has not definitively confirmed an atrial septal defect, it can be used to diagnose it and similar congenital heart defects.
WHAT ARE THE TREATMENTS FOR ASD?
The size of the hole in the heart and if you or your kid has other congenital heart problems influence treatment for atrial septal defect.
During childhood, many atrial septal abnormalities close on their own. Some tiny atrial septal abnormalities may not require treatment if they do not close. A cardiologist (a doctor who specializes in heart disorders) may advise regular health examinations to see if it closes on its own.
When you or your kid requires treatment, your health care practitioner will discuss it with you. Many persistent atrial septal abnormalities necessitate surgery. However, if there is substantial pulmonary hypertension, closure is not advised.
Medications
Although medications cannot fix an atrial septal defect, they can help alleviate symptoms. Drugs to control the heartbeat (beta blockers) or to lower the danger of blood clots may be used to treat atrial septal defect (anticoagulants).
Surgery or other procedures
To avoid future difficulties, many cardiologists advocate surgery to fix a medium to large atrial septal defect discovered in childhood or maturity.
Atrial septal defect repair surgery for adults and children entails sealing the hole in the heart. This can be accomplished in two ways:
- Catheter-based repair: Using imaging techniques, a thin, flexible tube (catheter) is placed into a blood artery, generally in the groin, and guided to the heart. To close the hole, a mesh patch or plug is placed via the catheter. Heart tissue grows around the seal, sealing the hole permanently.
The catheter-based repair method is only utilized for secundum atrial septal abnormalities. However, some big secundum atrial septal abnormalities may necessitate open-heart surgery.
- Open-heart surgery: This type of atrial septal defect repair surgery includes making an incision through the chest wall to provide direct access to the heart. Patches are used by the surgeons to seal the hole. The only option to treat primum, sinus venosus, and coronary sinus atrial defects is by open-heart surgery.
Atrial septal defect correction can sometimes be performed utilizing small incisions (minimally invasive surgery) and a robot (robot-assisted heart surgery).
Anyone who has had atrial septal defect surgery should have regular echocardiograms and health checks to monitor for potential issues such as irregular heartbeats (arrhythmias), heart valve abnormalities, high blood pressure in the lung arteries (pulmonary hypertension), and heart failure.
People with big atrial septal defects who do not have surgery to seal the hole have poorer long-term outcomes. They may have more difficulty doing daily tasks (lower functional capacity) and are more susceptible to arrhythmias and pulmonary hypertension.
HOME REMEDIES FOR ASD
If you or your kid has an atrial septal defect, your doctor may suggest certain lifestyle changes to keep your heart healthy and prevent consequences.
- Exercise: Exercise is normally safe for those who have an atrial septal defect. However, if ASD surgery is required, a doctor may advise you to avoid certain activities until the heart defect is repaired. A cardiologist (a specialist who specializes in heart problems) can advise you on which activities are best for you or your child.
- Extreme altitude changes: If you have an unrepaired atrial septal defect, changes in altitude may be cause for concern. If you intend to scuba dive or trek at high elevations, consult your cardiologist first to ensure that the activities are safe.
- Dental care: If you recently had ASD repair surgery and require dental work, your doctor will most likely advise you to take prophylactic antibiotics for six months after the hole in your heart is healed.