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3.6 Minute

12-07-2024 Team Medicover Cardiology

Atrial Septal Defect (ASD): Symptoms, Causes and Treatment

ASD is a congenital heart defect in the wall that separates the two upper chambers (atrial septum) of the heart.

This wall is called the atrial septum. A small opening/hole between the two atria is present at birth and is usually is closed off afterwards.

The hole causes oxygen-rich blood leakage from the left side of the heart to the right side, which means excess blood flow from the right ventricle to the lungs due to extra work on the right side of the heart.

Atrial Septal Defect Definition:

An ASD is a heart condition that begins at birth with a hole in the septum, allowing blood to pass between the atria. Treatment depends on the size and symptoms, from monitoring to surgery.

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Symptoms of Atrial Septal Defect:

Difficulty breathing in childhood
Frequent respiratory infections in children
Irregular heartbeat in adults
Shortness of breath
Symptoms of ASD may resemble other medical problems or heart problems. So, it is important to consult the best pediatric cardiologist / cardiothoracic surgeon for further diagnosis.

Atrial Septal Defect Types

There are several types of Atrial Septal Defects based on their area and size. Types of ASD closure are classified based on the location. Here are the details:

Ostium Secundum Atrial Septal Defect

An ostium secundum ASD is a hole in the center of the atrial septum. Generally, the left side pumps oxygen-rich blood to the body, while the right side of the heart pumps oxygen-poor blood to the lungs.
An Ostium Secundum atrial septal defect (ASD) allows blood to mix from both sides, decreasing the heart's work efficiency.
A small size hole may be fine. A larger hole can cause a series of problems such as respiratory infections, shortness of breath, irregular heart rhythms, and fainting. It may lead to pulmonary artery hypertension or heart failure.

Patent Foramen Ovale

Patent means after birth and foramen ovale means a hole in the heart.
Naturally, a small hole is present in babies’ hearts who are still in the womb for fetal circulation and it will close soon after birth.
If it doesn’t close properly, that condition is called a patent foramen ovale. The majority of the patients with a PFO don’t have any particular signs or symptoms.
However, the condition may play a role in migraine headaches and it increases the risk of Transient ischemic attack, stroke and heart attack. It’s better to have regular checks with a pediatric cardiologist nearby.

Ostium Primum Atrial Septal Defect

Ostium primum atrial septal defect also known as endocardial cushion defect. an ostium primum atrial septal defect is a defect in the atrial septum at the level of the tricuspid and mitral valves.

Sinus Venosus Atrial Septal Defect

Sinus venous atrial septal defects are diagnosed upon the detection of a heart sound produced when the blood flow of the heart valves, a fixed split-second heart sound, and/or right heart enlargement on chest x-ray or electrocardiogram (ECG) in the usually asymptomatic patient.

Single Atrium ASD

It is a rare congenital heart disease in which there is a developmental absence of both the septum primum and secundum part of the atrial septum.

Atrial Septal Defect Causes:

Here are the causes of the atrial septal defect (ASD):

Genetic Factors : ASDs can sometimes run in families, suggesting a genetic predisposition.
Environmental Factors : Exposure to certain substances during pregnancy, such as alcohol or medications, may increase the risk of ASD development in the fetus.
Other Medical Conditions : Certain genetic syndromes, like Down syndrome, and infections during pregnancy, such as rubella (German measles), can be associated with an increased likelihood of ASDs.
Developmental Factors : During fetal development, the septum (the wall between the heart's upper chambers) may not form properly, leading to the presence of a hole.
Unknown Causes : In many cases, the exact reason why an ASD develops is not known, and it occurs spontaneously without identifiable genetic or environmental factors.

Diagnosis of Atrial Septal Defect:

Your pediatrician may suspect a heart defect or atrial septal defect while listening to a heart murmur using a stethoscope during a regular checkup. If a cardiologist / cardiothoracic surgeon suspects you or your child has a heart defect, the doctor may request one or more of the following tests:

Chest x-ray
2D Echocardiogram
Cardiac catheterization
Electrocardiogram (ECG)
CT Scan
MRI Scan

Atrial Septal Defect Treatments:

Most atrial septal defects close on their own during the growth of children. For that atrial septal defects (ASD) don’t close, some small ASD doesn’t cause any problems and do not require any surgery.
If the atrial septal defect (ASD) size MM is large then it requires surgery to be corrected.
In the olden days, ASD closure surgery required open-heart surgery and patients needed to stay three to five days in the hospital.
Nowadays cardiothoracic surgeons are doing a small insertion ASD Closure surgery also popularly known as minimal invasive ASD Closure surgery.
However, ASD closure surgery isn’t recommended if you have severe pulmonary hypertension because it might make the condition worse.
After diagnosis, most cardiologists/cardiothoracic surgeons will recommend repairing an atrial septal defect (ASD) during childhood to prevent further complications.
For adults or children, the cardiothoracic surgeon will evaluate the condition and determine which procedure is the most appropriate for the patient.

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Atrial Septal Defect Medical Procedure

Cardiac Catheterization

In this procedure, a cardiologist / cardiothoracic surgeon inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the heart using imaging techniques.
Through the cardiac catheter, the cardiothoracic surgeon/cardiologist sets a mesh patch or plug into place to close the hole.
The heart tissue grows around the mesh, permanently sealing the hole. This type of procedure may be done to repair only the secundum atrial septal defects (ASD) type.
Some large Secundum ASD surgery may not be able to be repaired through cardiac catheterization and may require open-heart surgery.

Open-Heart ASD Surgery

This type of surgery is performed under general anesthesia with the usage of a heart-lung machine by a small incision in the chest, surgeons use patches to close the hole.
This procedure is the preferred treatment for certain types of atrial septal defects (premium, sinus venous, and coronary sinus), and these types of atrial defects can only be repaired through open-heart surgery.
Doctors use imaging techniques after the defect has been repaired to check the repaired area.

Follow-up Care

Follow-up care depends on the type of defect and whether other defects are present. Repeated echocardiograms are done after hospital discharge, one year later and then as requested by you or your cardiologist / cardiothoracic surgeon. For simple atrial septal defects closed during childhood, only occasional follow-up care is generally needed. Adults who have had atrial septal defect repair need to be monitored throughout life to check for complications, such as:

Pulmonary hypertension
Arrhythmias
Heart failure or valve problems.
Follow-up exams are typically done on a yearly basis.
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Diet Control After Heart Surgery?

Control Sodium Intake (Salt)

Cardiac patients should limit their intake of salt to no more than 2000 milligrams per day. otherwise, it increases the blood pressure and creates excessive stress on the heart. As per American Heart Association guidelines, cardiac doctors may limit this to 1500 milligrams per day for heart patients.

Foods to Avoid

Eating healthy foods is essential for heart patients after heart surgery to supply adequate nutrients to your body while maintaining a healthy weight. obesity creates stress in the heart due to more amount of oxygen is required to pump blood throughout your body.
The daily patient should limit the sugar content foods and 30 percentage fat foods because some medicines may increase the amount of fat in your blood.
Don’t eat meat more than 3 oz per day and patients should consume less than 300 milligrams of dietary cholesterol per day.
Don’t take cheese, which contains more amount of saturated fat. Instead of that, choose low-fat cheeses such as farmer’s cheese, low-fat cottage cheese, and part-skim ricotta.

Foods to Add to the Diet

Choose foods like beans, fish (oily fish), peas and skinless poultry. which contains protein without an excessive amount of cholesterol.
You can take oily fish twice a week which contains heart-healthy fats.
You should also include skim milk and nonfat yoghurt daily containing low-fat.
You can take whole grains in your diet that contain rich carbohydrates.
You can consume as much as fat-free fruits and vegetables.

Frequently Asked Questions

An atrial septal defect (ASD) is not typically life-threatening in childhood, but untreated large defects can lead to serious complications in adulthood.

Surgery is generally recommended for ASDs larger than 8-10 mm or if there are symptoms or signs of heart strain.

ASDs themselves do not usually get bigger, but the effects and symptoms can worsen over time.

Yes, untreated ASDs can eventually lead to heart failure, especially in older adults.

ASD surgery is generally considered safe with a high success rate, though, like all surgeries, it carries some risks.

ASDs can be genetic and may occur in families, though not all cases are hereditary.

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