Atrial Septal Defect

What Is an Atrial Septal Defect?

An atrial septal defect (pronounced: AY-tree-ul SEP-tul DEE-fekt), or ASD for short, is sometimes called a hole in the heart. It's a type of congenital heart defect, which means a person is born with it.

People with an ASD have an abnormal opening in the dividing wall between the upper filling chambers of the heart, or the atria. In most cases, ASDs are diagnosed and treated successfully with few or no complications.

What Happens in an Atrial Septal Defect?

In an atrial septal defect, there's an opening in the wall (septum) between the atria. As a result, some oxygenated blood from the left atrium flows through the hole in the septum into the right atrium, where it mixes with oxygen-poor blood and increases the total amount of blood that flows toward the lungs.

The increased blood flow to the lungs creates a swishing sound, known as a heart murmur. A heart murmur, along with other specific heart sounds, is often the first tip-off to a doctor that a teen has an ASD.

What Causes an Atrial Septal Defect?

ASDs happen during a baby's development in the mother's womb. Before birth, the heart develops from a large tube, dividing into sections that will eventually become its walls and chambers. If there's a problem during this process, a hole can form in the wall that divides the left atrium from the right.

In some cases, the tendency to develop an ASD may be inherited, or genetic. For most people with an ASD, no one knows exactly why it happens.

What Are the Signs & Symptoms of an Atrial Septal Defect?

The size of an ASD and its location in the heart determines the symptoms it causes. Most people with ASDs seem healthy and appear to have no symptoms. Usually, someone with an ASD grows normally and feels well.

People with larger, more severe ASDs might have some of these signs or symptoms:

• poor appetite
• poor growth
• being very tired during activity
• shortness of breath
• lung problems and infections, such as pneumonia

What Problems Can Happen?

If an ASD isn't treated in childhood, health problems can develop later, including an abnormal heart rhythm (an atrial arrhythmia) and problems in how well the heart pumps blood.

As kids with ASDs get older, they also might be at an increased risk for stroke because a blood clot could form, pass through the hole in the septum, and travel to the brain. Pulmonary hypertension (high blood pressure in the lungs) also may develop over time in older patients with larger untreated ASDs.

Fortunately, most teens with ASD are treated long before the heart defect causes physical symptoms.

How Are Atrial Septal Defects Diagnosed?

After hearing the heart murmur that suggests a hole in the atrial septum, a doctor may refer a teen to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart disease in kids and teens.

The cardiologist will do a physical exam and take a medical history, asking you about any concerns and symptoms you have, your past health, your family's health, any medicines you're taking, and other issues relating to the heart.

The cardiologist might order one or more of these tests:

• a chest X-ray, which produces a picture of the heart and surrounding organs
• an electrocardiogram (EKG), which records the electrical activity of the heart
• an echocardiogram (echo), which uses sound waves to create a picture of the heart

How Are Atrial Septal Defects Treated?

Treatment for an ASD will depend on the patient's age, the size of the hole, and where it's located in the heart.

Very small ASDs might not need any treatment. In other cases, the cardiologist may recommend follow-up visits for observation.

In most teens with ASD, though, the cardiologist will recommend having the hole fixed, either with cardiac catheterization or heart surgery.

Cardiac Catheterization

Many ASDs can be treated with cardiac catheterization (pronounced: CAR-dee-ack cath-uh-turr-ih-ZAY-shun), in which a thin, flexible tube (a catheter) is inserted into a blood vessel in the leg that leads to the heart. The cardiologist guides the tube into the heart to make measurements of blood flow, pressure, and oxygen levels in the heart chambers. A special implant is positioned into the hole and is designed to flatten against the septum on both sides to close and permanently seal the ASD.

In the beginning, the natural pressure in the heart holds the device in place. Over time, the normal tissue of the heart grows over the implant and covers it entirely. This nonsurgical technique leaves no chest scar, has a shorter recovery time than heart surgery, and usually needs just an overnight stay in the hospital.

If you have a cardiac catheterization, your doctor will probably recommend that you take it easy for a few days afterward and perhaps stay out of gym class for a week or two.

Your doctor might want you to take one aspirin each day for about 6 months to prevent small clots from forming on the device and being sent into the arteries of the body. Over time, the normal tissue of the heart grows over the device and the aspirin is no longer necessary.

Heart Surgery

Sometimes, when the ASD is very large or close to the wall of the heart, a device cannot be safely used and heart surgery is needed to close the defect.

A patient will get general anesthesia so he or she doesn't feel pain or move around during the surgery. The surgeon will make a cut in the chest, then stitch the hole in the atrial septum closed or sew a patch of manmade surgical material (such as Gore-Tex) over the defect. Eventually, the tissue of the heart heals over the patch or stitches, making the area smooth and nearly normal in appearance.

Teens usually can leave the hospital 3 to 4 days after surgery, if there are no problems. The first few days at home, you should hang out in bed or on the couch doing quiet activities such as reading, sleeping, and watching TV. Within a week or two, you'll probably feel better. Your doctor will advise you on when to go back to school.

It takes about 6 weeks for a chest incision to heal, and during that time you may need to sit out gym class or sports. After that, if you don't have other problems and the doctor gives the go-ahead, you should be fully recovered and able to return to normal activities.

Heart surgery does leave a permanent scar on the chest. It will be sore at first and your doctor will likely prescribe a pain reliever, or recommend acetaminophen or ibuprofen. You may feel numbness, itchiness, tightness, and burning around the cut, although these feelings shouldn't be severe.

Once a scar is healed, there's no need to keep it covered. If you want to minimize its appearance, you can use an over-the-counter cosmetic concealer (after your doctor gives the OK — you'll need to wait for a while after surgery to do this).

What Should I Expect After Surgery?

You'll have follow-up visits with your doctor as you recover from catheterization or surgery. He or she may repeat an echocardiogram at these visits.

For 6 months after surgery or catheterization, ASD patients need to take antibiotics before a visit to the dentist or if they need certain other kinds of surgery, such as tonsil removal. This is to prevent bacteria from getting into the bloodstream and causing infective endocarditis (pronounced: en-doe-kar-DYE-tus), an infection of the inner surface of the heart. When the heart tissue has healed over the closed ASD, most patients no longer need to worry about the risk of infective endocarditis.

After their ASD is closed and they've had plenty of time to heal, most teens have no further symptoms or problems.

What Else Should I Know?

In most cases, teens who have had ASD surgery or cardiac catheterization recover quickly.

But some signs and symptoms may indicate a problem. If you have trouble breathing or feel your heart racing, tell a parent or another adult so you can get medical treatment right away.

Other signs that might indicate a problem include:

• a bluish color around the mouth or on the lips and tongue
• loss of appetite
• weight loss
• feeling lethargic
• a lasting or unexplained fever
• increasing pain, tenderness, or pus oozing from your incision

Tell an adult and seek medical help if you notice any of these signs.

Most people who have an ASD corrected during their teenage years go on to live otherwise healthy lives. After the recovery period, they can exercise, play sports, and do the other things they love — and perhaps do them even better than before!