The atrial septum is the wall between the two upper chambers of the heart, and an atrial septal defect (ASD) is an abnormal hole in the wall. ASD, a heart problem that is present at birth, allows the blood from the high-pressured left side of the heart to cross into the lower pressured right side of the heart, increasing the work load of the right side. Over time, the excess blood flow to the right side of the heart and the lungs can result in right heart enlargement and dysfunction and can also result in serious permanent damage to the blood vessels in the lungs.
ASDs can occur as isolated heart defects or may occur in combination with other congenital heart defects, according to Neill Videlefsky, MD, pediatric cardiologist at Sibley Heart Center Cardiology. ASD is sporadic, not usually inherited, but in some cases, individuals may have a family history of this defect due to a specific genetic mutation. These genetic disorders are often associated with other congenital cardiac and extracardiac abnormalities. Atrial septal defects are common, accounting for approximately 10 to 15 percent of congenital heart disease.
“Most patients with an atrial septal defect are asymptomatic, and the ASD is usually detected in childhood by the primary care physician during routine physical examination,” Dr. Videlefsky said. “On auscultation (listening) of the heart, a heart murmur (turbulent blood flow) and abnormal heart sounds are heard.”
Most heart murmurs are innocent, but if it is suspected to be abnormal, the child is referred to a pediatric cardiologist, who may perform an EKG and echocardiogram to confirm the findings.
“The echocardiogram is a definitive diagnostic tool with which we can conduct a noninvasive, painless study that provides exquisite definition of the anatomy of a child’s heart,” Dr. Videlefsky said. “An echo provides information about the size of the defect and the size and function of the heart chambers.”
If ASD is found, the patient will be monitored regularly. Smaller atrial septal defects may close spontaneously over time. Larger ASDs are usually closed between three and five years of age.
Some of the complications occurring from an untreated ASD include congestive heart failure, pulmonary hypertension and arrhythmias. A rare complication is stroke due to a blood clot passing across the ASD and reaching the brain.
In the past, a child would have to undergo open heart surgery to close an ASD, but an exciting development in atrial septal defect closure called Transcatheter Device Closure is now regarded as just as effective, with an almost 100 percent success rate in suitably selected patients. This eliminates the need for open heart surgery, placing the child on cardiopulmonary bypass and is accomplished with no scars to the chest. The Transcatheter Device Closure procedure involves inserting a catheter through the groin into a vein and advancing into the heart, where a device shaped like a clam shell is positioned, resulting in permanent closure of the ASD. This provides a complete repair, and the child should not require further interventions in his or her lifetime.
“Sibley has a specialty interventionalist clinic,” Dr. Videlefsky said. “If the family opts for the procedure, they would be referred for multiple opinions, not just one, and they would meet with the actual interventionalist who will discuss the procedure in detail with them and determine whether their child is a suitable candidate for the procedure. The beautiful thing is that life expectancy is normal, and patients can have a normal life with no restrictions.”
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