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An atrial septal defect (ASD) occurs when part of the wall that separates the two upper chambers of the heart does not form properly. It is classified based on the location and size of the hole in the septum. While some small ASDs close on their own, larger ones may require surgery or the use of an umbrella-shaped patch. A pediatric cardiologist can diagnose ASD through an echocardiogram. Treatment depends on the size of the hole and the presence of other heart defects.
The heart is divided into four chambers. The septum or wall separates the two upper chambers, called the atria. In some cases, part of this wall does not form in the fetal heart. The result is an atrial septal defect (ASD).
All babies have a small opening in the atria shortly after birth, called the foramen ovale. Sometimes, when the fetal heart forms, lower pressure in the right heart causes the left atrium to send more blood through the foramen ovale, creating a larger hole than usual. While the normal foramen ovale closes shortly after the baby is born, this larger hole may not close and is called an atrial septal defect.
An atrial septal defect is classified based on the location of the hole in the septum and its size. When the hole is in the middle of the septum, it is called a sinus venomous defect. A hole in the lower part of the septum is called an ostium primum and one in the upper part of the septum is an ostium secondum.
Atrial and ventricular septal defects are the most common of all heart defects. Often, an atrial septal defect is so small that it will close on its own and never require surgery, as is the case with a small foramen ovale. In some cases, however, the size of the atrial septal defect causes the right atria to become larger and also enlarge the pulmonary valve. It can affect the way a child grows up and cause fatigue as well.
The diagnosis is usually made when the child’s pediatrician hears a heart murmur. A pediatric cardiologist then performs an echocardiogram to determine both the location and size of the atrial septal defect. Unless the atrial septal defect is very large, a prenatal ultrasound probably won’t capture this defect, and fetal echocardiograms also don’t often see ASD.
Treatment depends on the size of the hole and the presence of other heart defects. Sometimes in sinus venosus there is an abnormality of the pulmonary veins where some of them connect to the wrong ventricle. In the AV canal, ASD is actually a complete absence of the septum and requires immediate surgical attention.
Fortunately, even if an atrial septal defect doesn’t close on its own, it may not need to be addressed with surgery. Experimentation with catheters has led to the use of an umbrella-shaped patch, which is taped to the atria to plug small holes. When this is not possible, the surgery is usually short and has an excellent success rate. A person with a repaired atrial septal defect has a normal life expectancy and no activity restrictions after recovery.
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