Atrial Septal Defect, or ASD, is an abnormal hole in the wall of the upper chambers of the heart where the wall between the right and left atria does not close completely. The size of the hole and its exact location vary from patient to patient.
An ASD can increase the amount of blood that flows to the lungs. During childhood, there may be no symptoms, but over time the condition can lead to pulmonary hypertension or congestive heart failure.
An ASD can close by itself, but more often than not needs repairing. It is typically repaired in children between 3 and 5 years of age, but infants and older children may also undergo the treatment when necessary.
Diagnosis
A family history of heart defects may suggest a genetic predisposition to the condition.
During a physical examination, the blood pressure of the child is measured, and a stethoscope is used to listen to sounds made by the heart and blood flowing through the arteries. Some heart murmurs (abnormal heart sounds) could indicate an Atrial Septal Defect. The patients pulse, reflexes, height, and weight are checked and recorded. The oxygen saturation in blood is also measured using a Pulse Oximeter. Internal organs may also be palpated, or felt, to determine if they are enlarged.
A chest X-ray, electrocardiogram (ECG, EKG), echocardiogram (echo), or magnetic resonance imaging MRI) can confirm the presence of an Atrial Septal Defect. A chest X-ray evaluates the size, shape, and location of the heart and lungs.
An electrocardiogram helps the physician evaluate the electrical activity of the heart. During an EKG, small electrode patches are attached to the skin on the chest. The electrodes are connected to a computer that measures the heart's electrical impulses and records them in a zigzag patter on a moving strip of paper.
An echocardiogram uses ultrasound, or high-frequency sound waves, to display an image of the heart's internal structures. It can detect valve and other heart problems. A Doppler echo uses sound waves to measure blood flow. Magnetic resonance imaging is a scanning method that uses magnetic fields and radio waves to create three-dimensional images of the heart, which reveal how blood flows through the heart and how the heart is working.
Causes
Abnormal openings in the Atrial Septum occur during fetal development. These abnormalities can go unnoticed if the opening is small and produces no abnormal symptoms. If the defect is large, oxygen-rich blood from the left atrium flows back into the right atrium and gets pumped back to the lungs again, causing more work for the heart and lungs. The right atrium may swell or enlarge to hold the extra blood.
In some cases, an Atrial Septal Defect can allow blood clots from the body to enter the brain and cause a stroke. Untreated Atrial Septal Defect can lead to Pulmonary Hypertension, Chest infection, Eisenmenger's syndrome, Aatrial fibrillation, Atrial flutter, Stroke, or Right-sided heart failure.
Symptoms
A person born with an Atrial Septal Defect may have no symptoms in childhood, and the condition may go undetected into adulthood. Stunted growth may be a symptom of Atrial Septal Defect. Other symptoms that might develop over time include:
Device for Closure
By using the mesh device called the Amplatzer, Pediatric cardiologists are now able to close the hole in a hospital procedure room known as the Catheterization Laboratory.
The Amplatzer, which is FDA approved, is a two-tiered, expanding device that closes the ASD and are available in different-sizes. The Cardiologist determines what size Amplatzer to use by inflating a balloon within the defect, and measuring the indentation in the balloon created by the defect.
The Amplatzer, which is made of wire mesh, is then inserted through a catheter and placed securely in the hole. The clamshell-like device closes the hole and then stays in the heart.
Surgery
Atrial Septal Defects are corrected by two types of surgical methods. Primary closure in which the opening is repaired with sutures alone if the defect is small; or secondary closure in which a patch closes the opening if the defect is large.
During traditional Atrial Septal Defect surgery, the heart is exposed through an incision made in the chest or between the ribs. A heart-lung bypass machine pumps blood for the heart while the heart is stopped and the wall defect is being repaired. Recuperation from surgery involves three to five days in the hospital and four to six weeks recovering at home. When possible, minimally-invasive surgical techniques that use smaller incisions (3–4 inches [7–10 cm]) may be performed, depending on the size and location of the defect. Minimally invasive surgery results in a much reduced hospital stay, reduced scarring, and a faster recovery than traditional surgery.
The patient receives general anesthesia, and no large incision is needed. The closure can be performed as a semi-outpatient procedure, and the recovery time is just a few days. This type of treatment is much less traumatic for children because they are able to go home a day after the procedure, and there is no incision or scarring.
Hospital stay of would typically be for about 8 days.
The other major cardiac procedures are:
Few popular hospitals for Atrial Septal Defect Closure are:
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