Atrial Septal Defects
What are Atrial Septal
Defects (ASDs)?
Atrial septal defects, sometimes called
a “hole” in the heart, are the
most common cause of congenital heart defects
found in adults. The defect involves an
opening in the septum, the inner wall that
separates the heart's left and right sides.
If the opening is between the heart's two
upper “pumping” chambers (the
atria), it is called an atrial septal defect
(ASD).
Atrial septal defects account for 30-40%
of congenital heart disease seen in adults.
Females are twice as likely as males to
have an ASD.
The terms atrioventricular (septal) defects,
atrioventricular canal defects and endocardial
cushion defects also are used to describe
these defects.
There are three types of ASDs: secundum,
primum and sinus venosus:
- Secundum atrial septal defects account
for 80% of all ASDs. This involves a hole
between the two upper chambers of the
heart.
- Primum atrial septal defects are associated
with a split in the leaflet of the mitral
valve – called a cleft mitral
valve.
- Sinus venosus atrial septal defect occurs
where the superior vena
cava and the right atrium join. It
is associated with abnormal drainage of
the right upper pulmonary vein.
In addition, other congenital defects are
associated with atrial septal defects.
- Ebstein's anomaly. This form
of congenital heart disease involves downward
displacement of the tricuspid
valve into the heart's right lower
“pumping” chamber (right ventricle).
Patients with mild Ebstein anomaly may
not experience symptoms. Patients with
moderate Ebstein anomaly may begin to
experience symptoms during late adolescence
or young adult life. Symptoms of severe
Ebstein are usually present at birth or
even in before birth (in utero).
- Eisenmenger's syndrome. This
form of congenital heart disease causes
pulmonary hypertension
Eisenmenger's is often accompanied by
a shunt (passage) of deoxygenated blood
from the right to the left side of the
circulation. This causes blueness of the
face and fingers and toes.
Symptoms
When ASD is present, the already oxygen-rich
blood from the left atrium flows back into
the right atrium and gets pumped back to
the lungs again. This makes the heart work
harder. ASD can result in the following
symptoms:
- Arrhythmia
[link glossary/arrhythmia ]
- Enlargement (dilation)
of the right side of the heart.
- Exercise intolerance: shortness of breath
(dyspnea) and fatigue.
- Palpitations (sensation of irregular
or fast heartbeat)
- Pulmonary hypertension
An echocardiogram
will be performed to help confirm the diagnosis
and determine the type of ASD defect present.
Other tests may include:
If suspected, tricuspid valve defects may
be diagnosed with the following tests:
Treatment Options
Treatment may depend on the type of ASD
present:
- Secundum ASD - Surgery is performed
to close the opening.
- Primum ASD - Surgical repair involves
closure of the ASD with a patch. Mitral
valve repair may also be performed.
- Sinus venosus ASD - Surgical repair
involves closure of the ASD plus redirection
of the abnormal pulmonary vein back into
the left atrium.
- Ebstein's anomaly - There are several
surgical options for including tricuspid
valve reconstruction.
Penn Cardiac Care surgeons perform many
atrial septal defect repairs every year.
Patients who have had this procedure do
extremely well. Penn Cardiac Care surgeons
offer a variety of minimally invasive techniques
for repairing ASD through very small (2
inch) skin incisions, which avoids the need
to open the chest. This enables patients
to experience less discomfort and have a
quicker recovery.
Follow-up Care
Routine follow-up by experienced cardiologists
is important for adults with congenital
heart disease, including those who have
had ASD repairs. Patients with palpitations
or fainting may need medical therapy. Once
an ASD has been closed, however, it’s
unlikely that more surgery will be needed.
Need an appointment? Request one online 24
hours a day, 7 days a week; or call 800-789-PENN (7366) to speak to a
referral counselor.
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