Atrial Septal Defect

Treatment

While an atrial septal defect is present from birth, most children who have an ASD will not have symptoms or complications until they become adults. To avoid future heart problems, it is recommended that atrial septal defects be repaired during childhood, if detected.

Treatment of an ASD depends on the size, location, degree of symptoms present and the effect the defect has on the heart muscle.

Observation and monitoring

Patients who have a small ASD without symptoms or heart rhythm disturbances, may only require periodic monitoring by a cardiologist specializing in adult congenital heart disease. A typical evaluation would include a thorough physical exam, electrocardiogram, chest X-ray, echocardiogram, and an exercise test. A Holter monitor or event recorder may also be used to check for irregular heart rhythms.

Medical management

In some circumstances, closure either by surgery or catheter-delivered occluder is not recommended. In these situations, medical management is important to decrease the risk of complications of the atrial septal defect or to reduce symptoms.

When an ASD is associated with high pulmonary pressures, closing the defect may not be appropriate. Early detection and regular evaluation are very important to avoiding high pulmonary pressures.

Surgery

The standard method for closure of atrial septal defects has been open-heart surgery. Surgery requires a heart-lung cardiac bypass machine to allow the heart to be opened and the defect closed — with stitches if it is small, or, if too large, with a patch. This surgery has a very low risk and has been performed for more than 35 years. Minimally invasive incisions are utilized in selected circumstances when surgery for this defect is performed. Long-term survival after repair of this defect is similar to that of a healthy person of the same age.

Nonsurgical Closure

Nonsurgical closure, a relatively new procedure is done in the heart catheterization laboratory and avoids the need for surgery. A patch, usually resembling a small umbrella, is inserted into the damaged area through a small tube, called a catheter. Various other patches are being investigated. Cardiologists at Mayo Clinic are involved in investigational trials for these devices.