Many atrial septal defects close on their own during childhood. For those that don't close, some small atrial septal defects don't cause any problems and may not require any treatment. But many persistent atrial septal defects eventually require surgery to be corrected.
If your child has an atrial septal defect, your child's cardiologist may recommend monitoring it for a period of time to see if it closes on its own. Your child's doctor will decide when your child needs treatment, depending on your child's condition and whether your child has any other congenital heart defects.
Medications won't repair the hole, but they may be used to reduce some of the signs and symptoms that can accompany an atrial septal defect. Drugs may also be used to reduce the risk of complications after surgery. Medications may include those to keep the heartbeat regular (beta blockers) or to reduce the risk of blood clots (anticoagulants).
Many doctors recommend repairing an atrial septal defect diagnosed during childhood to prevent complications as an adult. Doctors may recommend surgery to repair medium- to large-sized atrial septal defects. However, surgery isn't recommended if you have severe pulmonary hypertension.
For adults and children, surgery involves plugging or patching the abnormal opening between the atria. Doctors will evaluate your condition and determine which procedure is most appropriate. Atrial septal defects can be repaired using two methods:
Cardiac catheterization. In this procedure, doctors insert a thin tube (catheter) into a blood vessel in the groin and guide it to the heart using imaging techniques. Through the catheter, doctors set a mesh patch or plug into place to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.
This type of procedure may be performed to repair secundum atrial septal defects. Some large secundum atrial septal defects may not be able to be repaired through cardiac catheterization, and may require open-heart surgery.
Open-heart surgery. This type of surgery is done under general anesthesia and requires the use of a heart-lung machine. Through an incision in the chest, surgeons use patches to close the hole. This procedure is the preferred treatment for certain types of atrial septal defects (primum, sinus venosus and coronary sinus), and these types of atrial defects can only be repaired through open-heart surgery.
This procedure may also be conducted using small incisions (minimally invasive surgery) for some types of atrial septal defects.
Doctors use imaging techniques after the defect has been repaired to check the repaired area.
Follow-up care depends on the type of defect and whether other defects are present. For simple atrial septal defects closed during childhood, only occasional follow-up care is needed.Adults who've had atrial septal defect repair need to have regular follow-up appointments to check for complications, such as pulmonary hypertension, arrhythmias, heart failure or valve problems.
Dec. 11, 2014
- What are holes in heart? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/holes/. Accessed Aug. 27, 2014.
- Facts about atrial septal defect. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.html. Accessed Aug. 27, 2014.
- Atrial septal defect (ASD). The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/pediatrics/congenital_cardiovascular_anomalies/atrial_septal_defect_asd.html?qt=atrial%20septal%20defect&alt=sh. Accessed Aug. 27, 2014.
- St. John Sutton MG. Clinical manifestations and diagnosis of atrial septal defects in adults. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- Vick GW, et al. Classification of atrial septal defects (ASDs), and clinical features and diagnosis of isolated ASDs in children. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- Congenital heart defects and CCHD. March of Dimes. http://www.marchofdimes.org/baby/congenital-heart-defects.aspx. Accessed Aug. 27, 2014.
- Connolly HM. Management of atrial septal defects in adults. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Sept. 18, 2014.
- Connolly HM. Medical management of Eisenmenger syndrome. http://www.uptodate.com/home. Accessed Sept. 19, 2014.
- St. John Sutton MG. Identification and assessment of atrial septal defects in adults. http://www.uptodate.com/home. Accessed Sept. 19, 2014.
- Vick GW, et al. Management and outcome of isolated atrial septal defects in children. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- The American Heart Association's diet and lifestyle recommendations. American Heart Association. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp. Accessed Sept. 23, 2014.
- Riggin EA. Decision Support System. Mayo Clinic, Rochester, Minn. Accessed July 10, 2014.
- Mankad R (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 10, 2014.