Atrial septal defect (ASD)

Diagnosis

Some atrial septal defects (ASDs) are found before or soon after a child is born. But smaller ones may not be found until later in life.

If an ASD is present, a healthcare professional may hear a whooshing sound called a heart murmur when listening to the heart with a device called a stethoscope.

Tests

Tests that help diagnose an atrial septal defect (ASD) include:

• Echocardiogram. This is the main test used to diagnose an atrial septal defect. Sound waves are used to make pictures of the beating heart. An echocardiogram shows the structure of the heart chambers and valves. It also shows how well blood moves through the heart and heart valves.
• Chest X-ray. A chest X-ray shows the condition of the heart and lungs.
• Electrocardiogram (ECG or EKG). This quick and painless test records the electrical activity of the heart. It can show how fast or how slow the heart is beating. An ECG can help find irregular heartbeats, called arrhythmias.
• Cardiac magnetic resonance imaging (MRI) scan. This imaging test uses magnetic fields and radio waves to make detailed images of the heart. It might be done if other tests didn't provide a sure diagnosis.
• Computerized tomography (CT) scan. This test uses a series of X-rays to create detailed pictures of the heart. It may be used if other tests don't give enough information to make a diagnosis.

Treatment

Treatment for atrial septal defect (ASD) depends on:

• The size of the hole in the heart.
• Whether there are other heart problems present at birth.

An atrial septal defect may close on its own during childhood. For small holes that don't close, regular health checkups may be the only care needed.

Some atrial septal defects that do not close need a procedure to close the hole. But closure of an ASD isn't recommended in those who have severe pulmonary hypertension.

Medications

Medicines won't repair an atrial septal defect (ASD). But they can help reduce symptoms. Medicines for atrial septal defect might include:

• Beta blockers to control the heartbeat.
• Blood thinners, called anticoagulants, to lower the risk of blood clots.
• Diuretics to reduce fluid buildup in the lungs and other parts of the body.

Surgery or other procedures

A procedure is often suggested to repair a medium to large atrial septal defect (ASD) to prevent future complications.

Atrial septal defect repair involves closing the hole in the heart. This can be done two ways:

• Catheter-based repair. This type is done to fix the secundum type of atrial septal defects. A thin, flexible tube called a catheter is put into a blood vessel, most often in the groin. The tube is then guided to the heart. A mesh patch or plug goes through the catheter. The patch is used to close the hole. Heart tissue grows around the patch, closing the hole for life. However, some large secundum atrial septal defects might need open-heart surgery.
• Open-heart surgery. This type of ASD repair surgery involves making a cut through the chest wall to get to the heart. The surgeons use patches to close the hole. Open-heart repair surgery is the only way to fix primum, sinus venosus and coronary sinus atrial defects.

Sometimes, atrial septal defect repair can be done using smaller cuts than traditional surgery. This method is called minimally invasive surgery. If the repair is done with the help of a robot, it's called robot-assisted heart surgery.

Anyone who has had surgery for atrial septal defect needs regular imaging tests and health checkups. These appointments are to watch for possible heart and lung complications.

People with large atrial septal defects who do not have surgery to close the hole often have worse long-term outcomes. They may have more trouble doing everyday activities. This is called reduced functional capacity. They also are at greater risk for irregular heartbeats and pulmonary hypertension.

Lifestyle and home remedies

Following a heart-healthy lifestyle is important. This includes eating healthy, not smoking, managing weight and getting enough sleep. If you or your child has an atrial septal defect, talk to your healthcare team about the following:

• Exercise. Exercise is usually OK for people with an atrial septal defect. But if ASD repair is needed, you might have to stop certain activities until the hole in the heart is fixed. Ask a healthcare professional what type and amount of exercise is safest.
• Extreme altitude changes. Extreme changes in location above or below sea level may cause complications in people with an unrepaired atrial septal defect. For example, there's less oxygen at higher altitudes. The lower amount of oxygen changes blood flow through the lung arteries. This can cause shortness of breath and strain the heart.
• Dental work. If you or your child recently had an ASD fixed and need dental work, talk to a healthcare professional. You or your child may need to take antibiotics for about six months after repair surgery to prevent infection.

Preparing for your appointment

A doctor trained in heart problems present at birth usually provides care for people with an atrial septal defect. This type of healthcare professional is called a congenital cardiologist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your or your child's symptoms, and when you noticed them.
• Important personal information, including major stresses, recent life changes and any family history of heart problems present at birth.
• All medicines, vitamins or other supplements being taken. Include the dosages.
• Questions to ask during your appointment.

For atrial septal defect, questions to ask might include:

• What's the most likely cause of these symptoms?
• Are there other possible causes?
• What tests are needed?
• Is the atrial septal defect likely to close on its own?
• What are the treatment choices?
• What are the risks of repair surgery?
• Are there any activity restrictions?
• Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask questions, including:

• Do you or your child always have symptoms or do they come and go?
• Do symptoms get worse with exercise?
• Does anything else seem to make the symptoms worse?
• Is there anything that seems to make the symptoms better?
• Is there a family history of congenital heart defects?