Hearing a heart murmur during a checkup might cause your or your child's doctor to suspect an atrial septal defect or other heart defect. For a suspected heart defect, your doctor might request one or more of the following tests:
Echocardiogram. This is the most commonly used test to diagnose an atrial septal defect. Sound waves are used to produce a video image of the heart. It allows your doctor to see your heart's chambers and measure their pumping strength.
This test also checks heart valves and looks for signs of heart defects. Doctors can also use this test to evaluate your condition and determine your treatment plan.
- Chest X-ray. This helps your doctor see the condition of your heart and lungs. An X-ray can identify conditions other than a heart defect that might explain your signs or symptoms.
- Electrocardiogram (ECG). This test records the electrical activity of your heart and helps identify heart rhythm problems.
Cardiac catheterization. A thin, flexible tube (catheter) is inserted into a blood vessel at your groin or arm and guided to your heart. Through catheterization, doctors can diagnose congenital heart defects, test how well your heart is pumping, check heart valve function and measure the blood pressure in your lungs.
However, this test usually isn't needed to diagnose an atrial septal defect. Doctors might also use catheterization techniques to repair heart defects.
- MRI. This uses a magnetic field and radio waves to create 3D images of your heart and other organs and bodily tissues. Your doctor might request an MRI if echocardiography can't definitively diagnose an atrial septal defect or related conditions.
- CT scan. This uses a series of X-rays to create detailed images of your heart. It can be used to diagnose an atrial septal defect and related congenital heart defects if echocardiography hasn't definitely diagnosed an atrial septal defect.
Many atrial septal defects close on their own during childhood. For those that don't close, some small atrial septal defects might not require treatment. But many persistent atrial septal defects eventually require surgery.
If you or your child has an atrial septal defect, your cardiologist might recommend monitoring it for a time to see if it closes on its own. Your doctor will decide when you or your child needs treatment, depending on your condition and whether you or your child has 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 a medium to large atrial septal defect diagnosed during childhood or adulthood to prevent future complications. However, surgery isn't recommended if you have severe pulmonary hypertension because it might make the condition worse.
For adults and children, surgery involves sewing closed or patching the abnormal opening between the atria. Doctors will evaluate your condition and determine which of two procedures to use:
Cardiac catheterization. Doctors insert a thin, flexible tube (catheter) into a blood vessel in the groin and guide it to the heart using imaging techniques. Through the catheter, doctors place a mesh patch or plug to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.
This type of procedure is used to repair only the secundum type of atrial septal defects. Some large secundum atrial septal defects, however, might 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 only way to repair primum, sinus venosus and coronary sinus atrial defects.
This procedure can be done using small incisions (minimally invasive surgery) and with a robot for some types of atrial septal defects.
Follow-up care depends on the type of defect, the treatment suggested and whether other defects are present. Repeated echocardiograms are done after hospital discharge, one year later and then as requested by your or your child's doctor. For simple atrial septal defects closed during childhood, only occasional follow-up care generally is needed.
Adults who've had atrial septal defect repair need to be monitored throughout life to check for complications, such as pulmonary hypertension, arrhythmias, heart failure or valve problems. Follow-up exams are typically done yearly.
Lifestyle and home remedies
If you have a congenital heart defect or you've had surgery to correct one, you might wonder about limitations on activities and other issues.
Exercise. Having an atrial septal defect usually doesn't restrict you from activities or exercise. If you have complications, such as arrhythmias, heart failure or pulmonary hypertension, you might be counseled to avoid some activities or exercises. Your cardiologist can help you learn what is safe.
If you have an unrepaired defect, your doctor will likely advise you to avoid scuba diving and high-altitude climbing.
Preventing infection. Some heart defects and the repair of defects create changes to the surface of the heart that make it more prone to infection (infective endocarditis). Atrial septal defects generally aren't associated with infective endocarditis, though your doctor will likely recommend preventive antibiotics for about six months after closure whenever you have dental work done.
But if you have other heart defects besides an atrial septal defect, or if you've had atrial septal defect repair within the last six months, you might need to take antibiotics before certain dental or surgical procedures.
Preparing for your appointment
If your doctor suspects an atrial septal defect, you or your child will likely be referred to a doctor trained in heart disorders (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
- Key personal information, including major stresses or recent life changes, and family history of heart defects
- All medications, vitamins or other supplements you or your child takes, including doses
- Questions to ask your doctor
For atrial septal defect, questions to ask your doctor include:
- What's the most likely cause of these symptoms?
- Are there other possible causes?
- What tests are needed?
- Is this condition temporary or long lasting?
- What are the treatment options?
- What are the risks of cardiac catheterization or surgery?
- Are there activity restrictions you recommend?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, including:
- Have the symptoms been continuous or occasional?
- Do symptoms get worse with exercise?
- Does anything else seem to make the symptoms worse?
- Is there anything that seems to improve the symptoms?
- Is there a family history of birth defects?
Dec. 20, 2019