Atrial septal defect (ASD)

Diagnosis

Some atrial septal defects are diagnosed before or soon after a child is born. However, smaller atrial septal defects may not be diagnosed until later in life.

If an atrial septal defect is present, the health care provider may hear a whooshing sound (heart murmur) when listening to the heart with a stethoscope.

Tests that are done to help diagnose an atrial septal defect include:

• Echocardiogram. This is the most commonly used test to diagnose an atrial septal defect. Sound waves are used to create pictures of the heart in motion. An echocardiogram can show how well blood is moving 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. An ECG can help identify irregular heartbeats (arrhythmias).
• Cardiac magnetic resonance imaging (MRI) scan. This imaging test uses magnetic fields and radio waves to create detailed images of the heart. A health care provider might request this type of MRI if echocardiography didn't provide a definitive diagnosis.
• Computed tomography (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.

Treatment

Treatment for atrial septal defect depends on the size of the hole in the heart and whether you or your child has other congenital heart defects.

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. A doctor specializing in heart diseases (cardiologist) might recommend monitoring it with regular health checkups to see if it closes on its own.

Your health care provider will discuss with you when you or your child needs treatment. Many persistent atrial septal defects eventually require surgery. However, closure isn't recommended if severe pulmonary hypertension is present.

Medications

Medications won't repair an atrial septal defect, but they can help reduce signs and symptoms. Medications for atrial septal defect might include drugs to control the heartbeat (beta blockers) or to reduce the risk of blood clots (anticoagulants).

Surgery or other procedures

Many cardiologists recommend surgery to repair a medium to large atrial septal defect that's diagnosed during childhood or adulthood to prevent future complications.

For adults and children, atrial septal defect repair surgery involves closing the hole in the heart. This can be done two ways:

• Catheter-based repair. A thin, flexible tube (catheter) is inserted into a blood vessel, usually in the groin, and guided to the heart using imaging techniques. A mesh patch or plug is passed through the catheter and used to close the hole. Heart tissue grows around the seal, permanently closing the hole.

  The catheter-based repair procedure is used only for 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 atrial septal defect repair surgery involves an incision through the chest wall to access the heart directly. The surgeons use patches to close the hole. This 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 small incisions (minimally invasive surgery) and with a robot (robot-assisted heart surgery).

Anyone who has had surgery for atrial septal defect needs regular echocardiograms and health checkups to watch for possible complications, such as irregular heartbeats (arrhythmias), heart valve problems, high blood pressure in the lung arteries (pulmonary hypertension) and heart failure.

People with large atrial septal defects who do not have surgery to close the hole typically have worse long-term outcomes. They may have more difficulty performing everyday activities (reduced functional capacity) and are at greater risk for arrhythmias and pulmonary hypertension.

Lifestyle and home remedies

If you or your child has an atrial septal defect, the health care provider may recommend some lifestyle steps to keep the heart healthy and to prevent complications.

• Exercise. Exercise is usually safe in patients with atrial septal defect. But if ASD repair is needed, a health care provider may recommend avoiding certain activities until the heart defect is fixed. A doctor trained in heart diseases (cardiologist) can help you learn what activity is safest for you or your child.
• Extreme changes in altitude. Changes in altitude may cause concern if you have an unrepaired atrial septal defect. If you plan to scuba dive or hike in high altitudes, talk with your cardiologist to make sure the activities are safe.
• Dental work. If you recently had ASD repair surgery and need dental work, your health care provider will likely recommend that you take preventive antibiotics for about six months after the hole in the heart is closed.

Preparing for your appointment

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 health care provider

For atrial septal defect, questions to ask your health care provider include:

• What's the most likely cause of these symptoms?
• Are there other possible causes?
• What tests are needed?
• Is the atrial septal defect temporary or long lasting?
• What are the treatment options?
• 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?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask many 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 congenital heart defects?