Your or your child's doctor may first suspect an atrial septal defect or other heart defect during a regular checkup if he or she hears a heart murmur while listening to the heart using a stethoscope.
If your doctor suspects you or your child has a heart defect, the doctor may request one or more of the following tests:
Echocardiogram. This is the most commonly used test to diagnose an atrial septal defect. Some atrial septal defects can be found during an echocardiogram done for another reason.
During an echocardiogram, 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 any signs of heart defects. Doctors may use this test to evaluate your condition and determine your treatment plan.
- Chest X-ray. An X-ray image helps your doctor to see the condition of your heart and lungs. An X-ray may identify conditions other than a heart defect that may explain your signs or symptoms.
- Electrocardiogram (ECG). This test records the electrical activity of your heart and helps identify heart rhythm problems.
Cardiac catheterization. In this test, 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 and check the function of your heart valves. Using catheterization, the blood pressure in your lungs also can be measured.
However, this test usually isn't needed to diagnose an atrial septal defect. Doctors may also use catheterization techniques to repair heart defects.
- Magnetic resonance imaging (MRI). An MRI is a technique that uses a magnetic field and radio waves to create 3-D images of your heart and other organs and tissues within your body. Your doctor may request an MRI if echocardiography can't definitively diagnose an atrial septal defect.
- Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create detailed images of your heart. A CT scan may be used to diagnose an atrial septal defect 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 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 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 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 only the secundum type of 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. 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 is generally 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 on a yearly basis.
Lifestyle and home remedies
If you find out you have a congenital heart defect, or you've had surgery to correct one, you may 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 may not be able to do 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 in which bacteria can become stuck and grow into an 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 in addition to an atrial septal defect, or if you've had atrial septal defect repair within the last six months, you may 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).
Because appointments can be brief, and there's often a lot to discuss, it's a good idea to arrive well-prepared. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For atrial septal defect, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What are my treatment options?
- What are the risks of cardiac catheterization or surgery?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage these conditions together?
- Are there any activity restrictions that I need to follow?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did the symptoms first begin?
- 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 heart problems?
- Is there a family history of birth defects?