Atrial Septal Defect – A Hole In The Heart
Ever wonder why doctor have to listen to your heart every time you go for a check up? Here’s the reason – listening to the thumping of your heart can give doctors the heads-up on some problems, like an atrial septal defect.
Atrial Septal Defect
The heart has four chambers. The two lower chambers are the ventricles: the left ventricle and the right ventricle. The upper chambers are the atria, and there are also two of them – the left atrium and the right atrium.
In a person without a heart defect, blood that is in need of oxygen flows to the right atrium, then to the right ventricle, then it is pumped to the lungs to receive oxygen. The oxygenated blood then returns to the left atrium, flows into the left ventricle, and then heads out to the body through the aorta, a large blood vessel that carries blood from the heart to the smaller blood vessels in the body.
In a person with an atrial septal defect, there is an opening in the wall between the right atrium and the left atrium (this wall is called the atrial septum). As a result of this opening, some oxygenated blood from the left atrium flows through the hole in the septum into the right atrium, where it mixes with oxygen-poor blood and increases the total amount of blood that flows toward the lungs.
Atrial septal defect is a type of congenital heart disease, which means that a person is born with it. About 8 out of 1,000 babies born have heart disease, and 6 percent to 8 percent of those babies have an atrial septal defect.
How Do You Know If You Have Atrial Septal Defect?
It is usually found during a checkup or routine physical exam. Because the murmur caused by an atrial septal defect can be difficult to hear, the condition may not be diagnosed right away. An atrial septal defect can be discovered in a person as an infant, child, teen, or even as an adult.
Most patients with an atrial septal defect are asymptomatic, which means that they don’t have any problems or symptoms from their atrial septal defect. Whether a person has symptoms from an atrial septal defect usually depends on the size and severity of the hole in the atrial septum. About 1 in 4 people with a small hole between the atria don’t require treatment because the hole closes on its own over time.
For most people with an atrial septal defect, no one knows exactly why it happens. In some cases, the tendency to develop an atrial septal defect may be inherited, or genetic.
Atrial Septal Defect Signs And Symptoms
Most patients who have atrial septal defect seem healthy and have no symptoms. Usually, a patient with an atrial septal defect grows normally and feels well. Most don’t need to take any medications. Rarely, patients with atrial septal defect may show the following signs:
- fatigue and tiredness during activity
- abnormal heartbeat
- stroke (this is very rare)
If an atrial septal defect isn’t treated in childhood, people with larger atrial septal defect may develop a problem called pulmonary hypertension, which means high blood pressure in the lungs. This occurs because these holes in the septum cause too much blood to flow through the lungs, which gradually damages the lung blood vessels.
If the defect isn’t diagnosed and treated, this blood vessel damage can become permanent, causing the pressure in the lung vessels to rise dangerously.
Fortunately, most patients with atrial septal defect are treated long before the heart defect causes physical symptoms.
How Is Atrial Septal Defect Diagnosed And Treated?
After hearing the heart murmur that suggests a hole in the atrial septum, a doctor may refer a patient to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart disease in kids and teens.
In addition to doing a physical examination, the cardiologist will take a medical history by asking you about any concerns and symptoms you have, your past health conditions, your family’s health history, any medications you’re taking, and other issues relating to the heart.
The cardiologist may then order one or more of the following tests:
- a chest X-ray, which produces a picture of the heart and surrounding organs
- an electrocardiogram (ECG), which records the electrical activity ofthe heart
- an echocardiogram (echo), which uses sound waves to create a picture of the heart
In most patients with atrial septal defect, though, the cardiologist will recommend having the hole fixed by using these treatments:
Treated with Cardiac Catheterization
In cardiac catheterization, a thin, flexible tube called a catheter is inserted into a blood vessel in the leg that leads to the heart.
There is no surgical scar in this procedure, just a small mark in the groin area where the catheter went into the blood vessel. Usually the person can go home the very next morning.
If you have had this procedure, your doctor will probably recommend that you take it easy for a few days afterwards and may want you to stay out of gym class for a few weeks. Your doctor may also ask you to take one aspirin each day for about 6 months after the device is implanted to prevent small clots from forming on the device and being sent into the arteries of the body. Over time, the normal tissue of the heart grows over the device and the aspirin is no longer necessary.
Treated with Surgery
When the atrial septal defect is very large or close to the wall of the heart, a device cannot be safely used and surgery is needed to close the defect. If surgery is necessary, a person will receive general anesthesia so he or she doesn’t feel pain or move around during the surgery.
Atrial septal defect surgery involves making a cut in the chest so a surgeon can stitch the hole in the atrial septum closed or sew a patch of pericardium (layer covering the heart) over the defect. Eventually, the tissue of the heart heals over the patch or stitches, making the area smooth and nearly normal in appearance. Patients who have surgery for atrial septal defect usually leave the hospital within 3 to 4 days after surgery, if there are no problems.
Most people who have atrial septal defect corrected have a normal life expectancy and go on to live otherwise healthy lives. After the recovery period, people who have had atrial septal defect will be able to exercise, play sports, and do the other things they love – and perhaps do them even better than before!