Atrial Septal Defect (ASD)

1 What is Atrial Septal Defect (ASD)?

Atrial septal defect (ASD) is a congenital heart defect characterized by an opening in the septum between the two atria. This opening is usually closed during birth, separating non-oxygenated blood from oxygenated blood. 

In ASD this opening persists, and the size of the opening may vary from miniscule to large. Small opening often close during childhood. Large and persistent opening in the septal wall may damage heart and lungs. 

Small defects in the septum may not cause much problem, and is often discovered later in life. The persistent opening is closed by surgical method to avoid complications.

2 Symptoms

Atrial Septal Defect (ASD) may remain asymptomatic in many children. In adults, the symptoms may appear around 30 years or after several years. 

Some of the common symptoms of ASD include: 

3 Causes

The actual cause for Atrial septal defect (ASD) is not known. Combination of genetic and environmental factors are implied in the development of this condition. ASD causes the mixing of oxygenated and deoxygenated blood in the two upper chambers of the heart. 

When the opening is large, the extra volume of blood may overfill the lungs and the heart. This may cause enlargement and weakening of the right side of the heart. With the progress of the disease, pressure within the lungs increases leading to pulmonary hypertension

The different types of ASD are:

  • Secundum – this is the most common form of septal defect, and is characterized by an opening in the middle of the septal wall. 
  • Primum – in this condition, the defect is present in the lower part of the septum. It is usually associated with other congenital heart deformities.
  • Sinus venosus – this is a rare form of ASD, and is characterized by defect in the upper part of the septum. 
  • Coronary sinus – in this condition, a part of the wall between the vein system of the heart and left atrium is absent. This is also a rare form of ASD. 

Congenital heart defects like ASD are found to run in families. These defects are often associated with other genetic diseases like Down syndrome

Some conditions that occur during pregnancy increase the risk of congenital heart disease in the baby. This includes rubella infection, substance abuse, diabetes, lupus, obesity, and phenylketonuria. 

4 Making a Diagnosis

Heart murmur is probably the first indication in the diagnosis of Atrial septal defect (ASD) in infants. This is often observed during a regular physical examination of the child. Many other tests are recommended once ASD is suspected.  

Echocardiogram is the most commonly used technique in the diagnosis of ASD. It helps to visualize the chambers of the heart and to assess the pumping strength of different chambers. It also checks for abnormalities in the valves. 

Chest x-ray is recommended to check the condition of heart and lungs. It is useful in differentiating other conditions that have similar symptoms. ECG is useful in detecting abnormalities in the heart rhythm. 

Cardiac catheterization is a procedure in which a catheter is inserted into the blood vessel and guided to the heart. This helps to diagnose congenital heart defects, functioning of heart and its valves, and also the pressure within the lungs. 

MRI and CT scans are usually suggested if echocardiogram is not effective in confirming the diagnosis of ASD. 

5 Treatment

Small Atrial septal defects may not require any specific treatment. Medical monitoring is suggested to check out for any issues and the progress of the condition. Medications are used to alleviate some of the symptoms of the conditions, particularly those that arise after a surgical procedure. 

This includes beta blockers that are recommended to regularize the heartbeat, and anticoagulants to reduce the chances of blood clot. 

Surgical repair of the defect are often done in childhood to prevent complications in adulthood. 

ASD can be repaired by cardiac catheterization or open surgery. In cardiac catheterization a thin catheter is inserted into the blood vessel and guided to the heart. 

Once in place, the catheter is used to place a patch or mesh in the hole. Tissue grows around the mesh and permanently seals the hole. In open heart surgery, a surgeon patches the hole after connecting heart-lung machine. 

It is the preferred procedure for primum, sinus venosus, and coronary sinus. Surgery is not recommended in patients with pulmonary hypertension

6 Prevention

In most of the cases, Atrial septal defect (ASD) cannot be prevented. Reducing the risk factors like rubella infection in pregnancy may be of help. 

Before getting pregnant, those with a family history of congenital heart defects should speak to a genetic counselor to understand the risk of getting a child with ASD.

7 Alternative and Homeopathic Remedies

Homeopathic remedies are suggested based on specific symptoms of Atrial septal defect (ASD).

Agar, aloe ant, bac bar, ferr flav, acon, apis apoc, acetan, aeth, bapt, camph, calc, nat mur, Lachesis, phosphoricum, and kali c are some of the remedies suggested.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Atrial septal defect (ASD).

Presence of septal defect or a surgical repair of ASD may put some restriction on the amount of physical activity one can perform. 

Understand the condition better to know what exercise is best for you. Heart-healthy diet is important to improve the overall health of the organ.

9 Risks and Complications

Large Atrial septal defects may lead to serious complications like pulmonary hypertension and permanent lung damage.

10 Related Clinical Trials