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Atrial Septal Defects

Atrial Septal Defects

A child born with a hole between the two upper chambers of the heart has a condition known as atrial septal defect (ASD). These chambers, separated by a wall of tissue called the atrial septum, are called the right atrium and left atrium.

A hole in the atrial septum allows blood from the left atrium to enter the right side of the heart. This can lead to enlargement of the right side of the heart, too much fluid in the lungs and heart failure.

Symptoms of an Atrial Septal Defect

When symptoms are present, they may develop within the first few months of life, during childhood or later in life. Possible symptoms include:

  • Trouble eating or gaining weight (failure to thrive)
  • Fast breathing or working hard to breathe
  • Frequent respiratory infections
  • Shortness of breath during activity
  • Feeling the heart beat (palpitations)
  • Abnormal heart rhythms

Many people with an ASD have no symptoms, especially if the hole is small.

Diagnosis of an Atrial Septal Defect

Often, an ASD is first detected by listening to the chest with a stethoscope. Your child’s doctor may hear abnormal heart sounds or a murmur. These sounds suggest blood is not flowing smoothly through the heart. Additional exams and tests may be performed to determine the size of the opening and how its size affects the heart and lungs. Tests may include:

  • Pulse Oximetry. This simple test estimates how much oxygen is in the blood. A small sensor is attached to a finger or toe (like a small bandage) to measure oxygen levels.
  • Echocardiography. This painless ultrasound test uses sound waves to create pictures of the heart. Doctors can see if there are problems with the heart structure or the way it works.
  • Electrocardiogram (EKG). This is another simple, painless test designed to record the heart’s electrical activity through electrodes attached to the skin like bandages. It can also be used to diagnose and monitor heart conditions.
  • Chest X-ray. X-rays provide yet a different set of images, primarily to show whether the heart is enlarged or if the lungs have extra fluid, which may be a sign of heart failure.
  • Cardiac Catheterization. Done under general anesthesia or light sedation, this procedure can diagnose and/or repair heart defects, depending on your child’s needs. A small, flexible tube is threaded through a blood vessel in the upper thigh or neck. As a diagnostic step, special dye may be injected to allow the doctor to see how the blood flows through the heart and blood vessels. The pressure and oxygen levels inside the heart can also be measured to determine if an opening is causing blood to mix between both sides of the heart.

Treatments

About half of ASDs close without treatment. One in five ASDs will close naturally during the first year of life. Your child’s doctor may suggest careful monitoring to see if the opening closes on its own before recommending further treatment.

While some ASDs close over time, others require treatment. Options include:

  • Careful monitoring. Depending on the diagnosis, doctors may monitor children who have ASD without symptoms of heart failure. This could require regular check ups and tests to see if the defect gets smaller or closes on its own.
  • Cardiac Catheterization. Often done under general anesthesia, an interventional cardiac catheterization uses a small, flexible tube threaded through a blood vessel. Through this tube, a small device can plug the hole in the atrial septum. Once secured in place, normal tissue grows around the device and no further procedures are required. Patients usually spend one night in the hospital after having ASD closure during a cardiac catheterization.
  • Surgery. In some cases, open-heart surgery is needed to repair the ASD. While your child is asleep for the repair, a heart-lung bypass machine maintains the body’s flow of blood and oxygen. Your child may spend two to four days in the hospital afterward. Outcomes from surgery are typically very good, although there are risks from possible complications and limits on activity during recovery.

Key Points to Remember

  • An ASD is a type of congenital heart condition.
  • Symptoms may appear soon after birth, or there may be no symptoms until later in life.
  • Some ASDs resolve naturally without treatment.
  • There are several methods for detecting ASDs, including listening to the heart for murmurs or other sounds that suggest an abnormal flow of blood.
  • Treatments range from careful monitoring to more invasive procedures, such as cardiac catheterization or surgery.

Support Services & Resources

Visit the websites below to find support groups, services and learn more about atrial septal defects.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Centers for Disease Control and Prevention

This U.S. government website offers health information to help parents and caregivers research conditions such as ASD.

Medline Plus

This resource is published by the U.S. National Library of Medicine and shares information about many conditions, including ASD.

Atrial Septal Defects Research

Clinical research is vital to finding new tests to help with diagnosis and new treatments. Our pediatric cardiologists actively participate in many studies at a local and national level, including research funded by grants from the National Institutes of Health (NIH) Program Project—a major institution that studies the cause and treatment of heart conditions. Cardiologists at Riley at IU Health may ask whether you are interested in volunteering your child for participation in clinical studies.

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

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Departments Treating This Condition