The heart is the core pumping organ of the body. Its job is to circulate blood and deliver oxygen and essential nutrients all through the body. It has two sides- the right side gets deoxygenated blood returned from the body, and takes this blood to the lungs and the left side gets oxygenated blood from the lungs in order to supply the body. It consists of four chambers: the right atrium, right ventricle, left atrium, and left ventricle. The right and left atria (the upper chambers) serve as chambers for return of blood, from the body or lungs, respectively. The right and left ventricles (the lower chambers) are in charge of pumping blood into the pulmonary artery to the lungs and the aorta to the whole body, correspondingly. Specific atrioventricular valves (these AV valves are like doors controlling flow of blood in a single direction and these include the tricuspid valve on the right and the mitral valve on the left) separate the atria from the ventricles and avert the flow of blood, back into the heart during cardiac pumping.
What is an atrial septal defect ?
An atrial septal defect (ASD) occurs when there is an opening in the septum (wall) between the atria (top two chambers of the heart). When a “hole” or gap is present between the atria, some oxygen-rich blood leaks back to the right side of the heart and goes back to the lungs. This causes a significant increase in the blood that goes back to the lungs, thereby increasing the pulmonary or lung pressure. So an atrial septal defect may be defined as an anomaly arising from birth of the atrial septum that permits a movement and mixing of the blood between the two atria (the two upper chambers of the heart) when actually it is not supposed to.
What are the types of atrial septal defects (ASDs) ?
ASDs are classified based on location of the defect within the atrial septum or the wall between the atria.
- Secundum ASD : The first type, secundum atrial septal defects comprises the majority of atrial septal defects and are located in and around the centre of the atrial septum.
- Primum ASD : This is a hole in the inferior or lower part of the atrial septum (wall) and is seen in combination with a atrioventricular valve (door between the upper and lower chamber) malformation dividing the left atrium from the left ventricle.
- Sinus Venosus ASD : Where the defect is situated very high, near entry of the great veins (superior vena cava- SVC or inferior vena cava- IVC). These veins are the largest veins returning blood from the entire body to the heart.
- Patent Foramen Ovale : The type with some flap valve tissue remaining (patent foramen ovale or PFO) is seen in newborn infants, generally but tends to close of its own accord over the initial few weeks and months. A Patent Foramen Ovale could remain open in a few cases but if small (less than 3mm) it is insignificant and should be considered as a normal finding.
What are the causes of atrial septal defects (ASDs) ?
Presently, the precise cause of atrial septal defects is still unknown. It is likely that genetics may have a contributing role in the appearance of heart defects, in simple terms, that if a person had a congenital heart defect, he or she has a bigger possibility of having a child with a heart defect. Disruption at any point of the mother’s pregnancy during the heart formation stage can result in this type of septal heart defect. The causes can be attributable either to genetics or to the environment, or sometimes to a combination of both.
What are the signs and symptoms of atrial septal defects (ASDs) ?
The vast majority of small atrial septal defects are asymptomatic in infancy and childhood, and they are found mostly upon hearing an incidental murmur, by placing a stethoscope on the chest. But, this anomaly, if increased in size, may give rise to serious symptoms and disabilities, which commonly appear in childhood itself. Growth is typically retarded with weight of the child lower than normal. Shortness of breath is common, especially on exercising and chest infections commonly occur. The heart is frequently enlarged, depending on the severity of the septal defect. The presence of pulmonary hypertension (Pulmonary hypertension is increased blood pressure in the arteries to your lungs, making your heart work twice as hard, subsequently causing heart failure in the long run), and increased blood flow to the lungs due to the hole in the atria can
occur.
How are atrial septal defects (ASDs) diagnosed ?
A paediatric cardiologist has to be consulted. The doctor will detect a different type of murmur/heart sound that what is heard normally. Murmurs are the heart sounds that doctors pick up on the stethoscope. A systolic murmur (heart sound during systole) is easily heard. An apical diastolic murmur can also be heard owing to turbulent flow across the tricuspid valve between the right atrium and the right ventricle. The electrocardiogram and X-rays both often show right ventricular hypertrophy (increase in the size of right ventricle), even right atrial hypertrophy (increase in the size of right atria) and increased pulmonary blood flow (or blood flow to the lungs). Size of the defect, its exact location and measurement can often be assessed accurately by an echocardiogram. Cardiac catheterization and angiocardiography help to confirm the diagnosis.
Catheterization is an invasive tool that gives an accurate measurement of blood flow and shunting to the lungs. Angiocardiography is seeing the heart and great vessels after injecting a liquid radiocontrast dye, typically containing iodine, into the bloodstream, and then taking X-rays.
How are atrial septal defects (ASDs) treated ?
Your child’s doctor(s) will talk about suitable treatment options with you. Without treatment, more medical problems may build up, including lung disease and heart disease.
Small atrial septal defects or the patent foramen ovale will seal up spontaneously. This can take its own time but it is recommended to be monitored by a cardiologist all through this phase. Larger defects will not close by themselves and will require closure.
- Catheterization and closure of the atrial septal defect by a device: The child or adult is anesthetized and a needle is inserted into the blood vessel at the apex of the leg. A narrow tube (called a catheter) is inched up the vein into the heart. The device, to seal the defect is guided through the centre of the tube and positioned across the defect or hole. This is done with trans-esophageal guidance (the proximity of the esophagus or the food tube to much of the heart and great vessels makes it an excellent ultrasonic window). The device will then remain in the heart and become part of it.
- Surgical Repair: Open-heart surgery and repair of the hole in the heart is the preferred mode of treatment for larger atrial septal defects. This will be done under general anesthesia. The average hospital stay, post surgery, is 3 to 4 days duration. Your cardiologist and medical care team at the hospital will explain to you how to carry out home care for your child. Medicines will be given for post-operative pain and recovery.
What is the after-care following surgery for atrial septal defect ?
Your child can leave the hospital 3 to 4 days after surgery, in case of no complications. In the first few days at home, it is important for your child to get good bed rest. The period that a child takes to heal for this surgery is about 6 weeks. Following that period, your child should be completely recovered and able to start with their normal activities. For the first six months after catheterization or surgical closure of an atrial septal defect,
antibiotics are suggested before routine dental work or surgical procedures to avoid infective endocarditis (an infection of the inner layers of the heart). When the heart tissue has healed over the closed hole, then there is no longer a need to worry about the risk of infective endocarditis.
What is the outcome of atrial septal defects (ASDs) treatment ?
The outcome depends on the sub-type of atrial septal defect. The outcome for small to moderate defects, is in most cases, excellent. Most of these children lead normal lives with no symptoms or complaints. In situations where the hole is revealed and treated in later adulthood, some of the medical problems with the heart may still persevere, even after treatment. The first type of atrial septal defect, the Ostium secondum (a defect only in the center of the atrial wall) has a brilliant prognosis, although the ostium primum (a defect in the lower part of
atrial wall as well as the atrioventricular valve) may require slightly prolonged treatment.
How to find pediatric cardiologists for the treatment of atrial septal defects ?
Now you can find pediatric cardiologists for the treatment of atrial septal defects from different hospitals and destinations for the treatment of atrial septal defects . You can avail opinions from multiple pediatric cardiologists, get approximate cost for the treatment of atrial septal defect from various heart hospitals, compare things and then choose a pediatric cardiologist for the treatment of atrial septal defect. Find a pediatric heart surgeon for the treatment of atrial septal defect on Hinfoways. Make an informed choice.
Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
