E-mail Form
Email Results

 
 
Print-Friendly
Bookmarks Save as Bookmark
bookmarks-menu

Atrial septal defect (ASD)

Congenital heart defect - ASD; Birth defect heart - ASD; Primum ASD; Secundum ASD

Atrial septal defect (ASD) is a heart defect that is present at birth (congenital).

As a baby develops in the womb, a wall (septum) forms that divides the upper chamber into a left and right atrium. When this wall does not form correctly, it can result in a defect that remains after birth. This is called an atrial septal defect, or ASD.

Causes

Normally, blood cannot flow between the two upper heart chambers. However, an ASD allows this to happen.

When blood flows between the two heart chambers, this is called a shunt. Blood most often flows from the left to the right side. When this happens the right side of the heart enlarges. Over time pressure in the lungs may build up. When this happens, the blood flowing through the defect will then go from right to left. If this occurs, there will be less oxygen in the blood that goes to the body.

Atrial septal defects are defined as primum or secundum.

  • The primum defects are linked to other heart defects of the ventricular septum and mitral valve.
  • Secundum defects can be a single, small or large hole. They may also be more than one small hole in the septum or wall between the two chambers.

Very small defects (less than 5 millimeters or ¼ inch) are less likely to cause problems. Smaller defects are often discovered much later in life than larger ones.

Along with the size of the ASD, where the defect is located plays a role that affects blood flow and oxygen levels. The presence of other heart defects is also important.

ASD is not very common.

Symptoms

A person with no other heart defect, or a small defect (less than 5 millimeters) may not have any symptoms, or symptoms may not occur until middle age or later.

Symptoms that do occur may begin at any time after birth through childhood. They can include:

Exams and Tests

The health care provider will check how large and severe an ASD is based on the symptoms, physical exam, and the results of heart tests.

The provider may hear abnormal heart sounds when listening to the chest with a stethoscope. A murmur may be heard only in certain body positions. Sometimes, a murmur may not be heard at all. A murmur means that blood is not flowing through the heart smoothly.

The physical exam may also show signs of heart failure in some adults.

An echocardiogram is a test that uses sound waves to create a moving picture of the heart. It is often the first test done. A Doppler study done as part of the echocardiogram allows the health care provider to assess the amount of shunting of blood between the heart chambers.

Other tests that may be done include:

  • Cardiac catheterization
  • Coronary angiography (for patients over 35 years old)
  • ECG
  • Heart MRI or CT
  • Transesophageal echocardiography (TEE)

Treatment

ASD may not need treatment if there are few or no symptoms, or if the defect is small and is not associated with other abnormalities. Surgery to close the defect is recommended if the defect causes a large amount of shunting, the heart is swollen, or symptoms occur.

A procedure has been developed to close the defect (if no other abnormalities are present) without open heart surgery.

  • The procedure involves placing an ASD closure device into the heart through tubes called catheters.
  • The health care provider makes a tiny cut in the groin, then inserts the catheters into a blood vessel and up into the heart.
  • The closure device is then placed across the ASD and the defect is closed.

Sometimes, open-heart surgery may be needed to repair the defect. The type of surgery is more likely needed when other heart defects are present.

Some people with atrial septal defects may be able to have this procedure, depending on the size and location of the defect.

People who have a procedure or surgery to close an ASD should get antibiotics before any dental procedures they have in the period following the procedure. Antibiotics are not needed later on.

Outlook (Prognosis)

In infants, small ASDs (less than 5 mm) will often not cause problems, or will close without treatment. Larger ASDs (8 to 10 mm), often do not close and may need a procedure.

Important factors include the size of the defect, the amount of extra blood flowing through the opening, the size of the right side of the heart, and whether the person has any symptoms.

Some people with ASD may have other congenital heart conditions. These may include a leaky valve or a hole in another area of the heart.

Possible Complications

People with a larger or more complicated ASD are at an increased risk for developing other problems, including:

When to Contact a Medical Professional

Contact your provider if you have symptoms of an atrial septal defect.

Prevention

There is no known way to prevent the defect. Some of the complications can be prevented with early detection.

References

Liegeois JR, Rigby ML. Atrial septal defect (interatrial communication). In: Gatzoulis MA, Webb GD, Daubeney PEF, eds. Diagnosis and Management of Adult Congenital Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 29.

Silvestry FE, Cohen MS, Armsby LB, et al. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr. 2015;28(8):910-958. PMID: 26239900 pubmed.ncbi.nlm.nih.gov/26239900/.

Sodhi N, Zajarias A, Balzer DT, Lasala JM. Percutaneous closure of patent formen ovale and atrial septal defect. In: Topol EJ, Teirstein PS, eds. Textbook of Interventional Cardiology. 8th ed. Philadelphia, PA: Elsevier; 2020:chap 49.

Valente AM, Dorfman AL, Babu-Narayan SV, Krieger EV. Congenital heart disease in the adolescent and adult. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 82.

  • Congenital heart defects (CHD) overview

    Congenital heart defects (CHD) overview

    Animation

  •  

    Congenital heart defects (CHD) overview - Animation

    Congenital heart disease describes defects of the heart or its vessels that are present at birth. They are the most common types of birth defect, affecting 1 out of every 120 babies. Some heart defects are severe, but many are not, ranging from simple defects with no symptoms, to complex defects with severe life-threatening symptoms. Each year, more than 35,000 babies in the United States are born with congenital heart defects. Most are simple defects that are easily corrected or do not need treatment. However, a small number of babies are born with complex heart defects and require special medical attention soon after birth. Over the past few decades, the diagnosis and treatment of these complex defects has greatly improved. Thanks to new and effective treatments, almost all children with complex heart defects grow to adulthood and can live active, productive lives. Most of these patients will nonetheless continue to need special heart care throughout their lives. Living with a congenital heart disease can also impact health insurance, employment, pregnancy, contraception, and the risk of infection during routine health procedures. Today, approximately 1 million American adults are living with congenital heart defects.

  • Atrial septal defect

    Atrial septal defect - illustration

    An atrial septal defect is a congenital heart defect where the wall between the right and left atria does not close properly, leaving a hole between the two atria.

    Atrial septal defect

    illustration

  • Congenital heart defects (CHD) overview

    Congenital heart defects (CHD) overview

    Animation

  •  

    Congenital heart defects (CHD) overview - Animation

    Congenital heart disease describes defects of the heart or its vessels that are present at birth. They are the most common types of birth defect, affecting 1 out of every 120 babies. Some heart defects are severe, but many are not, ranging from simple defects with no symptoms, to complex defects with severe life-threatening symptoms. Each year, more than 35,000 babies in the United States are born with congenital heart defects. Most are simple defects that are easily corrected or do not need treatment. However, a small number of babies are born with complex heart defects and require special medical attention soon after birth. Over the past few decades, the diagnosis and treatment of these complex defects has greatly improved. Thanks to new and effective treatments, almost all children with complex heart defects grow to adulthood and can live active, productive lives. Most of these patients will nonetheless continue to need special heart care throughout their lives. Living with a congenital heart disease can also impact health insurance, employment, pregnancy, contraception, and the risk of infection during routine health procedures. Today, approximately 1 million American adults are living with congenital heart defects.

  • Atrial septal defect

    Atrial septal defect - illustration

    An atrial septal defect is a congenital heart defect where the wall between the right and left atria does not close properly, leaving a hole between the two atria.

    Atrial septal defect

    illustration


Review Date: 1/9/2022

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
© 1997- adam.com All rights reserved.

 
 
 

 

 

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.
Content is best viewed in IE9 or above, Firefox and Google Chrome browser.