What is an Atrial Septal Defect?

An opening between the atria is called an atrial septal defect (ASD). Blood passes through the lungs more frequently because of this opening. The condition exists from birth and it also comes under congenital heart disease. (Read the article on Heart Valve Experts on Congenital Heart Disease for more details). Small atrial septal defects could be discovered by accident and never be a problem. Others often are closed during early childhood or infancy. The heart and lungs can suffer harm from a significant, persistent atrial septal defect. An atrial septal defect may require surgery to be fixed to avoid consequences.

What are the types of ASD?

There are several types of ASD which are categorized based on anatomy and pathophysiology. Ostium Secundum is the most typical ASD is this one. The midpoint of the wall separating the upper heart chambers is where it appears (atrial septum). Ostium Primum is a particular ASD that may coexist with other congenital heart abnormalities and affects the bottom portion of the atrial septum. Regarding sinus venosus, the upper portion of the wall dividing the heart chambers is where this uncommon kind of ASD typically manifests. It is linked to other birth-related alterations in the heart’s structure. When it comes to the coronary sinus,  part of the wall between the coronary sinus, which is a component of the heart’s venous system, and the left atrium is absent in this uncommon form of ASD.

Clinical context of ASD

Even though there are a lot of babies born with ASD who are asymptomatic, their signs and symptoms may appear later in their adulthood. Fatigue, shortness of breath, particularly when engaged in exercises, oedema of the lower limbs, palpitations, arrhythmias, and cardiac murmurs like the fixed splitting of the second heart sound in the pulmonary area are among few of the clinical features of patients having ASD. Large septal defects are often diagnosed before birth or soon after birth. Risk factors are common to most congenital heart diseases.

Echocardiogram, chest X-ray, Computed Tomography (CT) scan, electrocardiogram (ECG) and Cardiac Magnetic Resonance Imaging (MRI) scan are the tests performed to diagnose ASD. You can access these investigations in Heart Valve Experts

Treatments for ASD

During childhood, many atrial septal abnormalities close on their own. Some tiny atrial septal abnormalities may not require treatment even if they do not close. A cardiologist might advise keeping track of it with routine physicals to determine if it closes on its own.

Medications can aid in reducing the signs and symptoms of patients with ASD. They include medications like beta blockers to control heart rate or anticoagulants to aid in reducing the risk of thrombus formation.

When an adult or child is identified with a medium-sized atrial septal defect, many cardiologists advise surgery to fix it to avoid further difficulties. ASD repair surgery involves sealing up the heart defect in both adults and children. There are two ways in the current practice to do this. In open heart surgery, the chest wall is cut through to gain direct access to the heart. Then the defect is patched up by the surgeons. The only treatment for primum, sinus venosus, and coronary sinus atrial abnormalities is this open-heart repair procedure.

Only atrial septal abnormalities of the secundum type are repaired using catheters. However, some big secundum atrial septal abnormalities may need open heart surgery. Regarding the repair using a catheter, Imaging methods are used to direct a thin, flexible tube (catheter) to the heart after it has been put into a large artery like the femoral artery, in the groin region. To plug the defect, a mesh patch or plug is inserted through the catheter. The defect is permanently sealed as heart tissue develops around the seal. Robot-assisted heart surgery and minimally invasive surgery are among the other methods available to repair ASD

In summary

ASD is a relatively common congenital heart disease. Apart from the conventional treatment methods, there are new emerging treatment modalities like robot-assisted surgery to make the life of patients with ASD better. More advancements would be seen in the near future.

References

• Isolated atrial septal defects (ASDs) in children: Classification, clinical features, and diagnosis – UpToDate. Accessed August 7, 2022. https://www.uptodate.com/contents/isolated-atrial-septal-defects-asds-in-children-classification-clinical-features-and-diagnosis?search=asd&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1