Atrial Septal Defect

8 min readJun 4, 2019

Article context:

ASD:

ASD is a congenital heart defect in the wall that separates the two upper chambers (atrial septum) of the heart. This wall is called atrial septum. A small opening/hole between the two atria is present at birth, usually is close off afterwards. The hole causes oxygen-rich blood leakage from the left side of the heart to the right side, that means excess blood flow from the right ventricle to the lungs due to extra work on the right side of the heart.

Symptoms of Atrial Septal Defect:

Difficulty breathing in childhood
Frequent respiratory infections in children
Irregular heartbeat in adults
Shortness of breath

Symptoms of ASD may resemble other medical problems or the heart problems. So, it is important to consult best pediatric cardiologist / cardiothoracic surgeon for further diagnosis .

Types of ASD:

There are several types of Atrial Septal Defect based on occurred area and size.

For example, a secundum ASD is a hole present in the center of the atrial septal. which makes the blood flow from left to right Chamber or right to left chambers based on the pressures in the atria. Both chambers blood mixes together causing the heart to work less efficiently.

Types of ASD closure are classified based on the location. Here are the details:

Ostium Secundum Atrial Septal Defect:

An ostium secundum ASD is a hole in the center of the atrial septum.

Generally, the left side pumps oxygen-rich blood to the body, while the right side of the heart pumps oxygen-poor blood to the lungs. An Ostium Secundum atrial septal defect (ASD) allows blood mix from both sides, that decreases work efficiency of the heart.

A small size hole may not cause many problems. A larger hole can cause a series of problems such as respiratory infections, shortness of breath, irregular heart rhythms, fainting and may leads to pulmonary artery hypertension or heart failure.

Patent Foramen Ovale:

Patent means after birth and foramen ovale means a hole in the heart.

Naturally, a small hole present in babies hearts who is still in the womb for fetal circulation and it will close soon after birth. If it doesn’t close properly, that condition is called a patent foramen ovale.

Majority of the patient with a PFO don’t have any particular signs or symptoms. However, the condition may play a role in migraine headaches and it increases the risk of Transient ischemic attack, stroke and heart attack.

It’s better to have regular check with a pediatric cardiologist nearby.

Ostium Primum Atrial Septal Defect:

Ostium primum atrial septal defect also known as endocardial cushion defect. an ostium primum atrial septal defect is a defect in the atrial septum at the level of the tricuspid and mitral valves.

Sinus venosus atrial septal defect:

Sinus venosus atrial septal defects are diagnosed upon detection of a heart sound produced when the blood flow of the heart valves, a fixed split second heart sound, and/or right heart enlargement on chest x-ray or electrocardiogram (ECG) in the usually asymptomatic patient.

Single atrium ASD:

It is a rare congenital heart disease in which there is the developmental absence of both septum primum and secundum part of the atrial septum.

Diagnosis of Atrial Septal Defect:

Your pediatrician may suspect heart defect or atrial septal defect while listening to heart murmur using stethoscope during a regular checkup.

If cardiologist / cardiothoracic surgeon suspects you or your child has a heart defect, the doctor may request one or more of the following tests:

Treatments:

Most atrial septal defects close on their own during the growth of children. For that atrial septal defects (ASD) don’t close, some small ASD don’t cause any problems and do not require any surgery.

If the atrial septal defects (ASD) size is large then it required surgery to be corrected.

In the olden days, for ASD closure surgery required open heart surgery and patients need to stay three to five days in the hospital. Nowadays cardiothoracic surgeon is doing a small insertion ASD Closure surgery also popularly known as minimal invasive ASD Closure surgery. Although, ASD closure surgery isn’t recommended if you have severe pulmonary hypertension because it might make the condition worse.

After diagnosis, most of the cardiologist/cardiothoracic surgeons will recommend repairing an atrial septal defect (ASD) during childhood to prevent further complications.

For adults or children, the cardiothoracic surgeon will evaluate the condition and determine which procedure is the most appropriate to the patient.

2 Methods of Atrial Septal Defect Repair:

Cardiac Catheterization | Open-Heart ASD Surgery | Follow-up Care

Cardiac Catheterization:

In this procedure, a cardiologist / cardiothoracic surgeon inserts a thin tube (catheter) into a blood vessel in the groin and guide it to the heart using imaging techniques. Through the cardiac catheter, cardiothoracic surgeon/cardiologist set a mesh patch or plug into place to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.

This type of procedure may be done to repair only the secundum atrial septal defects (ASD) type. Some large secundum ASD surgery may not be able to be repaired through cardiac catheterization and may require open-heart surgery.

Open-Heart ASD Surgery:

This type of surgery is performed under general anesthesia with the usage of a heart-lung machine by a small incision in the chest, surgeons use patches to close the hole. This procedure is the preferred treatment for certain types of atrial septal defects (premium, sinus venosus, and coronary sinus), and these types of atrial defects can only be repaired through open-heart surgery.

Doctors use imaging techniques after the defect has been repaired to check the repaired area.

Follow-up Care:

Follow-up care depends on the type of defect and whether other defects are present. Repeated echocardiograms are done after hospital discharge, one year later and then as requested by your or your cardiologist / cardiothoracic surgeon. For simple atrial septal defects closed during childhood, only occasional follow-up care is generally needed.

Adults who have had atrial septal defect repair need to be monitored throughout life to check for complications, such as

Pulmonary hypertension
Arrhythmias
Heart failure or valve problems.
Follow-up exams are typically done on a yearly basis.

Get expert opinion with our chief cardiothoracic surgeon (Adult and Pediatrics)

Frequently Asked Questions:

What is ASD full form?

ASD full form is Atrial Septal Defect.

What would be the cost of ASD Closure surgery?

Generally, the cost of ASD closure surgery package would be around in between 2.5 lakh to 3.5 lakh Indian Rupees depends on the type of surgery (Minimally invasive surgery and open heart surgery) suitable to patient and types of room chosen (Single room, twin sharing, general ward).

Package Includes:

Surgeon Fees
Anesthesia charges
Room charges
Asst. Doctors fees
Implant charges
Operation theatre charges
Nurses fees
Medication charges during hospitalization
Physiotherapy charges (If required)

How can I prepare for my ASD closure?

You need to contact the cardiology team with your admission letter given by the cardiothoracic surgeon to make and confirm the availability of doctor and admission arrangements.

Get information with the cardiac team about what you need to do, and what are the medications to be taken and what you should bring with you before coming to the hospital.

Will I feel any pain?

The patient will not feel any pain during the surgery/operation because this procedure takes place under general anesthesia. The patient may feel some discomfort after the surgery for a shorter duration of time.

What happens after the ASD closure surgery?

After the ASD closure surgery, for the few hours patient will be attached to cardiac monitor machine, that allows us to see your heart rate and rhythm and likewise an electrical sensor will attach to finger to monitor the oxygen level in your blood.

What a patient needs to do after reached home?

Before leaving the hospital, Get the medical prescription from the doctor to make sure you know how long you should continue taking medicines because the doctor will provide certain medicine to thin your blood and stop large clots forming on the device.

You can get back to full activity, including driving, within 1–2 week. If you want to do any physical work, get advice from the doctor when you can go back to work.

Will I have a follow-up appointment?

Yes, our cardiac doctor/team will inform you, when to visit the doctor again at Medicover Hospitals after the procedure. In general after 1 month, 3 months.

Providing all is well, you will then need to come back for yearly heart check-ups (which includes generally 2D Echo, CBP, Serum Creatinine, CUE, ECG, TMT, Lipid Profile, X-ray Chest PA view, FBS, PLBS and Free Consultation with cardiologist and dietitian).

Book a Complete Heart Checkup / Comprehensive Heart Check-up Package at Medicover Hospitals in Hyderabad

Diet Control After Heart Surgery?

Control Sodium Intake (Salt):

Cardiac patients should limit the intake of salt to no more than 2000 milligrams per day.otherwise it increases the blood pressure and creates excessive stress on the heart.

As per American Heart Association guidelines, cardiac doctors may limit this to 1500 milligrams per day for heart patients.

Foods to Avoid:

Eating healthy foods is more essential for heart patient after heart surgery to supply adequate nutrients to your body while maintaining a healthy weight. obesity creates stress in the heart due to more amount of oxygen is required to pump blood throughout your body.
The daily patient should limit the sugar content foods and 30 percentage fat foods because some medicines may increase the amount of fat in your blood.
Don’t eat meat more than 3 oz per day and patients should consume less than 300 milligrams of dietary cholesterol per day.
Don’t take cheese, which contains more amount of saturated fat. Instead of that, choose low-fat cheeses such as farmer’s cheese, low-fat cottage cheese, and part-skim ricotta.

Foods to Add in Diet:

Choose foods like beans, fish (oily fish), peas and skinless poultry. which contains protein without an excessive amount of cholesterol.
You can take oily fish twice a week which contains heart-healthy fats.
You should also include skim milk and nonfat yogurt daily contain low-fat.
You can take whole grains in your diet contains rich carbohydrates.
You can consume as much as fat-free fruits and vegetables.

Citations:

Atrial Septal Defect, by Lewis Dexter, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC479579/
Atrial Septal Defects, by D. Evan Bedford, Cornelio Papp, and John Parkinson, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC503458/
Atrial Septal Defect, by Shahbudin H. Rahimtoola, from http://circ.ahajournals.org/content/38/1S5/V-2.short
Secundum Atrial Septal Defect Nonoperative Closure During Cardiac Catheterization, from https://jamanetwork.com/journals/jama/fullarticle/346030
A prosthetic device for atrial septal defect repair, from https://patents.google.com/patent/US5507811A/en
A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults, from http://www.nejm.org/doi/full/10.1056/NEJM199508243330801

Originally published at https://www.medicoverhospitals.in/atrial-septal-defect/