Atrial Septal Defect

Atrial Septal Defect (ASD) is a deformity of the heart in which the wall separating the upper heart chambers does not close completely. This opening in the heart is present in all foetuses and eases pressure on the baby’s lungs and helps in strengthening them. Around the time of birth, this wall closes completely. Atrial septal defect can be described as an abnormal opening between the right and the left atrium.

The heart has two auricles on the upper part and two ventricles on the lower part. The impure blood flows into the right auricle and then on to the right ventricle. Impure blood flows on to the lungs and after being oxygenated, moves back into the left auricle, then through the left ventricle to other parts of the body. In a child with ASD, some part of the oxygenated blood flows from the left auricle to the right auricle. The pressure on the right auricle and lungs due to excess flow of blood builds up leading to shortness of breath.

Symptoms:
 
Depending upon the severity of the hole in the partition, the child may exhibit some or all of the following symptoms:
  • Poor appetite
  • Retarded growth
  • Respiratory problems
  • Abnormal heart rhythm
Symptomatic patients are generally treated immediately after the symptoms are detected. Symptoms include shortness of breath, rapid breathing and difficulty in feeding, poor weight gain or poor exercise tolerance.
 
Asymptomatic patients who have increase in pulmonary blood flow of more than 50% are electively treated surgically, normally between the ages of two and four.

Diagnosis:
 
A paediatrician may diagnose ASD by listening to the heart murmur. Other diagnostic tools include a chest x Ray, and echo cardiogram.

Treatment:
 
Once ASD is diagnosed, the course of treatment is decided based upon the severity of the problem. In 20 per cent of cases, the partition closes on its own. In other cases, cardiac cauterization or open heart surgery is called for. This should be done within the first 4-5 years.

In a cardiac cauterization, a catheter is inserted through an incision in the groin into the blood vessel leading to the heart. A special implant is introduced through the catheter, placed over the holes and the ASD is sealed. Over time, normal heart tissue grows over the implant and covers it completely. To prevent clot formation, a course of medication may be prescribed.
 
In an open heart surgery procedure, the surgeon cuts into the thoracic cavity to reach the heart. Blood circulation is diverted to a heart lung machine. Surgical material is placed over the ASD and sewn into place. Over time, the heart tissue covers the ASD completely. Wide spectrum antibiotics and anti-clotting medication is prescribed after an open heart procedure.

With advances in modern science, most children with ASD go on to lead long, active and healthy lives.



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