Atrial Septal Defect (ASD)

Introduction

Atrial Septal Defect (ASD) is a congenital heart defect that occurs when there is an abnormal opening in the interatrial septum, the wall that separates the left and right atria of the heart. This condition allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium, leading to increased blood flow to the lungs and possible complications over time.

Types of Atrial Septal Defects

There are different types of ASD, including:

• Secundum ASD: The most common type, occurring in the middle of the atrial septum.
• Primum ASD: Located near the atrioventricular valves and often associated with other congenital anomalies.
• Sinus Venosus ASD: Located near the superior or inferior vena cava.
• Coronary Sinus ASD: A rare form where the wall between the coronary sinus and left atrium is incomplete.

Symptoms

ASD may be asymptomatic in childhood and diagnosed later in life. Common symptoms include:

• Shortness of breath, especially during physical activity
• Fatigue
• Heart palpitations or arrhythmias
• Frequent respiratory infections
• Heart murmur (detectable by a physician)

Diagnosis

ASD is diagnosed using:

• Echocardiography (ultrasound of the heart)
• Electrocardiogram (ECG)
• Chest X-ray
• Cardiac MRI or CT Scan (in complex cases)
• Cardiac catheterization (if additional evaluation is needed)

Treatment

Treatment depends on the size of the defect and whether it causes significant heart problems. Options include:

• Monitoring: Small ASDs may close spontaneously and require only periodic follow-ups.
• Medication: While ASD itself cannot be treated with drugs, medications may be used to manage symptoms such as arrhythmias or pulmonary hypertension.
• Catheter-Based Closure: Minimally invasive procedure using a closure device to seal the hole.
• Surgical Repair: Required for large ASDs or complex defects, involving patch closure via open-heart surgery.

Complications

If left untreated, ASD can lead to:

• Pulmonary hypertension (high blood pressure in the lungs)
• Right heart enlargement and heart failure
• Atrial arrhythmias (such as atrial fibrillation)
• Stroke (due to paradoxical embolism)

Conclusion

Early diagnosis and appropriate management of ASD improve life expectancy and quality of life. If you or a loved one have been diagnosed with ASD, consult a cardiologist for the best treatment plan.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines for the Management of Adults with Congenital Heart Disease

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000603
2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/08/13/16/26/2018-AHA-ACC-Guideline-for-the-Management-of-ACHD
3. https://pubmed.ncbi.nlm.nih.gov/30121240/
4. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
5. https://www.sts.org/sites/default/files/Endorsed%20Guidelines/2018%20Guideline%20for%20Management%20of%20Adults%20with%20CHD.pdf

2. European Society of Cardiology Guidelines on Adult Congenital Heart Disease

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Grown-Up-Congenital-Heart-Disease-Management-of
2. https://academic.oup.com/eurheartj/article/42/6/563/5898606
3. https://pubmed.ncbi.nlm.nih.gov/32860028/
4. https://www.jacc.org/doi/10.1016/j.jacc.2021.09.010
5. https://pubmed.ncbi.nlm.nih.gov/34736567/