Atrial Septal Defect

Atrial Septal Defect

An atrial septal defect (also called an ASD ) is what doctors call a hole in the septum that occurs between the atria. The hole is not a problem before birth, but if it does not heal, it can sometimes cause problems.

What is an atrial septal defect?

Doctors refer to the hole that can be seen in the septum between the atria as the “foramen ovale”; however, this closes by itself a few weeks after birth. For keratosis follicularis spinulosa decalvans (kfsd), please visit nonprofitdictionary.com.

If not, it is called an atrial septal defect. Strictly speaking, it is a congenital malformation.

About ten percent of all heart defects are an atrial septal defect.

The atrial septal defect is one of the shunt defects and usually does not cause any symptoms until the age of 50 or 60.

Causes

Blood flows from the left (left atrium) to the right (right atrium) directly across the atrial septal defect. This is because there is higher pressure in the left atrium of the heart. After the blood is in the right atrium, it is passed directly into the pulmonary artery via the main chamber.

Due to the atrial septal defect, however, there is a volume load, so that the right main chamber and the right atrium enlarge. The lungs are subsequently flooded. However, unlike in the case of a ventricular septal defect, there is no risk of pulmonary hypertension (pulmonary high pressure) developing.

Symptoms, Ailments & Signs

People who are affected by an atrial septal defect, if there is only a very small connection between the two atria, have no symptoms – before the age of 50. However, it is the increasing loss of performance with age that sometimes causes complaints. However, large openings can already cause problems in infancy. The patients are tired more quickly and also show an enormous reduction in performance.

Shortness of breath, especially associated with physical exertion, is another sign of an atrial septal defect. A blood clot can form due to the changed blood flow and pressure conditions. For this reason, there is also the risk that the thrombi will move directly through the atrial septal defect and get from the right to the left atrium and then be transported directly into the systemic circulation.

Possible consequences are clogged cerebral vessels, which subsequently cause a stroke. Above all, those affected are more susceptible to any infectious diseases that occur primarily in the respiratory tract. The prognosis is good. The course of the disease can be shaped so positively by therapy that the atrial septal defect is completely eliminated and the danger of any thrombosis no longer exists.

Diagnosis & course of disease

The doctor can relatively quickly express the suspicion that it is an atrial septal defect. Above all, the heart sounds (when listening) or the typical characteristics that the patient describes allow the conclusion that an atrial septal defect is sometimes present. If the patient does not complain of any symptoms, the diagnosis can still be made – but purely by chance, as part of a routine examination of the heart.

An ultrasound examination is necessary so that the doctor can prove that there is an atrial septal defect. Ultrasound or echocardiography can be used to show blood flow through the opening. Due to the additional stress, the atrial septal defect can also be seen on the X-ray image.

The doctor sees a significant enlargement of the right side of the heart. X-rays also show enlarged arteries. As a rule, however, the doctor stays with the ultrasound examination, since he can precisely identify the defect here. Sometimes there is also the possibility that the effects are already recognized or how enlarged the right side of the heart is and how large the opening actually is, which ultimately represents the problem.

Complications

In most cases, this disease does not cause symptoms or complications until relatively old age. For this reason, the disease is only recognized and treated very late. Those affected suffer from severe fatigue and exhaustion.

The performance drops significantly and the patients can no longer easily carry out normal everyday activities. It is also no longer possible to carry out sporting activities. Furthermore, an infarction can occur in the brain or in the heart and those affected often develop infections or inflammation. The respiratory tract in particular can be affected, so that breathing difficulties can often occur.

The patient’s quality of life is significantly reduced and limited by the disease. In most cases, this is treated with surgery. The earlier the disease is diagnosed, the higher the probability of a positive course of the disease. However, the life expectancy of those affected may be reduced by the disease. Those affected are still dependent on regular examinations by doctors in order to avoid complications.

When should you go to the doctor?

In the case of an atrial septal defect, the affected person is usually always dependent on a medical examination and treatment by a doctor so that there are no further complications or a further deterioration of the symptoms. The sooner a doctor is contacted, the better the further course of this disease is usually. The affected person should therefore consult a doctor as soon as the first symptoms and signs appear. In the worst case, the disease can lead to death if left untreated.

A doctor should be consulted for an atrial septal defect if the person affected frequently suffers from shortness of breath. These symptoms can occur especially under stress or during strenuous physical exertion. The susceptibility to infections also increases. If the patient falls ill very frequently, this can also indicate an atrial septal defect. With these symptoms, a general practitioner, an internist or a cardiologist can be consulted. In most cases, the disease is treated by surgery.

Treatment & Therapy

If there is a malformation due to the atrial septal defect – for example in the form of an enlargement of the right side of the heart – the connection must be closed. Even if no change in the heart is visible, but the patient complains about the typical symptoms. Closure of the defect is possible – in two ways.

For years, the connection has been closed as part of a small operation. The doctor inserts a thin wire through the groin vein, which is pushed to the right atrium. The doctor attaches two closed umbrellas to the tip of the wire beforehand. Those are pushed between the opening until they succumb there. The doctor then opens the umbrella, so to speak, stretches it open and can thus close the opening. This operation is a very simple and gentle procedure.

Another option is to sew up the opening or close it with “plastic patches”. That technique is only possible in conjunction with major heart surgery; During the procedure, the patient must be repeatedly connected to the heart-lung machine. After that procedure, the long recovery time is particularly important. This procedure is a major operation and is mainly carried out when the opening is relatively large or when there are already major problems.

Prevention

Since it is a congenital heart defect, no preventive measures can be taken. Once the atrial septal defect has been diagnosed, however, the treatment must be discussed with the doctor. If the defect remains untreated and causes symptoms, other diseases (stroke) can occur, which could have been prevented.

Aftercare

Follow-up care is required if the atrial septal defect is treated surgically. After the procedure, the patient is transferred to the hospital’s intensive care unit, where they are observed and treated. The patient is usually given medication to prevent blood clotting. These are usually heparin or marcumar.

The heparin is given intravenously over 24 hours. A dangerous blood clot that can cause a stroke can be prevented in this way. The patient also has to take acetylsalicylic acid (ACC) like aspirin every day for around six months. He receives a special pass for the Macumar treatment.

The doctors also check the coagulation values ​​at regular intervals. It is important to limit the intake of vitamin K, which is found in salads, for example. This procedure counteracts an increase in blood clotting.

Because infections such as common tooth or throat infections or skin diseases can damage the heart valves, antibiotics are required if necessary. In order to promote the healing process, light sporting activities are considered useful. However, the patient must not overdo it. In addition, the consent of the doctor is required. Rehabilitation can also be helpful for follow-up care. In addition, regular check-ups such as measuring blood pressure or an ECG are carried out.

You can do that yourself

An atrial septal defect must be surgically closed. The most important personal measure consists of monitoring the health of the child. Parents of affected children need to be alert for unusual symptoms and signs. If there is a reduction in performance or even cardiovascular problems, the doctor must be consulted immediately. Further measures can be discussed with the doctor, through which the atrial septal defect can be closed and the child can lead a normal life.

Since a surgical intervention must be carried out as early as possible in order to improve the prognosis, an examination should take place quickly if there is a suspicion. When the child is older, they can be told about the condition. Medical books suitable for children or a joint discussion with a cardiologist are suitable for this. The child should be encouraged to look out for unusual symptoms on their own.

If the atrial septal defect is found in adulthood, it needs to be treated quickly. From the age of 20 to 25, the mortality from the disease increases. In addition, developmental disorders or damage to the heart that have already occurred can no longer be corrected. Those affected must develop strategies to lead a fulfilling and active life despite the illness.

Atrial Septal Defect