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Atrial Septal Defect

DEFINITION

An atrial septal defect is a hole between the top two chambers of the heart. The heart is made of four chambers, the two upper chambers called the atria and the two lower chambers called the ventricles. Normally, oxygen-deficient blood moves from the body through the right atria to the right ventricle where it is pumped through the lungs to pick up oxygen. It then returns to the left atrium, through the left ventricle and is pumped back out to the body. An atrial septal defect is a hole between the right and left atria of the heart. Due to this defect, some of the oxygen-deficient blood can move from the right to the left side of the heart without picking up oxygen, lowering the total amount of oxygen available to the body in the blood. Smaller atrial septal defects can close in childhood on their own and may not ever cause any symptoms. Larger atrial septal defects can cause damage in the long term by overloading the lungs with high blood pressure which can lead to a condition called pulmonary hypertension. Having pulmonary hypertension can lead to decreased length of life. Atrial septal defect can less commonly cause Eisenmenger Syndrome, permanent damage to the lungs. Other complications of atrial septal defect include: right-sided heart failure, abnormal heart rhythms, and risk of stroke. These large atrial septal defects can be repaired through surgery. The exact cause of atrial septal defect is unknown, though doctors suspect that both genetics and environment in the womb play a role. A similar condition called patent foramen ovale happens as a result of the natural hole between the fetal atria not closing at birth. Risk factors for having a child with atrial septal defect include the following conditions during pregnancy: rubella infection, use of alcohol or drugs, or use of certain medications. Women who plan to become pregnant usually don’t have any problems from their atrial septal defects unless they are large or the woman has Eisenmenger Syndrome in which case the woman has much higher risk of heart failure and even death. A woman should discuss her atrial septal defect with her obstetrician prior to becoming pregnant.

SYMPTOMS
Heart murmur, fatigue, shortness of breath (especially when exercising), swelling of body or legs, palpitations, strokes, blue skin, recurrent lung infections

DIAGNOSIS
Your doctor will begin by taking a history and performing a physical exam. During the physical exam, your doctor will listen for any heart murmurs as well as look for the physical signs of heart failure, like swelling in the legs. Your doctor will likely recommend an echocardiogram (ultrasound or sonogram) of the heart which can create a picture of the blood flow in the heart and see if an atrial septal defect is present as well as look for any decrease of the pumping ability of the heart (heart failure). Your doctor or cardiologist may also recommend the following tests: chest x-ray (to see the lungs), electrocardiogram (which looks for abnormalities of the electrical activity of the heart, including arrhythmias), cardiac catheterization (where a thin catheter is advanced to the heart through a vein and can release dye to look at the blood flow through the heart), MRI of the heart (to look at the structure of the heart), or pulse oximetry (a monitor placed on the finger to check the amount of oxygen in the body).

TREATMENT
Treatment of atrial septal defect depends on the severity of the defect. If the defect is small, your doctor or cardiologist may recommend monitoring the defect over time. Atrial septal defect cannot be cured with medications, but they may help relieve symptoms. Medications options include some to maintain a normal heartbeat and those to decrease risk of blood clots. The only definitive treatment for atrial septal defect is surgery. Surgery can be done either through cardiac catheterization or open heart surgery. Cardiac catheterization involves inserting a thin, flexible catheter into a vein the leg or arm which is then advanced to the heart. In the heart, the cardiologist can place a mesh patch over the hole. Over time, the heart grows tissue over the mesh and keeps it in place. Open heart surgery involves opening the chest cavity while you are under general anesthesia and closing the hole with a patch or stitches. Because the heart needs t be opened, you need to be placed on a heart-lung machine during this procedure. You should discuss your treatment options with your physician or cardiologist.

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