Atrial septal defect (also called ASD) is the medical term for a hole in the septum that occurs between the atria of the heart. The hole is not an abnormality before birth, but if it does not grow together, it can sometimes cause discomfort.
What is an atrial septal defect?
Doctors refer to the hole that can be seen between the atria in the septum as the “foramen ovale”; however, that closes on its own a few weeks after birth. If it does not, it is called an atrial septal defect. Strictly speaking, this is a congenital malformation. About ten percent of all heart defects, are an atrial septal defect. The atrial septal defect belongs to the shunt vities and usually – until the age of 50 or 60 – does not cause any symptoms.
Causes
Blood flows from the left (left atrium) directly across the atrial septal defect to the right (right atrium). This is because there is higher pressure in the left atrium of the heart. After the blood is in the right atrium, it is sent directly to the pulmonary artery via the main chamber. However, due to the atrial septal defect, there is a volume load so that the right main chamber as well as the right atrium become enlarged. The lung is subsequently flooded. However, unlike the ventricular septal defect, there is no risk of pulmonary hypertension (pulmonary hypertension) developing.
Symptoms, complaints, and signs
Individuals affected by an atrial septal defect, provided 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 discomfort. Large openings, however, can cause problems even in infancy. Thus, patients are tired more quickly and also show a tremendous decrease in performance. Shortness of breath, especially in conjunction with physical exertion, is another sign of an atrial septal defect. Due to the altered blood flow and pressure conditions, a blood clot can form. For this reason, there is also a risk of thrombi moving directly through the atrial septal defect and passing from the right to the left atrium and then being transported directly into the systemic circulation. Possible consequences are clogged brain vessels, which subsequently cause a stroke. Above all, those affected are more susceptible to any infectious diseases, which mainly occur in the respiratory tract. The prognosis is good. The course of the disease can be made so positive by means of therapy that the atrial septal defect is completely repaired and thus the dangers of any thromboses are no longer present.
Diagnosis and Course of the Disease
The physician may relatively quickly suspect that the condition is an atrial septal defect. In particular, the heart murmurs (on listening) or even the typical features described by the patient suggest 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, during a routine examination of the heart. In order for the physician to prove that an atrial septal defect is present, an ultrasound examination is necessary. By means of ultrasound examination or echocardiography, it is possible to detect blood flow through the opening. Due to the increased strain, the atrial septal defect can also be seen on the X-ray image. The physician recognizes a clear enlargement of the right side of the heart. Furthermore, enlarged arteries can also be seen on the X-ray image. As a rule, however, the physician remains with the ultrasound examination, since here he can precisely identify the defect. Sometimes there is also the possibility that the effects are already detected respectively how much 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 also detected and treated very late. Those affected suffer from severe fatigue and exhaustion. Performance drops significantly and patients are no longer able to carry out normal everyday activities without further ado.Even the performance of sporting activities is no longer possible. Furthermore, an infarction in the brain or heart can occur and those affected often suffer from infections or inflammations. The respiratory tract in particular can be affected, so that breathing difficulties are common. The quality of life of the patient is considerably reduced and limited by the disease. In most cases, treatment is carried out by means of surgery. The earlier the disease is diagnosed, the higher the probability of a positive course of the disease. However, the life expectancy of the affected person may be reduced by the disease. Affected individuals continue to rely on regular checkups with physicians to avoid complications.
When should you see a doctor?
In the case of an atrial septal defect, the affected person is usually always dependent on medical examination and treatment by a physician to prevent further complications or further worsening of symptoms. The sooner a doctor is contacted, the better the further course of this disease usually is. The affected person should therefore see a doctor at the first symptoms and signs. In the worst case, the disease can lead to the death of the affected person if it is not treated. A doctor should be consulted for atrial septal defect if the affected person frequently suffers from shortness of breath. This discomfort may occur especially during exertion or vigorous physical exertion. The susceptibility to infections also increases. If the patient therefore becomes ill very frequently, this may also indicate an atrial septal defect. In the case of these symptoms, a general practitioner, an internist or a cardiologist can be consulted. In most cases, treatment of the condition is by surgical intervention.
Treatment and 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. This is also the case if no change in the heart is visible but the patient complains of typical symptoms. Closure is possible of the defect – in two ways. For years, the connection has been closed during a small operation. In this procedure, the physician inserts a thin wire through the inguinal vein, which is pushed up to the right atrium. The physician attaches two closed umbrellas to the tip of the wire in advance. These are pushed between the opening until they succumb there. Then the surgeon opens the umbrellas, stretches them open and closes the opening. This operation is very simple and gentle. Another possibility is to sew the opening or to close it by means of “plastic patches”. This technique is only possible in connection with a major heart operation; during the operation the patient must be repeatedly connected to the heart-lung machine. The long recovery time after the operation is very important. That intervention represents a major operation and is performed mainly when it is a relatively large opening, respectively, when enormous discomfort has already been announced.
Prevention
Since this is a congenital heart defect, no preventive measures can be taken. However, if the atrial septal defect has been diagnosed, treatment must be discussed with the medical professional. If the defect remains untreated and causes discomfort, other diseases (cerebral apoplexy) may well occur, but these could have been prevented.
Aftercare
Follow-up care is required if the atrial septal defect is treated surgically. Following the procedure, the patient is transferred to the hospital’s intensive care unit for observation and treatment. The patient is usually given medication to inhibit blood clotting. This is usually heparin or Marcumar. The heparin is administered intravenously for 24 hours. A dangerous blood clot that can cause a stroke can be prevented in this way. For about six months, the patient must also take acetylsalicylic acid (ACC) like aspirin every day. He receives a special pass for the Macumar treatment. In addition, the doctors 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 dental or throat infections or skin diseases can cause damage to the heart valves, antibiotics must be administered if necessary. To promote the healing process, light sporting activities are considered useful. However, the patient should not overdo it. In addition, the doctor’s consent is required. Rehabilitation can also be helpful for aftercare. In addition, regular check-ups such as measuring blood pressure or an ECG are performed.
Here’s what you can do yourself
An atrial septal defect must be closed surgically. The most important self-care measure is to monitor the child’s health. Parents of affected children need to watch for unusual symptoms and discomfort. If there is a decrease in performance or even cardiovascular problems, the doctor must be consulted immediately. Together with the physician, further measures can be discussed by which the atrial septal defect can be closed and the child can lead a normal life. Since surgical intervention must be performed as early as possible to improve the prognosis, an examination should take place quickly if it is suspected. When the child is older, he or she can be informed about the disease. Medical books suitable for children or a joint discussion with a cardiologist are suitable for this purpose. The child should be encouraged to watch for unusual symptoms on his or her own. If the atrial septal defect is diagnosed in adulthood, rapid treatment is the order of the day. From the age of 20 to 25, the mortality of the disease increases. In addition, developmental defects or damage to the heart that has already occurred can no longer be corrected. Affected individuals must develop strategies to lead full and active lives despite the disease.
