Atrial Septal Defect

Atrial Septal Defect

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Overview

t is the term used when the wall between the two atria known as the septum has a hole in it. This is a congenital defect that closes itself naturally during infancy or early childhood but if it doesn’t then it might affect the normal functioning of the heart and surgery might be required to rectify the same to prevent complications. 

What is an atrial septal defect?

If the hole in the atrial septum is small, it may not affect the heart function but if the hole is slightly larger, then the blood from the left atrium may travel to the right atrium causing the blood volume in the pulmonary artery to increase. Due to this additional blood flow in the artery to the lungs, the lungs and heart are forced to work harder which can result in their damage in the long run.

There are several types of atrial septal defects:

  • Secundum is the most common congenital defect in the middle portion of the septum between the atria.
  • Primum is the defect in the lower part of the wall between the atria that may be present along with other congenital heart defects.
  • Sinus venosus occurs in the upper part of the atrial septum.
  • Coronary Sinus is a rare heart defect in which the wall between the coronary sinus (and the left atrium is absent.

What are the symptoms of atrial septal defect?

There may be a complete absence of signs and symptoms if the defect is very small. Signs and symptoms if present might include:

  • Breathlessness on slightest exertion
  • Tiredness
  • Palpitations
  • Arrhythmia
  • Swelling in the lower legs, ankles and feet
  • A heart murmur that may be detected by the doctor during examination

What are the causes of atrial septal defect?

Heart defects are present at the time of birth, hence they occur due to some error in the heart development which may occur due to certain genetic and environmental factors. Though the exact cause for their occurrence is still not known, some of the risk factors have been identified:

  • Rubella infection: A rubella infection (German Measles) during pregnancy may be transmitted to the child and may damage the baby’s heart, lungs, and blood vessels.
  • Family History: If there is a family history of congenital heart defects, then the chances of developing this condition become higher.
  • Drug, tobacco or alcohol use: An excessive use of alcoholic beverages, tobacco in any form or drugs use can increase the risk of the atrial septal defect.
  • Diseases like diabetes and lupus: Females with diseased conditions like lupus or diabetes are more likely to give birth to a baby with the atrial septal defect.

What are the complications of atrial septal defect?

A considerably large defect in the atrial septum may lead to the complications like:

  • Right-sided heart failure: Due to increased load on the right side of the heart for a long time, the risk of right heart failure increases.
  • Arrhythmia: Due to leakage of the blood between the two sides of the heart, the heartbeat may fluctuate.
  • Stroke: This is one of the complications that might occur in the atrial septal defect.
  • Pulmonary Hypertension: In the presence of a large atrial septal defect, when it goes untreated, the excess blood supply to the lungs may result in pulmonary hypertension.
  • Eisenmenger syndrome: This is a rare complication of an untreated large hole in the atrial septum leading to lung failure.

If the atrial septal defect is small, then there might be no complications in bearing a child. However, if the hole in the septum is large enough or arrhythmia, pulmonary hypertension, heart failure have occurred, then the pregnancy might involve complications.

It is best to consult your doctor before planning your pregnancy so that adequate precautions are taken. Also, there is more risk of having a child with a congenital defect if you have a history of the same.

How is atrial septal defect diagnosed?

  • Electrocardiogram: A non-invasive procedure in which the electrical signals of the heart are studied for any abnormalities.
  • Chest X-ray: The lungs and heart can be analysed well in a chest x-ray for any abnormalities.
  • Echocardiogram: An imaging technique in which the images of the heart and blood vessels are obtained with the help of sound waves.
  • Cardiac catheterization: This is more of a therapeutic procedure than a diagnostic one for patent ductus arteriosus. It may be performed if the diagnosis of PDA has been confirmed and the doctors need to be sure if any other congenital heart defect may be present.
  • CT Scan/MRI: Either of these investigations can be advised if the atrial septal defect could not be diagnosed with other investigators procedures.

How is atrial septal defect treated?

Atrial septal defects resolve by themselves during infancy or early childhood. But if it does not happen, then the following interventions may be done:

  • Monitoring: If the atrial septal defect is not very large or is not causing any major symptoms, then the doctors may advise the wait and watch approach. This approach involves monitoring the condition of the child in a hope that the heart heals by itself without any need for surgery or medications.
  • Medications: If signs and symptoms are present due to the congenital defect, then appropriate medications may be prescribed by the doctor to deal with the same. The healthcare team may also be recommended medications to prevent any complications in future.
  • Surgery: Symptomatic atrial septal defect may need repair surgically for prevention of complications. Surgery may be performed in two ways:
    • Cardiac Catheterization: A catheter is inserted in the groin into the femoral artery, and is directed towards the heart with the help of a live x-ray machine. A mesh patch is placed on the hole with the help of the catheter which heals completely when the heart tissue grows around the mesh. The secundum type of heart defect is treated with this surgery in most cases.
    • Open-heart surgery: An open heart surgery is performed under general anaesthesia, with ventilator and heart-lung machine support. The ribs are widened and once the heart is exposed, it is stopped with the help of medication. Thereafter, the defect is repaired with a patch and is sealed. Once done, the chest incision is closed. This surgery may be done in a minimally invasive manner by making a small incision in the chest or even robotic surgery may be performed in some cases.

Tips for prevention

  • Rubella Vaccination: Infection with rubella is one of the major risk factors for an atrial septal defect. So, it is advisable to get vaccinated for the same.
  • Family history: If there is a history of congenital heart defects in your family, it is advisable to consult a genetic counsellor before planning your family.
  • Your health in pregnancy: When you are pregnant, make sure to clarify with your doctor which medications to take and avoid. Your health condition should be reviewed from time to time during your pregnancy to avoid any complications.

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