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Arterial Septal Defect (ASD)

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What is an atrial septal defect?

An atrial septal defect (ASD) is a hole in the wall (septum) that separates the two upper chambers (atria) of the heart. The defect allows blood to flow from one atrium to the other, usually from the left side to the right side. ASDs account for 5% to 10% of all coronary heart disease , and for about 30% of the congenital heart defects diagnosed in adults.The operative mortality is < 1% in the absence of significant pulmonary hypertension. Surgical repair in young adults (< 25 years) results in long-term survival rates similar to those of matched controls. Repair in patients older than 40 years does not eliminate the risk of atrial arrhythmias and cerebrovascular accidents.

How is this problem diagnosed?

Clinical features: Most infants and children with ASD do not exhibit symptoms even if the defect is large. Occasionally, infants with large ASD develop symptoms of congestive heart failure. Some older children have shortness of breath with exercise and lower stamina than their peers.

Physical findings: The diagnosis is most often made due to the presence of a heart murmur and/or an abnormal second heart sound. Growth and development is expected to be normal although many of the children have a slender body build. Since most children are without symptoms and the physical findings are subtle, it is not uncommon for the diagnosis to be made in late childhood or adolescence.

Medical tests: In patients with a significant atrial septal defect, the electrocardiogram often shows increased right ventricular forces and may show right atrial enlargement. The chest x-ray often shows a larger than normal heart size with evidence for increased pulmonary blood flow. An echocardiogram is able to detect even small atrial septal defects with almost 100% accuracy and permits measurement of the size and description of the precise location of the defect on the atrial septum. Cardiac catheterization is rarely needed for diagnostic purposes but may be done if there is concern about pulmonary artery hypertension, the pulmonary veins, or other diagnostic questions. Closure of the defect during a heart catheterization may be done to treat the problem.

How is the problem treated?

Indications for closure of an atrial septal defect

Closure of an atrial septal defect is done if there is persistence of a moderate to large defect when the child is between four and six years of age. If the defect is diagnosed in young adulthood, the benefits of closure remain significant. Although the benefits of closure of significant defects diagnosed in later adulthood are less clear, there is evidence that closure will improve health for many older patients.

Surgical closure of atrial septal defects

Atrial septal defects can be closed surgically. The procedure involves either placement of sutures that pull the hole closed or placement of a patch that is sewn over the edges of the defect. The chest wall incision is kept very short to improve cosmetic results and can be made either in the center of the chest or on the right side. Blood transfusions are rarely required and the total hospital length of stay is usually 3 or 4 days. Surgical results are excellent and complete closure of the defect is accomplished in virtually every case. Complications are rare but may include bleeding, infection, or a collection of fluid around the heart.

Transcatheter closure of atrial septal defects

Another treatment option for some patients is transcatheter closure of the defect. This procedure is done in the heart catheterization laboratory and avoids the need for surgery. Closure devices have been evolving since 1974 and are still investigational so current use is limited. More recent devices are the Angel Wing device, the ASDOS device, the Buttoned device, the Cardioseal device, and the Amplatzer device. As transcatheter ASD closure affords many advantages related to the avoidance of open heart surgery and anesthesia, it is anticipated that investigations into this approach will continue and that transcatheter closure will become a common treatment option for patients with ASD.

Not all patients with atrial septal defects are candidates for transcatheter closure. Factors which must be considered include size of the defect, position of the defect within the atrial septum (a rim of septal tissue all the way around the defect is needed to secure the device), and age (and size) of the patient.

During the procedure, catheters (thin plastic tubes) are placed into the large blood vessels in the legs and "floated" into the heart. The closure device is delivered to the site of the defect collapsed within a catheter. After the catheter tip is moved into place, the device is pushed out of the catheter, across the atrial septal defect, and secured in place. This procedure is done with IV sedation and usually the patient can go home the same day.

If you are considering arterial septal defect in China and would like to get know more information about arterial septal defect, please complete the inquiry form or email us at