This document provides an overview of atrial septal defect (ASD), including what it is, causes, symptoms, types, risks, diagnosis, and treatment. Key points include:
- ASD is a hole in the septum between the left and right atria that allows oxygen-poor and oxygen-rich blood to mix.
- It is usually a congenital defect caused by incomplete formation of the heart wall during development.
- Small ASDs may be asymptomatic, but larger defects can cause heart and lung strain over time.
- Treatment options range from monitoring small defects to closure of larger defects via catheterization or surgery.
- Women with congenital heart defects are at increased risk for complications during
This document provides an overview of atrial septal defect (ASD), including what it is, causes, symptoms, types, risks, diagnosis, and treatment. Key points include:
- ASD is a hole in the septum between the left and right atria that allows oxygen-poor and oxygen-rich blood to mix.
- It is usually a congenital defect caused by incomplete formation of the heart wall during development.
- Small ASDs may be asymptomatic, but larger defects can cause heart and lung strain over time.
- Treatment options range from monitoring small defects to closure of larger defects via catheterization or surgery.
- Women with congenital heart defects are at increased risk for complications during
This document provides an overview of atrial septal defect (ASD), including what it is, causes, symptoms, types, risks, diagnosis, and treatment. Key points include:
- ASD is a hole in the septum between the left and right atria that allows oxygen-poor and oxygen-rich blood to mix.
- It is usually a congenital defect caused by incomplete formation of the heart wall during development.
- Small ASDs may be asymptomatic, but larger defects can cause heart and lung strain over time.
- Treatment options range from monitoring small defects to closure of larger defects via catheterization or surgery.
- Women with congenital heart defects are at increased risk for complications during
This document provides an overview of atrial septal defect (ASD), including what it is, causes, symptoms, types, risks, diagnosis, and treatment. Key points include:
- ASD is a hole in the septum between the left and right atria that allows oxygen-poor and oxygen-rich blood to mix.
- It is usually a congenital defect caused by incomplete formation of the heart wall during development.
- Small ASDs may be asymptomatic, but larger defects can cause heart and lung strain over time.
- Treatment options range from monitoring small defects to closure of larger defects via catheterization or surgery.
- Women with congenital heart defects are at increased risk for complications during
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Baptist Health Blog
February 17, 2018
What is Atrial Septal Defect (ASD)?
atrial septal defect
atrial septal defect infographic
Atrial septal defect (ASD) is a hole in the septum, or muscular tissue, between the left and right atria, the upper valves of the heart. The right side of a healthy heart pumps oxygen-poor blood on to the lungs; oxygen-enriched blood is pumped from the lungs through the left atrium and throughout the body. In a heart with an atrial septal defect, the hole allows the oxygen-poor blood to mix with the oxygen- enriched blood, preventing the heart from performing its job properly.
In the case of a large ASD, oxygenated blood is pumped into the lung arteries, making the heart and lungs work harder; potentially damaging the lung arteries.
If the hole is small, the patient may not be aware of symptoms or problems. In fact, many healthy adults have a small opening in the wall between the atria. ASDs are further categorized by location of the defect within the atrial septum. Terms used to describe defect location include secundum, primum and sinus venosus atrial septal defects. Small defects had a maximal diameter > 3 mm to < 6 mm, moderate defects measured ≥ 6 mm to < 12 mm and large defects were ≥ 12 mm.
What Causes an Atrial Septal Defect (ASD)?
As the heart forms during the first eight weeks of pregnancy, it starts as a hollow tube and develops, creating a wall between the two sides of the heart. An ASD occurs when this partition remains incomplete, leaving a hole in the heart wall.
Like most congenital heart defects, ASDs are caused by a combination of factors including family history. A mother’s condition during pregnancy, such as alcohol/drug abuse, as well as diabetes, lupus and rubella can also be contributing factors.
What are the Symptoms of ASD?
Because symptoms may not appear, patients often don’t know they have the defect. However, ASDs can show up as a murmur or irregular heartbeat, shortness of breath or fainting.
Other symptoms include:
Fatigue after mild exercise or other activity
Swelling in the feet, legs or abdomen
Heart palpitations
Types of ASDs
The four most common types of ASD include:
Ostium secundum atrial septal defect – this is the most common type and affects nearly 70% of children with ASD. It occurs when part of the atrial septum doesn’t close completely. Ostium primum atrial septal defect – is a split in the mitral valve, which controls blood flow between the left atrium and left ventricle. Further, this might occur with other congenital heart problems.
Sinus venosus atrial septal defect – this type is rarer and the defect at the connection of the superior vena cava and right atrium, where deoxygenated blood typically enters the heart. This can cause flow of already-oxygenated blood through the right atrium and back through the lungs. This is is often associated with other congenital heart problems.
Coronary sinus atrial septal defect – the rarest ASD defect, affecting the coronary sinus, where the heart’s veins feed into the right atrium.
Risks of Atrial Septal Defect (ASD)
Here are some common risks associated with ASD:
Enlargement of the right side of the heart – can lead to heart failure.
Abnormal heart rhythms – including atrial fibrillation or atrial flutter, affect 50- 60% of all patients over 40 with an ASD.
Stroke – small clots formed on the right side of the heart are normally filtered by the lungs; when bypassing the lungs through the ASD, clots can cause stroke.
Pulmonary hypertension – high blood pressure in the pulmonary arteries supplying blood to the lungs.
Leaking tricuspid and mitral valves – caused by an enlarged heart.
Diagnosis of ASD
During a checkup, the detection of a heart murmur may be the first indication by your child’s doctor of a suspected heart defect or lead to an atrial septal defect diagnosis. ASDs can be diagnosed with electrocardiogram as well as X-ray and electronic imaging.
Treatment of ASD
About half of ASDs in children close on their own over time. If not, a closure device is often inserted into the hole via catheterization. Surgery is typically called for only in the rare cases of ostium primum or sinus venosus ASDs. Other options can include medical monitoring or medications. For those requiring surgery, our doctors will evaluate your condition for surgical options:
Cardiac catheterization. By inserting a catheter, or thin, flexible into a blood vessel, doctors can guide it to the heart, from the groin, and place a mesh patch or plug to close the hole. Then, the heart tissue grows around the mesh causing it to permanently seal the hole.
Open-heart surgery. Some large secundum atrial septal defects may require open-heart surgery. Through an incision, surgeons use patches to close the hole. At times, this procedure can be done using small incisions (minimally invasive surgery) and with a robot for some types.
Learn More About Atrial Septal Defect Treatment from Baptist Health
If you believe you or a loved one has atrial septal defect or would like to learn more about treatment, contact your nearest Baptist Health location today. Women with Heart Defects and Pregnancy-Related Health Issues
A happy pregnant couple
A study from the Centers for Disease Control and Prevention (CDC) found that many women with congenital heart defects become pregnant and experience pregnancy-related health complications. Women living with heart defects who are considering having a baby should talk with a healthcare provider before becoming pregnant to discuss how their pregnancy might affect them and their baby.
Main Findings
Based on information for more than 26,000 women living with heart defects in three areas in the United States, nearly 1 in 5 of these women became pregnant over approximately 3 years.
Compared to women without heart defects, women with heart defects may have a higher risk for some pregnancy-related issues, such as
Anemia (when the number of healthy red blood cells in the body is too low);
Hemorrhage (loss of blood); or
High blood pressure.
Compared to non-pregnant women with heart defects, pregnant women with heart defects had more documented health issues, such as
Diabetes;
Infectious diseases; or
Mental health issues.
With appropriate medical care and treatment, many women with heart defects can have a healthy pregnancy. Women living with heart defects who are considering having a baby should talk with a healthcare provider before becoming pregnant to discuss how their pregnancy might affect them and their baby.
About This Study
This is one of the first projects to look at pregnancies and both pregnancy-related and non-pregnancy- related health conditions among women with heart defects by collecting information from hospital, clinic, and health insurance records. Scientists reviewed data from women (ages 11–50 years) living in certain counties in Georgia and New York and statewide in Massachusetts between 2008 and 2010.
Data were from women who had a heart defect noted in their medical record between 2008 and 2010.
About Heart Defects
Congenital heart defects are conditions that are present at birth that can affect the structure of a person’s heart and its ability to work properly. Heart defects can vary from mild (such as a small hole in the heart) to severe (such as missing or poorly formed parts of the heart). Lifelong cardiac care can help people with heart defects live as healthy a life as possible!
Our Work
CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is tracking the number of people living with heart defects to learn about their long-term health, medical costs, and quality of life. This information can help identify opportunities to support the health and wellness of all people living with heart defects.
More Information
Basics About Congenital Heart Defects
Living with a Congenital Heart Defect
Highlighted Birth Defects Content
Reference
Raskind-Hood C, Saraf A, Riehle-Colarusso T, Glidewell J, Gurvitz M, Dunn JE, Lui GK, Van Zutphen A, McGarry C, Hogue CJ, Hoffman T. Assessing pregnancy, gestational complications, and co-morbidities in women with congenital heart defects (data from ICD-9-CM codes in 3 US surveillance sites). The American Journal of Cardiology. 2020; 125 (5): 812-819.
Page last reviewed: January 24, 2022
Pregnancy in women with congenital heart disease: General principles
Author:Carol A Waksmonski, MDSection Editors:Charles J Lockwood, MD, MHCMHeidi M Connolly, MD,
FACC, FASEDeputy Editor:Nisha Parikh, MD, MPH
INTRODUCTION Progress in medical and surgical treatment has resulted in larger numbers of women with congenital heart disease surviving to child-bearing years and proceeding with pregnancy [1].
The general principles of management of pregnancy and contraception in women who have unrepaired or repaired congenital malformations of the heart or great vessels will be reviewed here. Pregnancy in women with specific congenital cardiac anomalies, the management of valvular heart disease during pregnancy, and the management of heart failure and arrhythmias during pregnancy are discussed separately. (See "Pregnancy in women with congenital heart disease: Specific lesions" and "Pregnancy and valve disease" and "Management of heart failure during pregnancy" and "Supraventricular arrhythmias during pregnancy" and "Ventricular arrhythmias during pregnancy".)
EPIDEMIOLOGY
Because of improving medical and surgical management, most infants born with congenital heart disease will reach reproductive age, and women are now presenting for obstetric and congenital cardiac care, many following reparative cardiac surgery or intervention [1]. The maternal and fetal risk of a pregnancy for this population will depend on the anatomic and physiologic classification of the type of congenital heart disease as defined by the 2018 AHA/ACC Guidelines for the Management of Adults with Congenital Heart Disease [2].
In the Registry of Pregnancy and Cardiac Disease (ROPAC), among 5739 pregnancies in 53 countries from 2007 to 2018, congenital heart disease was the most prevalent form of structural heart disease (57 percent); the number of high-risk pregnancies (modified World Health Organization Class IV) increased from 0.7 percent in 2007 to 2010 to 10.9 percent in 2015 to 2018 [3]. United Kingdom and Ireland Confidential Enquiries into maternal deaths reported that of 910 maternal deaths between 2009 and 2014, 22.5 percent were caused by heart disease, and a minority from congenital heart disease [4].
Gravidas with congenital heart disease may be at higher risk during an individual pregnancy, but if they survive, the risk of pregnancy is generally not cumulative. Thus, successive pregnancies generally entail the same but not greater risk, assuming the cardiovascular status remains stable. This was illustrated in a case-control study of 58 females with mild to moderate congenital heart disease who were matched by maternal congenital cardiovascular risk (ie, WHO classification). In this study, women having ≥3 live births compared with <3 live births did not have materially different cardiac function by NYHA class or echocardiography. Literature review current through: Jan 2023. | This topic last updated: Sep 12, 2022.
This generalized information is a limited summary of diagnosis, treatment, and/or medication
Child, JS.. Management of Pregnancy and contraception in Congenital Heart Disease. In: Congenital Heart Disease in Adults, 3rd ed, Perloff, JK, Child, JS, Aboulhosn, J (Eds), Saunders/Elsevier, 2009. Twitter LinkedIn Syndicate
Baby with Septal Defect
An atrial septal defect (pronounced EY-tree-uhl SEP-tuhl DEE-fekt) is a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart.
What is Atrial Septal Defect?
An atrial septal defect is a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart. A hole can vary in size and may close on its own or may require surgery. An atrial septal defect is one type of congenital heart defect. Congenital means present at birth.
As a baby’s heart develops during pregnancy, there are normally several openings in the wall dividing the upper chambers of the heart (atria). These usually close during pregnancy or shortly after birth.
If one of these openings does not close, a hole is left, and it is called an atrial septal defect. The hole increases the amount of blood that flows through the lungs and over time, it may cause damage to the blood vessels in the lungs. Damage to the blood vessels in the lungs may cause problems in adulthood, such as high blood pressure in the lungs and heart failure. Other problems may include abnormal heartbeat, and increased risk of stroke.
Occurrence
In a 2019 study using data from birth defects tracking systems across the United States, researchers estimated that each year about 2,118 babies in the United States are born with Atrial Septal Defect. In other words, about 1 in every 1,859 babies born in the United States each year are born with Atrial Septal Defect1.
Causes and Risk Factors
The causes of heart defects such as atrial septal defect among most babies are unknown. Some babies have heart defects because of changes in their genes or chromosomes. These types of heart defects also are thought to be caused by a combination of genes and other risk factors, such as things the mother comes in contact with in the environment or what the mother eats or drinks or the medicines the mother uses.
Read more about CDC’s work on causes and risk factors »
Diagnosis
An atrial septal defect may be diagnosed during pregnancy or after the baby is born. In many cases, it may not be diagnosed until adulthood.
During Pregnancy
During pregnancy, there are screening tests (prenatal tests) to check for birth defects and other conditions. An atrial septal defect might be seen during an ultrasound (which creates pictures of the body), but it depends on the size of the hole and its location. If an atrial septal defect is suspected, a specialist will need to confirm the diagnosis.
After the Baby is Born
An atrial septal defect is present at birth, but many babies do not have any signs or symptoms. Signs and symptoms of a large or untreated atrial septal defect may include the following:
Frequent respiratory or lung infections
Difficulty breathing
Tiring when feeding (infants)
Shortness of breath when being active or exercising
Skipped heartbeats or a sense of feeling the heartbeat
A heart murmur, or a whooshing sound that can be heard with a stethoscope
Swelling of legs, feet, or stomach area
Stroke
It is possible that an atrial septal defect might not be diagnosed until adulthood. One of the most common ways an atrial septal defect is found is by detecting a murmur when listening to a person’s heart with a stethoscope. If a murmur is heard or other signs or symptoms are present, the health care provider might request one or more tests to confirm the diagnosis. The most common test is an echocardiogram which is an ultrasound of the heart.
Treatments
Treatment for an atrial septal defect depends on the age of diagnosis, the number of or seriousness of symptoms, size of the hole, and presence of other conditions. Sometimes surgery is needed to repair the hole. Sometimes medications are prescribed to help treat symptoms. There are no known medications that can repair the hole.
If a child is diagnosed with an atrial septal defect, the health care provider may want to monitor it for a while to see if the hole closes on its own. During this period of time, the health care provider might treat symptoms with medicine. A health care provider may recommend the atrial septal defect be closed for a child with a large atrial septal defect, even if there are few symptoms, to prevent problems later in life. Closure may also be recommended for an adult who has many or severe symptoms. Closure of the hole may be done during cardiac catheterization or open-heart surgery. After these procedures, follow-up care will depend on the size of the defect, person’s age, and whether the person has other birth defects. References
Mai CT, Isenburg JL, Canfield MA, et al. for the National Birth Defects Prevention Network. National population-based estimates for major birth defects, 2010-2014. Birth Defects Res 2019; 1– 16. https://doi.org/10.1002/bdr2.1589.
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