Atrial septal defect

Under a Atrial septal defect the doctor describes a congenital heart malformation. The problem is located directly between the atria of the heart septum; As part of the diagnosis, the doctor determines that the atria are not completely closed.

What is an atrial septal defect?

The atrial septal defect respectively Atrial septal defect - abbreviated ASD - is a hole in the heart septum, between the atria. With around ten percent of all congenital heart defects, it is the third most common congenital malformation of the heart.

However, the atrial septal defect can coexist with other heart defects. Depending on the severity, there is the possibility that patients who have not yet reached the age of 50 will not complain of any symptoms; Sometimes, however, even infants can suffer from discomfort if the opening is large.

causes

If there is an atrial septal defect, there is an unintended connection that exists between the atria on both sides. For this reason, the oxygen-rich blood, which is passed on from the left heart, can flow again through the pathological opening and mix again with the blood located there in the right atrium.

Due to the amount of blood that must subsequently be pumped into the human lungs, the left atrium is more stressed. This leads to an increase in pressure in the pulmonary vessels and in the right heart. The reasons why this congenital heart defect develops are unclear.

Symptoms, ailments & signs

If there is only a very small connection between the atria, it causes very few symptoms in people who are younger than 50 years. Due to the deterioration in performance of the heart due to aging, symptoms can only appear from the age of 60. However, if there are larger openings, problems can arise even in infancy.

Classic symptoms are permanent tiredness as well as rapid physical inefficiency when exercising from time to time. As with all other heart defects, the pressure and blood flow ratio can change significantly, so that blood clots can form.

Furthermore, people who suffer from an atrial septal defect are more susceptible to any infectious diseases (especially the respiratory tract and the lungs are affected here). Around half of all people diagnosed with an atrial septal defect also suffer from cardiac arrhythmias and cardiac insufficiency; both factors occur between the ages of 40 and 50. In many cases, however, the defect goes unnoticed; the doctor often also makes a “chance diagnosis”.

Diagnosis & course

On the basis of the symptoms and complaints described, the doctor can already suspect that the problem is an atrial septal defect. The doctor tries to locate the heart murmur correctly and can, if there is a suspicion, carry out further tests. The attending physician uses echocardiography (ultrasound examination) so that a connection to the atria can be established.

By means of this examination it is possible, on the one hand, to determine the opening or, on the other hand, to provide evidence that the flow of blood is flowing through it. Due to the additional stress that the right atrium in particular has to cope with, a significantly enlarged “right heart” can also be visible on X-rays.

It is important that any other heart defects can be ruled out once the diagnosis of the atrial septal defect is established. The further course of the disease depends on various factors. The main problem of an atrial septal defect is that clots can form, which subsequently loosen and are then sometimes responsible for heart attacks or strokes.

As a rule, only operations can enable a cure; In the case of asymptomatic patients, however, medical professionals are divided as to whether heart surgery should actually be performed.

Complications

When there is an atrial septal defect, the right heart has to work harder to pump the larger amount of blood into the lungs. The blood often builds up and gas exchange is hindered. Recurrent pneumonia can occur as a complication. There is also a risk of infectious endocarditis.

A feared consequence of the atrial septal defect is the formation of blood clots (thrombi), which can trigger a paradoxical embolism. A thrombus passes through the hole in the heart septum from the venous to the arterial system and is carried away by the bloodstream. The complication is a vascular occlusion, which can trigger a stroke, heart attack or hemorrhagic mesenteric infarction.

Despite the significant volume load on the right heart, an atrial septal defect can be compensated by the body for decades and does not cause any major discomfort. The increased stress has an increasing effect with increasing age, so that physical performance decreases steadily. The long-term effects include arrhythmias, right heart failure, pulmonary hypertension, and right heart failure.

An untreated atrial septal defect that persists over a long period of time can, in rare cases, lead to a shunt reversal (Eisenmenger syndrome). Closing an atrial septal defect is one of the safest cardiac operations. Serious complications are extremely rare. A blood transfusion is sometimes necessary for major bleeding. Occasionally, cardiac arrhythmias or pericardial effusion occur after the operation.

When should you go to the doctor?

An atrial septal defect is most often diagnosed during a routine examination. By listening to the heart, the doctor can determine the defect and suggest appropriate treatment. Small defects do not always have to be surgically removed. If the opening does not close by the age of three or four, surgical intervention is recommended. Larger defects should be treated promptly. Especially in the case of a very large or poorly located atrial septal defect, an immediate operation with the help of the heart-lung machine must be carried out.

Even if the pediatrician does not find any irregularities when examining the heart, there may be a defect. Parents should therefore pay attention to typical warning signs and, for example, have permanent fatigue or rapid physical weakness clarified.

Even with frequent infectious diseases, you should speak to the pediatrician as soon as possible. Children who already suffer from cardiac arrhythmias or cardiac insufficiency should also be examined for an atrial septal defect. If the heart defect is detected early, the chances of recovery are very good.

Doctors & therapists in your area

Treatment & Therapy

If there is an enlarged "right heart" or if some symptoms are so pronounced that they actually cause discomfort, the connection between the two atria must be closed. That treatment can be done in two ways.

For a number of years it has been possible that the connection can be closed without major heart surgery. The doctor inserts a very thin wire through the patient's inguinal vein and pushes it to the right atrium. A small umbrella is attached to the wire tip. The so-called umbrella is then pushed towards the opening until it finally “hooks”. Then the umbrella can be "opened" and thus closes the atrial septal defect.

Another treatment option is to sew the small defects together. The doctor uses "plastic flicks" for this. However, this technique is only possible in connection with a relatively large heart operation. During the procedure, the patient is connected to the heart-lung machine; A long recovery period must be planned for after that procedure.

If the atrial septal defect is closed before the age of 25, there are almost no complications or the complication rate is extremely low. However, it is still controversial in asymptomatic patients between the ages of 25 and 40. Because in asymptomatic patients who have a shunt volume of less than 40 percent, there is no actual therapeutic indication.

Therapy is only indicated when the volume is over 40 percent or symptoms occur or the person concerned complains of severe symptoms. The older the patient, the higher the risk of any complications.

Outlook & forecast

Atrial septal defect has a favorable prognosis with early medical care. In a surgical procedure, the congenital defect is corrected. Normally, this is followed by a natural and unrestricted heart activity. Most middle-aged people are expected to be free of symptoms within a few weeks of the procedure. Then the patient has to adapt his lifestyle to his health possibilities.

Sick people at an older age have a less favorable prognosis. In addition, the healing path is immensely extended. In many cases, a heart-lung machine is needed to ensure survival. The likelihood of any complications and the non-treatability of the patient also increases significantly with increasing age.

Without medical care, the prognosis is poor. The congenital heart defect cannot be cured by any alternative healing methods or the body's self-healing process. In addition, if the disease progresses poorly, a thrombus can form.

The occlusion of the blood vessels leads to blood congestion. Malfunctions set in and numerous complaints arise. If the blood vessels burst, there is a risk of a stroke. This is associated with lifelong impairments and functional disorders. In addition, there is a high risk of death if intensive medical treatment cannot be initiated within a very short time.

prevention

The atrial septal defect cannot be prevented. It is a congenital heart defect.

Aftercare

Middle-aged patients usually do not need follow-up care. The prognosis for them is good. The heart continues to work in a healthy and unrestricted manner after the operation. Since there are no complaints, scheduled follow-up examinations are unnecessary.

Statistically speaking, it is different for older women and men. The time it takes for them to heal takes much longer than four to six weeks. You need to take great care of yourself after the operation. Stress and physical exertion should be avoided. As part of the aftercare, the attending physician will order an echocardiography.

An X-ray can also provide clarity about the current situation. Sometimes complications arise in the form of blood clots. A stroke can develop from these. There is not always a final healing. After a successful operation, there is no immunity to heart defects.

Those affected may have to change their lifestyle. They are responsible for this in their everyday life. Preventive measures include abstaining from nicotine and a low-fat diet. Integrating light physical activities into everyday life proves to be very beneficial. Atrial septal defect prevention is not possible. It is a hereditary disease, on the occurrence of which doctors have no influence.

You can do that yourself

An atrial septal defect usually requires surgical treatment. The most important self-help measure is good preparation for the procedure. The patient must undergo a thorough examination before the operation and inform the doctor about any allergies, illnesses and medication taken. This will ensure that there are no complications.

A few days before the procedure, the diet must be changed. Before an operation on the heart, stimulants such as coffee, cigarettes or alcohol should be avoided. The diet should also consist of light foods, lean fish and meat products and plenty of fluids. The other measures that have to be taken depend on the individual health of the patient. The doctor will inform the patient about the necessary steps and accompany the preparation for the operation.

After the procedure, the person concerned has to take it easy. It is recommended that you be on sick leave for at least four to six weeks, depending on whether you are performing large-scale heart surgery or an inguinal vein procedure. Regular visits to the doctor are necessary to accompany the rest. Physical exertion, stress and other risk factors should be reduced so as not to jeopardize the healing process.