Atrial septal defect

Under a Atrial septal defect (also ASD called) the doctor describes a hole in the septum, which occurs between the atria. 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?

The doctor calls the hole that can be seen between the auricles in the septum "foramen ovale"; but that closes by itself a few weeks after the birth. If not, one speaks of one Atrial septal defect. Strictly speaking, it is a congenital malformation. About ten percent of all heart defects are an atrial septal defect. The atrial septal defect is one of the shunt diseases and does not usually cause any symptoms - up to the age of 50 or 60.

causes

The blood flows from the left (left atrium) directly over the atrial septal defect to the right (right atrium). This is because there is a higher pressure in the left atrium of the heart. After the blood is in the right atrium, it is forwarded directly to the pulmonary artery via the main chamber.

Due to the atrial septal defect, however, there is a volume load, so that the right main chamber and the right atrium enlarge. The lungs are then flooded. However, unlike with a ventricular septal defect, there is no risk of pulmonary hypertension (pulmonary high pressure) developing.

Symptoms, ailments & signs

People who are affected by an atrial septal defect, provided that there is only a very small connection between the two atria, have no symptoms - before the age of 50. However, it is the deterioration in performance that increases with age that sometimes cause symptoms. However, large openings can cause problems even in infancy. Patients are tired more quickly and also show an enormous reduction in performance.

Shortness of breath, especially when combined with physical exertion, is another sign of an atrial septal defect. Due to the changed blood flow and pressure conditions, a blood clot can form. For this reason, there is also the risk that the thrombi will shift directly through the atrial septal defect and get from the right to the left atrium and then be transported directly into the body's circulation.

Possible consequences are clogged cerebral vessels, which subsequently cause a stroke. Above all, those affected are more susceptible to any infectious diseases that mainly occur in the respiratory tract. The prognoses are good. The course of the disease can be shaped so positively by therapy that the atrial septal defect is completely eliminated and the dangers of possible thromboses are no longer given.

Diagnosis & course of disease

The medical professional can quickly express the suspicion that it is an atrial septal defect. Above all, the heart murmurs (when listening) or the typical characteristics that the patient describes allow the conclusion that an atrial septal defect is sometimes present. If the patient does not complain of any complaints, the diagnosis can still be made - however purely by chance, as part of a routine examination of the heart.

An ultrasound scan is necessary so that the doctor can provide evidence that an atrial septal defect is present. By means of an ultrasound examination or echocardiography, it is possible that the blood flow through the opening can be detected. Due to the increased stress, the atrial septal defect can also be seen on the X-ray.

The doctor recognizes a significant enlargement of the right side of the heart. The x-ray also shows enlarged arteries. As a rule, however, the doctor stays with the ultrasound examination, since he can precisely identify the defect here. Sometimes there is also the possibility that the effects are already recognized or how much the right side of the heart is enlarged and how big the opening actually is, which ultimately represents the problem.

Complications

In most cases, symptoms or complications do not arise with this disease until relatively old age. For this reason, the disease is recognized and treated very late. Those affected suffer from severe fatigue and exhaustion.

The performance drops significantly and the patients can no longer carry out normal everyday activities without further ado. It is also no longer possible to carry out sporting activities. Furthermore, it can lead to an infarction in the brain or heart and those affected often get sick from infections or inflammations. The respiratory tract in particular can be affected, which can often lead to breathing difficulties.

The quality of life of patients is considerably reduced and restricted by the disease. In most cases, the treatment is carried out by surgery. The earlier the disease is diagnosed, the higher the probability of a positive course of the disease. However, the life expectancy of the person affected may be reduced by the disease. Those affected continue to need regular medical examinations to avoid complications.

When should you go to the doctor?

In the case of an atrial septal defect, the person concerned is usually always dependent on a medical examination and treatment by a doctor so that there are no further complications or worsening of the symptoms. The earlier a doctor is contacted, the better the further course of this disease is usually. The person concerned should therefore consult a doctor at the first symptoms and signs. In the worst case, the illness can lead to death if it is not treated.

A doctor should be consulted in the case of atrial septal defect if the person concerned frequently suffers from shortness of breath. These complaints can occur especially under stress or during intense physical exertion. The susceptibility to infections also increases. If the patient falls ill very frequently, this can also indicate an atrial septal defect. A general practitioner, internist, or cardiologist can be seen if these symptoms occur. In most cases, the disease is treated with surgery.

Therapy & Treatment

If there is a deformity 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. Even if no change in the heart is visible, but the patient complains about the typical symptoms. The defect can be closed in two ways.

For years the connection has been closed as part of a minor intervention. The doctor inserts a thin wire through the inguinal vein, which is pushed to the right atrium. The doctor attaches two closed umbrellas to the wire tip in advance. Those are pushed between the opening until they succumb there. Then the doctor opens the umbrella, so to speak spans it and can thus close the opening. That operation is a very simple and gentle procedure.

Another possibility is to sew up the opening or to close it with "plastic patches". This technique can only be used in conjunction with major heart surgery; As part of the procedure, the patient must be repeatedly connected to the heart-lung machine. After that procedure, the long recovery time is particularly important. This procedure represents a major operation and is mainly carried out if the opening is relatively large or enormous complaints have already been reported.

prevention

Since it is a congenital heart defect, no preventive measures can be taken. However, if the atrial septal defect has been diagnosed, the treatment must be discussed with the medical professional. If the defect remains untreated and causes symptoms, other diseases (stroke) can occur, which 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, where they are observed and treated. The patient is usually given medication to prevent blood clotting. This is mostly heparin or marcumar.

The heparin is administered intravenously for 24 hours. A dangerous blood clot that can cause a stroke can be prevented this way. The patient also has to take acetylsalicylic acid (ACC) like aspirin every day for around six months. He receives a special ID for Macumar treatment.

The doctors also 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 tooth or throat infections or skin diseases can damage the heart valves, antibiotics must be given if necessary. In order to promote the healing process, light sporting activities are considered useful. However, the patient must not overdo it. In addition, the consent of the doctor is required. Rehabilitation can also be helpful for aftercare. In addition, regular check-ups such as measuring blood pressure or an EKG are carried out.

You can do that yourself

An atrial septal defect must be closed surgically. The most important self-measure is to monitor the child's health. Parents of affected children should watch out for unusual symptoms and symptoms. Should there be a reduction in performance or even cardiovascular problems, the doctor must be consulted immediately. Together with the doctor, further measures can be discussed with which the atrial septal defect can be closed and the child can lead a normal life.

Since a surgical procedure must be carried out as early as possible in order to improve the prognosis, an examination should be carried out quickly if it is suspected. When the child is older, they can be informed about the disease. Child-friendly medical books or a joint conversation with a cardiologist are suitable for this. The child should be encouraged to independently look for unusual symptoms.

If the atrial septal defect is discovered in adulthood, treatment should be prompt. From the age of 20 to 25, the mortality from the disease increases. In addition, developmental disorders or damage to the heart that have already occurred can no longer be corrected. Those affected need to develop strategies to lead a full and active life despite being ill.