Atrial Septal Defect (Add image of heart)
Atrial septal defect (ASD) is a defect or hole in the upper chambers of the heart – the atria - where the wall between the right and left atria is supposed to close completely but does not. ASD is congenital, meaning it is a defect present at birth.
About 8 out of 1,000 babies have heart disease, and 6% to 8% of those babies have an ASD.1 It's usually found during a checkup or routine physical exam and confirmed with an echocardiogram. Because the murmur caused by an ASD can be difficult to hear, the condition may not be diagnosed right away. An ASD can be discovered in infants, children, teens, or even adults. Most teens with an ASD are asymptomatic , which means that they don't have any related problems or symptoms. Whether a person has symptoms usually depends on the size and severity of the hole in the atrial septum. About 1 in 4 people with a small hole between the atria don't require treatment because the hole closes on its own over time.
In fetal development, there is normally an opening between the atria to allow blood to bypass the lungs and that opening should close by the time the baby is born. If it does not, and the ASD is large, oxygen-rich blood will leak from the left to the right atria. This is called a shunt. The blood is then pumped back to the lungs, despite already having been refreshed with oxygen. This is inefficient, because already-oxygenated blood is replacing blood that needs oxygen. The shunt can be reversed so that blood flows properly but many problems can occur if the shunt is large and not reversed. Symptoms may begin any time after birth through childhood. Also, people with ASD are at an increased risk for developing a number of complications including: 2
- Atrial fibrillation (abnormal heart rhythm in adults)
- Heart failure
- Pulmonary overcirculation (excess blood flow to the lungs)
- Pulmonary hypertension (High blood pressure in the lungs)
- Stroke
Symptoms
A small to moderate sized ASD, particularly in children, may cause no symptoms or very few symptoms until later in life. But if symptoms are present, they may include: 3
- Difficulty breathing
- Frequent respiratory infections in children
- Palpitations (sensation of feeling the heart beat in adults)
- Shortness of breath during activities
Treatment
Closing an ASD in childhood can prevent serious problems later in life and the long-term outlook is typically excellent. If an ASD is diagnosed in adulthood, the defect is also repaired. Rarely is the defect left unrepaired if there is pulmonary hypertension but your doctor can determine if the defect should be closed.
Many teens with ASDs who need treatment can be treated with cardiac catheterization (pronounced: car -dee-ack cath-uh-turr-eye- zay -shun). In cardiac catheterization, a thin, flexible tube called a catheter is inserted into a blood vessel in the leg that leads to the heart. A cardiologist guides the tube into the heart and inserts a device shaped like a dumbbell (two mesh discs connected by a short mesh waist) into the hole in the heart wall. The waist of this device fills the hole in the heart, while the two discs secure it in place. There is no surgical scar, just a small mark in the groin area where the catheter went into the blood vessel. Usually the person can go home the next morning but is asked to rest for a few days. Your doctor may also ask you to take one aspirin each day for 6 months after the device is implanted to prevent small clots from forming on the device and being sent into the arteries of the body. Over time, the normal tissue of the heart grows over the device and the aspirin is no longer necessary.
When the ASD is very large or close to the wall of the heart, a device cannot be safely used and surgery is needed to close the defect. The traditional "open" surgical approach to ASD repair requires the surgeon to cut through the breastbone, pull back the ribs to access the heart and make the repair. This approach is done through a sternotomy ( surgeons access the heart by making an 8- to 10-inch incision down the chest, cut through the breastbone and open the ribs). A sternotomy can prolong healing time, increase risk of infection and serious complications.
During ASD surgery, your surgeon will stitch the hole in the atrial septum closed or sew a patch of manmade surgical material (such as Gore-Tex) over the defect. Eventually, the tissue of the heart heals over the patch or stitches, making the area smooth and nearly normal in appearance. Teens who have surgery for ASDs usually leave the hospital within 3 to 4 days after surgery, if there are no problems.
da Vinci® ASD Repair : A Less Invasive Procedure
If your doctor recommends surgical repair of your ASD, you may be a candidate for a new, less invasive surgical procedure called da Vinci ASD Repair. This procedure uses a state-of-the-art surgical system designed to help your surgeon see more clearly with 3D-high definition vision and to perform a more precise operation.
For most patients, da Vinci ASD Repair offers several potential benefits over traditional open-chest surgery, including:
- Shorter hospital stay
- Less pain and scarring
- Less risk of infection
- Less blood loss and fewer transfusions
- Faster recovery
- Quicker return to normal activities
As with any surgery, these benefits cannot be guaranteed since surgery is unique to each patient and procedure.
To learn more about da Vinci ASD Repair, talk with your doctor. To find a doctor who performs ASD repair using the da Vinci Surgical System, use our hospital and doctor locator to find a cardiothoracic surgeon.
2. “Atrial Septal Defect”, National Institutes of Health, www.nim.nih.gov URL: http://www.nlm.nih.gov/medlineplus/ency/article/000157.htm
3. Ibid.
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.