Atrial Septal Defect, Pediatric

An atrial septal defect (ASD) is a hole in the heart. This hole is located in the thin tissue (septum) that separates the two upper chambers of the heart, the right and left atrium. This hole is present at birth (congenital). A few minutes after birth, this hole normally closes so that blood is not able to go between the right and left atrium. The two most common types of ASD are ostium primum or ostium secundum. A less common form of ASD is called sinus venosus.

In a normal heart:

Blood from the right side of the heart is pumped to the lungs, where oxygen is added to it (oxygenated) and carbon dioxide is removed.
The oxygenated blood from the lungs is pumped to the left side of the heart.
From the left side of the heart, blood is pumped out to the rest of the body.

When an ASD is present:

Blood from the left atrium mixes with blood in the right atrium.
The blood flows to the lungs and the left side of the heart. This means that the blood makes the trip twice.
From the left side of the heart, blood is pumped out to the rest of the body.

An ASD makes the heart work harder by increasing the amount of blood in the right side of the heart. This causes heart overload and eventually weakens the heart's ability to pump.

What are the causes?

The cause of this condition is not known.

What are the signs or symptoms?

Symptoms of this condition include:

Mild to extreme tiredness (fatigue).
Trouble breathing or shortness of breath.
Sensations of fluttering in the chest due to irregular heartbeat (arrhythmias).
An extra "swishing" or "whooshing" sound (heart murmur) heard when listening to the heart.

How is this diagnosed?

This condition is diagnosed based on the results of one or more of the following tests:

Electrocardiogram, ECG. This test records the electrical activity of your child's heart and traces the patterns of his or her heartbeat onto paper.
Chest X-ray.
Echocardiogram. One of these two types may be done:
- Transthoracic echocardiogram (TTE). This test uses sound waves to view images of your child's heart and blood vessels by placing a wand-like tool on your child's chest.
- Transesophageal echocardiogram (TEE). In this test, a flexible tube with a camera is passed down the tube that connects the mouth and the stomach (esophagus). This device uses sound waves to take more detailed images of your child's heart and blood vessels.
MRI.
CT Scan.
Cardiac catheterization. In this test:
- A small, thin tube (catheter) is passed through a large vein in your child's neck, groin, or arm.
- Your child's heart specialist (cardiologist) looks at the heart defect, checks how well the heart is pumping, and checks the function of the heart valves.

How is this treated?

Treatment for this condition depends on the size of the hole and the amount of blood that goes into the right atrium.

Small ASD. Treatment may not be needed if your child has a small ASD. In this case, only a small amount of blood is moving back and forth (shunting) from the left to right atrium. Your child may not have symptoms.
Large ASD. Larger ASDs cause symptoms. Treatment is required. Depending on the type and location of the defect, one of the following procedures will be used to close the ASD:
- A small incision. This treatment is done in a cardiac catheterization lab.
- Minimally invasive surgery.
- Open heart surgery. This is performed if the first two procedures cannot be done.

Get help right away if:

Your child appears unusually tired when playing, taking part in sports, or doing other high-energy activities.
Your child has chest pain when resting or with activity.
Your child's fingertips or lips appear pale or blue.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

An atrial septal defect (ASD) is a hole in the heart. This hole is located in the thin tissue (septum) that separates the chambers of the heart.
The cause of this condition is not known. Symptoms include fatigue, trouble breathing, shortness of breath, and heart murmur.
Treatment for this condition depends on the size of the hole and the amount of blood that goes into the right atrium.
Get help right away if your child feels very tired when he or she does activities, has chest pain with activity or at rest, or you notice that his or her lips or fingertips have turned pale or blue.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.