This leaflet provides information for parents and carers about atrial septal defect in children and the management and treatment of this condition.
What is an Atrial Septal Defect?
An atrial septal defect (ASD) is a hole between the two small chambers of the heart. It allows blood from the left sided chamber to pass to the right sided chamber.
This results in the right side of the heart being overloaded with blood and also results in the lungs becoming congested because they receive an excessive amount of blood.
Such defects cause only mild symptoms in young children (such as breathlessness on exertion), but if an ASD is left untreated over a period of many years it can eventually lead to permanent damage to the heart and sometimes to the lungs as well.
This may prove fatal when the patient reaches later adult life, so it is important that an ASD is treated when the child is young and before the heart or lungs have been permanently damaged.
Tests
An ultrasound scan of the heart (an “echocardiogram”) is required to make the diagnosis.
Treatment
There are 2 types of treatment, surgery, or keyhole, to close an ASD. This depends on the size and where the hole is situated.
Surgical treatment for ASD
If your child requires surgery, the surgeon will meet you in clinic and discuss the benefits, risks and potential complications with you in more detail.
Please watch the following video for more information about surgery.
ASD and Surgical Closure – YouTube
ASD and Surgical Closure – YouTube. Transcript
this video explains the congenital heart
condition
atrial septal defect and how it is
treated with open heart surgery
you may wish to view our video on normal
heart function
before viewing this blood from the body
returns to the part of the heart
called the right atrium blood then flows
to the right ventricle from where it is
pumped to the lungs
via the pulmonary artery
blood from the lungs returns to the part
of the heart called the left atrium
from where it flows to the left
ventricle which is the part of the heart
that pumps blood to the body
via the aorta
the right atrium and left atrium are
divided by the atrial septum
a hole in the atrial septum is called an
atrial septal defect
or asd when an asd is present
some of the blood that should flow from
the left atrium to the left ventricle
passes through the asd to the right
atrium and to the right ventricle
pulmonary artery and lungs
this means that more blood flows through
the right side of the heart to the lungs
than flows through the left side of the
heart to the body
this extra blood can cause the right
side of the heart to enlarge
the impact of an asd largely depends on
its size
at one end of the spectrum a large asd
results in a large amount of extra blood
flow through the right side of the heart
to the lungs
and may cause problems such as
breathlessness and abnormal heart
rhythms
if larger asds are left untreated over a
long period of time
the extra blood flow can cause permanent
damage to the right side of the heart
and the arteries of the lungs at the
other end of the spectrum
when an asd is small there may only be a
very small amount of extra blood flow
through the right side of the heart and
lungs
such that the right side of the heart
does not become enlarged
these smaller asds often require no
treatment
but may require observation over time
an atrial septal defect can be closed in
one of two ways
either with open heart surgery or in a
keyhole procedure
many asds are suitable for treatment via
the keyhole procedure
but some require open heart surgery
here we explain the open heart surgery
technique but we have a separate video
explaining the keyhole procedure
surgery involves either directly
stitching up the hole
or sewing in a patch of material over
the hole
preventing blood flowing through it and
allowing the enlarged heart to reduce in
size
once an asd has been closed the right
side of the heart becomes smaller
it may return to a completely normal
size but doesn’t always
especially if a larger hole is not
closed until later in life
“Keyhole” treatment for ASD
A keyhole device can be used to close an ASD without opening the chest. It is made of a mixture of very fine wire and synthetic cloth (Dacron). It is delivered to the heart folded up inside a long thin tube (catheter) which is inserted into the vein in the groin under general anaesthetic.
Once in the correct position, the device is unfolded by pushing it out of the catheter.
It is held inside the ASD by its “button” shape and once its position is satisfactory it is released and stays inside the heart, permanently blocking the hole. The device stays inside the heart and becomes covered over by the patients’ own tissue during the healing process. If your child requires keyhole treatment, the cardiologist will discuss this with you in more detail in cluding the risks and potential complications.
Please watch the following video for more information about keyhole treatment.
ASD and Keyhole Treatment – YouTube
ASD and Keyhole Treatment – YouTube. Transcript
this video explains how the congenital
heart condition
atrial septal defect or asd is treated
with a keyhole procedure
we explain what an asd is and how it
affects the heart in another video an
asd
can be closed in one of two ways either
with open heart surgery
or in a keyhole procedure many asds are
suitable for treatment via the keyhole
procedure
which we explain here but some require
open heart surgery which we explain in
our other video
the keyhole procedure is performed with
the patient to sleep
under a general anaesthetic a long thin
tube is inserted into a large vein in
the groin
this tube is passed through the vein to
the heart
and once in the heart through the asd
through this tube a device is delivered
to the heart
the device essentially has two disks one
of which
sits on the left side of the asd while
the other sits on the right side of the
asd
the device plugs the hole in the atrial
septum so that blood can no longer flow
across it
once an asd has been closed the right
side of the heart becomes smaller
it may return to a completely normal
size but doesn’t always
especially if a larger hole is not
closed until later in life
General advice for the future
Most patients will remain completely well and lead a completely normal life after treatment to close an ASD. No restrictions to physical activity are recommended and no special precautions are necessary.
