An atrial septal defect is a congenital heart defect characterized by an abnormal opening between the two upper chambers of the heart, causing abnormal blood flow through the heart. If the defect is large, a larger-than-normal amount of oxygen-rich blood leaks from the left side of the heart to the right side. The blood is pumped to the lungs, although it is already refreshed with oxygen. This can overfill your lungs and cause an increased workload for your heart, causing the right side of the heart to enlarge and weaken and blood pressure in the lungs to increase.

Some atrial septal defects require surgical repair. Others can be treated with less invasive cardiac catheterization procedures.

Causes

Atrial septal defects occur during fetal development, and their cause is not known. Genetics may play a role in some cases. If heart defects run in your family, you may wish to consult with a genetic counselor who may recommend genetic testing.

Symptoms

Symptoms of atrial septal defects include:

• Shortness of breath
• Fatigue
• Heart murmur
• Heart palpitations
• Lung infections such as pneumonia and bronchitis
• Swelling of the abdomen or lower extremities
• Bluish skin color
• Stroke

Why choose Ohio State for atrial septal defect treatment?

Ohio State’s Wexner Medical Center offers a team approach to congenital heart defects (CHDs), which means each patient is evaluated by an adult congenital heart disease (ACHD) specialist, and when appropriate, a cardiac surgeon, an imaging specialist and an interventional cardiologist with training in CHD. This integrated approach means that each patient’s disease is treated individually, with that particular patient’s needs and physical condition in mind.

Anyone who has ever been diagnosed with or treated for atrial septal defect should have lifelong care from a cardiologist who specializes in congenital heart defects. We provide this care from birth to adulthood – we partner with Nationwide Children’s Hospital to provide the resources necessary for the care of adult congenital cardiac patients through the Columbus Ohio Adult Congenital Heart Disease Program (COACH).

The COACH program focuses on:

• Adults with congenital heart disease (CHD)
• Pulmonary hypertension
• Cardiovascular connective tissue disorders
• Pregnancy in women with heart disease
• Transition of adolescents with CHD into adult congenital heart disease (ACHD) care
• Training of future ACHD providers

Diagnosis

Tests used to diagnose an atrial septal defect include:

• Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart
• Echocardiogram (also called echo) – A test that uses sound waves to assess the function and structure of the heart muscle and valves
• Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine
• Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating
• Cardiac catheterization – A procedure to measure the pressures in the heart and evaluate the arteries that supply blood to the heart. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, and then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.

Treatments

Medications

Medications cannot repair atrial septal defects, but they may help relieve symptoms. Your physician may prescribe medications such as beta blockers, digoxin, anticoagulants and diuretics.

Surgery

Depending on the location within the atrial septum and the relationship to surrounding structures, atrial septal defects may be closed during a cardiac catheterization or they may require open heart surgery.

If the atrial septal defect is in the midportion of the septum, a special device called an atrial septal occluder device can be placed across the defect at the time of a heart catheterization effectively “plugging” the hole. However, open heart surgery may be necessary to repair an atrial septal defect in some patients. Your ACHD specialists can help decide which option of closure is best for you.