Atrial Septal Defect (ASD) in Children
What is an atrial septal defect in children?
The atrial septum is the wall between the two upper chambers of the heart (right and
left atria). An atrial septal defect (ASD) is an abnormal hole in this wall. ASD is
a heart problem that is present at birth (congenital). ASDs are common and account
for about 10% to 15% of congenital heart disease. The clinical significance is typically
related to the location and size of the ASD.
ASDs can happen on their own. Or they can happen in children born with other congenital
heart defects.
ASDs are classified by their different location and development:
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Secundum ASD. This occurs in the middle part of the atrial septum.
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Primum ASD. This occurs in the lower part of the atrial septum close to the tricuspid and mitral
valves.
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Sinus venosus. This occurs in the upper part of the atrial septum near the veins that drain into
the right and left atrium.
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Coronary sinus ASD. This occurs when there is a defect in the wall between the coronary sinus and the
left atrium.
Patent foramen ovale (PFO) is an opening between the right and left atria that is
normally present in fetal circulation. It typically closes shortly after birth. But
a PFO is not considered an ASD because no septal tissue is missing.
What causes an atrial septal defect in a child?
The heart forms during the first 8 weeks of pregnancy. It starts as a hollow tube
and divides into 4 chambers. These chambers are separated by walls (septa). It's normal
for the walls to have openings as the fetus grows. The openings usually close shortly
before or just after birth. If they don't all close, the atrial septum will have a
hole in it. This is called an ASD. ASDs are often associated with other congenital
heart defects. Often the associated defect causes more problem than the ASD itself.
Some congenital heart defects may be passed down in certain families. Most atrial
septal defects occur by chance. There is no clear reason why they happen.
What are the symptoms of an atrial septal defect in a child?
Many children have no symptoms and seem healthy. If the ASD is large, your child may
have symptoms. Your child may:
Older children and adults with ASDs may have migraine headaches. But it's not clear
if the ASD is the cause. A small blood clot that forms in the bloodstream that may
cause a stroke can be linked to ASD in older children and adults. But it does not
seem that closing the defect or taking blood thinners (anticoagulants) decreases risk.
The symptoms of ASD can seem like other health conditions. Have your child see their
healthcare provider for a diagnosis.
How is an atrial septal defect diagnosed in a child?
Your child's healthcare provider may have heard a heart murmur when listening to your
child's heart with a stethoscope. The heart murmur is from the abnormal flow of blood
through the heart.
Your child may need to see a pediatric cardiologist for a diagnosis. This is a healthcare
provider with special training in treating heart problems in children. This provider
will examine your child and listen to your child's heart and lungs. They will find
out where the murmur is best heard and how loud it is. Your child may have some tests,
such as:
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Chest X-ray. This test may show an enlarged heart. Or it may show changes in your child's lungs
because of the blood flow changes caused by an ASD.
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Electrocardiogram (ECG). This test records the electrical activity of the heart. It shows abnormal rhythms
(arrhythmias) that may be caused by an ASD. It can also find heart muscle stress caused
by an ASD.
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Echocardiogram (echo). This test uses sound waves to make a moving picture of the heart and heart valves.
An echo can show the blood flow through the atrial septal opening and find out how
big the opening is.
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Cardiac catheterization. This test uses a thin, flexible tube (catheter) put near the heart. Contrast dye
is used to get even clearer pictures. In some children, this procedure may be used
to close the ASD.
How is an atrial septal defect treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is. The most common type of ASD may close on its
own as your child grows.
Once an ASD is diagnosed, your child's cardiologist will check your child to see if
the defect is closing on its own. An ASD will often be fixed if it hasn't closed by
the time a child starts school. The decision to close the ASD may also depend on the
size of the defect or the symptoms caused by the defect.
Treatment may include:
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Medicine. Many children have no symptoms and don't need medicine. But medicine can help some
children's hearts work better. For example, water pills (diuretics) help the kidneys
get rid of extra fluid from the body.
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Surgery. Your child's ASD may be repaired by surgery. The surgery is done under general anesthesia.
The defect may be closed with stitches or a special patch.
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Device closure. Some children may have their ASDs closed with this procedure. The healthcare provider
uses cardiac catheterization to put a special device (septal occluder) in the open
ASD. The device stops blood from flowing through the ASD. The ASD must meet certain
requirements to be able to be closed in this way.
What are possible complications of an atrial septal defect in a child?
Large ASDs may cause lung problems, such as high blood pressure in the lungs, over
time if not treated. This is because the extra blood passing through the defect and
then into the lungs may harm the vessels in the lungs.
How can I help my child live with an atrial septal defect?
All children with an ASD need to be cared for by a pediatric cardiologist. Most children
who have had an ASD repair will live healthy lives. After the repair, your child's
healthcare provider may want your child to take antibiotics. This will prevent an
infection of the heart lining (bacterial endocarditis).
With early diagnosis and repair of an ASD, children usually do very well. They don't
need much follow-up care. Children are more likely to have problems if an ASD is diagnosed
later in life and never repaired. Or they may have problems if complications occur
after closing the defect.
Some children develop high blood pressure in the lungs (pulmonary hypertension). These
children should have follow-up care at a center that specializes in congenital heart
disease.
Talk with your child's healthcare provider about the outlook for your child.
When should I call my child's healthcare provider?
Call your child's healthcare provider if your child has new symptoms or symptoms get
worse. Symptoms may include:
Key points about atrial septal defect in children
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An ASD is an opening in the wall dividing the two upper chambers of the heart.
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Symptoms include tiring easily, fast breathing, shortness of breath, poor growth,
arrhythmias, and frequent respiratory infections.
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ASDs range from small to large.
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Small ASDs may close on their own. ASDs that are large or cause symptoms can be repaired.
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Most children who have had an ASD repair will live healthy lives.
Next steps
Tips to help you get the most from a visit to your child’s healthcare provider:
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Know the reason for the visit and what you want to happen.
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Before your visit, write down questions you want answered.
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At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
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Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
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Ask if your child’s condition can be treated in other ways.
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Know why a test or procedure is recommended and what the results could mean.
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Know what to expect if your child does not take the medicine or have the test or procedure.
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If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
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Know how you can contact your child’s healthcare provider after office hours. This
is important if your child becomes ill and you have questions or need advice.