Atrial septal defect (ASD)
Atrial septal defect (ASD) is a heart defect that is present at birth (congenital).
As a baby develops in the womb, a wall (called the interatrial septum) forms that divides the upper chamber into a left and right atrium. An abnormal formation of this wall can result in a hole that remains after birth. This is called an atrial septal defect, or ASD.
Blood can flow between the two upper heart chambers through the ASD.
When blood flows between the two heart chambers. This is called a shunt. Pressure in the lungs may build up. Over time, there will be less oxygen in the blood that goes to the body.
Small atrial septal defects often cause very few problems, and may be discovered much later in life. Many problems can occur if the opening is large, or if there is more than one opening.
ASD is not very common.
A person with no other heart defect, or a small defect (less than 5 millimeters) may not have symptoms, or the symptoms may not occur until middle age or later.
Symptoms that do occur may begin at any time after birth through childhood. They can include:
- Difficulty breathing (dyspnea)
- Frequent respiratory infections in children
- Feeling the heart beat (palpitations) in adults
- Shortness of breath with activity
Exams and Tests
The doctor will check how large and severe an ASD is based on the symptoms, physical exam, and the results of heart tests.
The doctor may hear abnormal heart sounds when listening to the chest with a stethoscope. A murmur may be heard only in certain body positions. Sometimes, a murmur may not be heard at all. A murmur means that blood is not flowing through the heart smoothly.
The physical exam may also show signs of heart failure in some adults.
An echocardiogram is a test that uses sound waves to create a moving picture of the heart. It is often the first test done.
Other tests that may be done include:
- Cardiac catheterization
- Coronary angiography (for patients over 35 years old)
- Doppler study of the heart
- Heart MRI
- Transesophageal echocardiography (TEE)
ASD may not need treatment if there are few or no symptoms, or if the defect is small and is not associated with other abnormalities. Surgery to close the defect is recommended if the defect causes a large amount of shunting, the heart is swollen, or symptoms occur.
A procedure has been developed to close the defect without surgery.
- The procedure involves placing an ASD closure device into the heart through tubes called catheters.
- The health care provider makes a tiny cut in the groin, then inserts the catheters into a blood vessel and up into the heart.
- The closure device is then placed across the ASD and the defect is closed.
Some people with atrial septal defects may be able to have this procedure, depending on the size and location of the defect.
People who have surgery for ASD should get antibiotics before any dental procedures they have in the period following the procedure. Antibiotics are not needed later on.
In infants, small ASDs (less than 5 mm) will often not cause problems, or will close without treatment. Larger ASDs (8 to 10 mm), often do not close and may need a procedure.
Important factors include the size of the defect, the amount of extra blood flowing through the opening, and whether the person has any symptoms.
Some people with ASD may have other congenital heart conditions. These may include a leaky valve or a hole in another area of the heart.
People with a larger or more complicated ASD are at an increased risk for developing other problems, including:
- Arrhythmias, particularly atrial fibrillation
- Heart failure
- Heart infections (endocarditis)
- High blood pressure in the arteries of the lungs (pulmonary hypertension )
When to Contact a Medical Professional
Call your health care provider if you have symptoms of an atrial septal defect.
There is no known way to prevent the defect. Some of the complications can be prevented with early detection.
Marelli AJ. Congenital heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 69.
Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, MO: WB Saunders; 2011:chap 65.
Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics. 2006;118(4):1560-1565.
Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation. 2008;118:e714-e833.
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.