Atrial Septal Defect Health Article

Diagnosis

The medical and family history help the physician determine if the child has any conditions or disorders that might contribute to or cause the heart defect. A family history of heart defects may suggest a genetic predisposition to the condition.

During the physical exam, the child's blood pressure is measured, and a stethoscope is used to listen to sounds made by the heart and blood flowing through the arteries. Some heart murmurs (abnormal heart sounds) can indicate an atrial septal defect. The child's pulse, reflexes, height, and weight are checked and recorded. The child's blood oxygen level can be measured using a pulse oximeter, a sensor placed on the fingertip or earlobe. Internal organs are palpated, or felt, to determine if they are enlarged.

A chest x ray, electrocardiogram (ECG, EKG), echocardiogram (echo), or magnetic resonance imaging MRI) can confirm the presence of an atrial septal defect. A chest x ray evaluates the size, shape, and location of the heart and lungs.

An electrocardiogram helps the physician evaluate the electrical activity of the heart. During an EKG, small electrode patches are attached to the skin on the chest. The electrodes are connected to a computer that measures the heart's electrical impulses and records them in a zigzag patter on a moving strip of paper.

An echocardiogram uses ultrasound, or high-frequency sound waves, to display an image of the heart's internal structures. It can detect valve and other heart problems. A Doppler echo uses sound waves to measure blood flow.

Magnetic resonance imaging is a scanning method that uses magnetic fields and radio waves to create three-dimensional images of the heart, which reveal how blood flows through the heart and how the heart is working.

In some cases, cardiac catheterization, a more invasive diagnostic procedure, may be performed to diagnose atrial septal defect. This procedure should be performed by a specially trained physician and diagnostic team in a well-equipped heart center. During the procedure, a long, slender tube called a catheter is inserted into a vein or artery and slowly directed to the heart, using x ray guidance. To better view the heart and blood vessels, contrast material (dye) is injected through the catheter and viewed and recorded on an x ray video as it moves through the heart. This imaging technique is called angiography. The catheter measures the amount of oxygen present in the blood within the heart. If the heart has an opening between the atria, oxygen-rich blood from the left atrium enters the right atrium. The cardiac catheterization can help doctors detect the higher-than-normal amount of oxygen in the heart's right atrium and right ventricle, and in the large blood vessels that carry blood to the lungs, where the blood would normally collect its oxygen.

Treatment

Twenty percent of atrial septal defects in children correct themselves without medical treatments by the time a child is two years old. If the opening does not close on its own, it needs to be repaired to prevent the pulmonary arteries from becoming thickened and blocked due to increased blood flow. If this condition (pulmonary vascular obstructive disease) is left untreated, it can increase the risk of death by 25 percent.

Treatment should be provided by a pediatric cardiologist, a specialist trained to diagnose and treat congenital heart disease. Surgery should be performed by a pediatric cardiovascular surgeon. A catheter-based cardiac implant should be done by an interventional cardiologist skilled in performing this procedure on children.

Surgery

There are two types of surgical repair for atrial septal defects: primary closure in which the opening is repaired with sutures alone if the defect is small; or secondary closure in which a patch closes the opening if the defect is large. The secondary closure may involve sewing a synthetic patch made of Dacron material over the opening, or wrapping the patient's own tissue (often from the fluid-filled sac around the heart called the pericardium) to close the opening.

During traditional atrial septal defect surgery, the heart is exposed through an incision made in the chest or between the ribs. A heart-lung bypass machine pumps blood for the heart while the heart is stopped and the wall defect is being repaired. Recuperation from surgery involves three to five days in the hospital and four to six weeks recovering at home. When possible, minimally-invasive surgical techniques that use smaller incisions (3–4 inches [7–10 cm]) may be performed, depending on the size and location of the defect. Minimally invasive surgery results in a much shorter hospital stay, reduced scarring, and a faster recovery than traditional surgery.

Surgical repair in asymptomatic children is usually recommended before the child begins grade school. Earlier surgical treatment is recommended when the child develops symptoms or has stunted growth.