Atrial Septal Defect (ASD)
Before you begin reading about this heart defect, please read the explanation of how the normal heart works for a basic understanding of its structure and function.
- What is an atrial septal defect?
- What are the symptoms?
- How is it diagnosed?
- What are the treatment options?
- What kind of follow-up care is required?
What is an atrial septal defect?
The normal heart has two sides, which are separated by a muscular wall called the septum. Each side of the heart also has two parts - the upper chamber called an atrium, and the lower chamber called a ventricle.
An atrial septal defect (ASD) is an opening in the wall (the atrial septum) 
Atrial septal defect (ASD)
Enlarge+ between the heart's two upper chambers (the right and left atria). An ASD is one of the defects referred to as "a hole in the heart."
Normally, the right side of the heart carries deoxygenated blood back into the heart and the left side carries oxygenated blood back out to the body.
An ASD allows the oxygenated blood to pass from the left atrium, through the opening in the septum, into the right atrium causing the two to mix. This leads to increased blood flow through the right side of the heart and lungs. Over time, this "extra" blood volume stresses the heart and causes the right atrium, ventricle and pulmonary arteries to dilate (become wider). This can eventually lead to heart failure, pulmonary hypertension, or heart rythym abnormalities.
What are the symptoms?
Unless the hole is large, an ASD often won't cause symptoms in infants until they over 1 year of age. Symptoms may include:
- heart murmur - the heart sounds abnormal when a doctor listens with a stethoscope
- fatigue
- racing heartbeat
How is it diagnosed?
Our doctors usually diagnose an ASD after a primary care doctor refers a child to us for evaluation.
Diagnosis may require some or all of these tests:
- echocardiogram (also called "echo" or ultrasound) - sound waves create an image of the heart
- electrocardiogram (ECG) - a record of the electrical activity of the heart
- chest X-ray
What are the treatment options?
Doctors may decide to wait and see whether the ASD will close on its own. Some small ASDs will do so before the child is 2 years old.
If the ASD is large, or won't close on its own, additional steps will be required. Our doctors are among the most experienced in ASD closure. Options include:
- Cardiac catheterization - A thin tube (catheter) is inserted into the heart through a large vein in the leg. Doctors use the tube to close the hole with one of several available devices. In most cases, an ASD can be closed via catheterization.
- Open heart surgery - In cases where the hole is very large, or the heart anatomy is complex, surgery may be required. Surgeons use stitches or patches to close the hole.
What kind of follow-up care is required?
Through 18
After ASD repair, most children recover quickly and don't experience additional cardiac problems. They must see a pediatric cardiologist for checkups. Rarely, additional surgery is required.
Children who have other heart abnormalities will require more extensive follow-up care.
Our pediatric cardiologists follow patients until they are young adults, coordinating care with the primary care physicians.
Into adulthood
Follow-up care into adulthood may be necessary. We will help the transition to an adult cardiologist.
The Philadelphia Adult Congenital Heart Center, a joint program of The Children's Hospital of Philadelphia and the University of Pennsylvania, meets the unique needs of adults who were born with heart defects.
Because of enormous strides in medicine and technology, today many children with heart conditions go on to lead healthy, productive lives as adults.
Contact the Cardiac Center at The Children's Hospital of Philadelphia for a second opinion or for more information.
Reviewed by:
Matthew Gillespie, MD
Gil Wernovsky, MD
Date: October 2008
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