A “hole” is a defect in the wall that separates the top two chambers of the heart. This defect allows oxygen-rich blood to leak into the oxygen-poor blood chambers in the heart.
Holes can be present in the walls of the heart between the upper heart chambers or between the lower heart chambers.
Many defects are small, cause no symptoms, and close without treatment.
The diagnosis is suspected based on a typical heart murmur (a sound created by turbulent blood flow through narrowed or leaking heart valves or through abnormal heart structures) and is confirmed by echocardiography.
Some septal defects that do not shrink on their own must be closed with a plug or other specialized device inserted through a catheter or with surgery.
A septal defect is a hole in the wall (septum) that separates the heart into the left and right sides. Atrial septal defects are located between the heart’s upper chambers (atria). Ventricular septal defects are located between the lower chambers (ventricles). In both types, some oxygenated blood, intended for the body, is short-circuited. It is returned to the lungs rather than pumped to the rest of the body.
Congenital heart defects arise from problems early in the heart’s development, but there’s often no clear cause. Genetics and environmental factors may play a role. VSDs can occur alone or with other congenital heart defects.
Within the broad category of ASDs, there are several types of defects. Atrial Septal Defects are classified by where they occur and their size.
Secundum: This is the most common type of ASD and occurs in the middle of the wall between the atria (atrial septum).
Primum: This defect occurs in the lower part of the atrial septum and might occur with other congenital heart problems.
Sinus venosus: This rare defect usually occurs in the upper part of the atrial septum and is often associated with other congenital heart problems.
Coronary sinus: In this rare defect, part of the wall between the coronary sinus — which is part of the vein system of the heart — and the left atrium is missing.
About 10 per cent of congenital heart problems are caused by specific genetic defects. Most congenital heart defects are likely due to maternal environmental factors combined with a genetic predisposition. Environmental factors include use of alcohol as well as diseases such as diabetes.
Atrial Septal Defect accounts for about 7 per cent of all congenital heart defects, making them the third most common type. In addition, ADSs are the most common congenital defect in adults and are more common among women than men.
Normally, the right side of the heart pumps blood that is low in oxygen to the lungs, while the heart’s left side pumps oxygen-rich blood to the body. When there is an ASD, blood from the left and right sides mix, and the heart generally does not work at its most efficient level.
The risk of problems is greater when the defect is large (greater than 2 cm).
Although ASDs are present from birth, there are usually no associated symptoms, and the condition can go undetected until adulthood. In some patients, the defect is discovered incidentally during a chest X-Ray that reveals enlargement of the right side of the heart.
By age 50, an individual with an ASD may start having symptoms such as:
Shortness of breath
Irregular heart rhythms
Fatigue after mild activity or exercise
In people with PFO, a stroke may be the first indication of the defect. More than 40 per cent of people who have a stroke but do not have any other risk factors for a stroke are diagnosed with PFO.
Over time, if an ASD isn’t repaired, the extra blood flow to the right side of the heart and lungs may cause heart problems. Usually, most of these problems don’t show up until adulthood, often around age 30 or later. Complications are rare in infants and children. Possible complications include:
Right heart failure: An ASD causes the right side of the heart to work harder because it has to pump extra blood to the lungs. Over time, the heart may become tired from this extra work and not pump well.
Arrhythmias: Extra blood flowing into the right atrium through an ASD can cause the atrium to stretch and enlarge. Over time, this can lead to arrhythmias (irregular heartbeats). Arrhythmia symptoms may include palpitations or a rapid heartbeat.
Stroke: Usually, the lungs filter out small blood clots that can form on the right side of the heart. Sometimes a blood clot can pass from the right atrium to the left atrium through an ASD and be pumped out to the body. This type of clot can travel to an artery in the brain, block blood flow, and cause a stroke.
Pulmonary hypertension (PH): PH is increased pressure in the pulmonary arteries. These arteries carry blood from the heart to the lungs to pick up oxygen. Over time, PH can damage the arteries and small blood vessels in the lungs. They become thick and stiff, making it harder for blood to flow through them.
Treatment of an ASD depends on the type and size of the defect, its effect on the heart, and the presence of any other related conditions, such as pulmonary hypertension, valve disease or coronary artery disease.
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