ATRIAL SEPTAL DEFECT

The atria are the upper chambers of the heart. The septum is the wall of heart muscle that divides the left and right sides. A defect in the septum produces a hole in the heart. These abnormalities develop before birth (congenital) and may persist as holes into adulthood.

The left side of the heart normally pumps under higher pressure than the right side. The defect produces a left-to-right shunt that allows blood from the two sides of the heart to mix. Blood with less oxygen is pumped to the body, and oxygenated blood travels back to the lungs. This may overload the circulation on the right side of the system and cause pulmonary hypertension. Small defects may not cause a problem. Larger defects eventually overload the right heart system, possibly causing heart failure (inefficient pumping of the heart). Heart failure causes fatigue, difficulty breathing, especially with exertion, or chest pain. Cyanosis, a bluish tone to the skin, occurs if poorly oxygenated blood reaches the skin. Abnormal heart rhythms (arrhythmias) may develop.

Atrial septal defects are more common among girls than among boys. Some defects close as the child grows, but others may persist into adulthood. Atrial septal defect is the most common congenital heart defect diagnosed among adults. Persons with small defects or defects that close may never have symptoms and need no treatment. If the defect persists, symptoms may develop that necessitate treatment to correct the defect.

The diagnosis of atrial septal defect is made on the basis of symptoms and findings at physical examination. An electrocardiogram (ECG) may show abnormalities and a chest radiograph (x-ray) is nearly always abnormal, demonstrating enlargement of the lung vessels and an enlarged heart. An echocardiogram (ultrasound examination of the heart) is performed to assess the structure and pumping function of the heart and to measure relative pulmonary versus systemic (to the body) blood flow.

Persons with atrial septal defect are referred to a cardiologist. Management of excessive pulmonary flow generally necessitates requires an operation to correct the defect. Heart failure may be managed with diuretics to reduce excess blood volume or digitalis to help the contracting efficiency of the heart. Arrhythmias may be managed with antiarrhythmic drugs. If there is no other heart disease, correcting the defect usually allows a normal life span and lifestyle.

• Take all prescribed medications.
• Exercise if allowed by your doctor.

• Do not ignore worsening symptoms. Seek medical attention immediately.

• If you have symptoms of atrial septal defect.

Contact the American Heart Association at 1-800-242-8721 and ask for the literature department.




Closure of sinus venosus atrial septal defect. A patch is placed to divide the superior vena cava (SVC) into an anterior systemic venous channel directed into the right atrium and a posterior pulmonary venous channel directed into the left atrium. inf., Inferior; I.V.C., Inferior vena cava; pul. v., Pulmonary vein; Rt., Right; sup., Superior. (From Giuliani ER, Gersh BJ, McGoon MD, Hayes DL, Schaff HV: Mayo clinic practice of cardiology, ed 3, St Louis, 1996, Mosby. Used by permission.)

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