Atrial septal defects (ASD)

Individuals who have a small atrial septal defect, a hole in the atrial septum, without symptoms or heart rhythm disturbances may require only periodic monitoring to ensure that the right side of the heart is not enlarging or that pulmonary hypertension does not develop. A typical evaluation would include a thorough physical exam, electrocardiogram, chest X-ray, echocardiogram, and an exercise test. A Holter monitor or event recorder may be necessary to check for irregular heart rhythms. More details about these tests can be found in the Testing section.

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Larger ASDs require catheterization or surgery to close the opening between the atria. Repairing the ASD before elevated blood pressures develop in the artery of the lungs, a condition known as pulmonary hypertension, is critical for these patients. Once pulmonary hypertension develops, it usually is not reversible and closing the defect may actually exacerbate the patient's condition.

Historically, the opening has been closed with a heart operation, preferably before age 6. Surgical closure is very effective, having been performed for over 35 years, and is considered very safe; however, minimally invasive techniques have been developed that are just as effective with shorter recovery times. Today, most ASDs are closed by cardiologists using a heart catheterization technique. During this procedure, the cardiologist inserts a patch that resembles a small umbrella into the damaged area of the atrial septum. The cardiologist enters the heart using a catheter that enters the body through a blood vessel in the arm or leg. More information on heart catheterization is under Heart Catheterization in the Testing section.

People who do not have the ASD repaired usually die of heart failure before age 50. In contrast, long-term survival rates after a successful repair of this defect is similar to that of a healthy person of the same age who never had the defect. Continued medical monitoring including regular echocardiograms is required to ensure that the repair remains effective.