A whole in the heart of a baby is referred to as Atrial Septal Defect (ASD). This is a hole in the wall between the two upper chambers of your heart (atria) and is usually congenital. If the defects are small, they may never cause a problem and maybe found incidentally. It’s also possible that small atrial septal defects may close on their own during infancy or early childhood.
However, if the defects are large and long-standing, it can damage your heart and lungs. An adult who has had an undetected atrial septal defect for decades may have a shortened life span from heart failure or high blood pressure that affects the arteries in the lungs (pulmonary hypertension). Surgery may be necessary to repair atrial septal defects to prevent complications.
CAUSES OF ASD
Every child is born with an opening between the upper heart chambers. It’s a normal foetal opening that allows blood to detour away from the lungs before birth. After birth, the opening is no longer needed and usually closes or becomes very small within several weeks or months.
Sometimes the opening is larger than normal and doesn’t close after birth. In most children, the cause isn’t known while some children can have other heart defects along with ASD.
In some cases, symptoms of ASD may not occur until decades later. Some signs and symptoms that may occur includes:
- Shortness of breath, especially when exercising
- Swelling of legs, feet or abdomen
- Heart palpitations or skipped beats
- Heart murmur, a whooshing sound that can be heard through a stethoscope
The main risk factor or cause of atrial septal defects is not known but this has been traced to run in families and sometimes occur with other genetic problems, such as Down syndrome.
This means that if you have a heart defect, or you have a child with a heart defect, a genetic counselor can estimate the odds that any future children will have one.
During pregnancy, some conditions that one is predisposed to may increase the risk of having a baby with a heart defect. This includes:
- Rubella infection. Becoming infected with rubella (German measles) during the first few months of your pregnancy can increase the risk of foetal heart defects.
- Drug, tobacco or alcohol use, or exposure to certain substances. Use of certain medications, tobacco, alcohol or drugs, such as cocaine, during pregnancy can harm the developing foetus.
- Diabetes: If you have diabetes, you may be more likely to have a baby with a heart defect.
- Obesity: Being extremely overweight (obese) may play a role in increasing the risk of having a baby with a birth defect.
- Phenylketonuria (PKU): If you have PKU and aren’t following your PKU meal plan, you may be more likely to have a baby with a heart defect.
If the opening is small, it doesn’t make the heart and lungs work harder. Surgery and other treatments may not be needed. Small ASDs that are discovered in infants often close or narrow on their own. There isn’t any medicine that will make the ASD get smaller or close any faster than it might do naturally.
However, if the ASD is large, it can be closed with open-heart surgery, or by cardiac catheterization using a device inserted into the opening to plug it. Sometimes, if the ASD is an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart (pulmonary veins), the ASD can’t be closed with the catheter technique. Then surgery is needed.
Closing a large ASD by open-heart surgery usually is done in early childhood, even in patients with few symptoms, to prevent complications later. Many defects can be sewn closed without using a patch.
References: American Heart Association, Mayo Clinic, Cleveland clinic
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