Atrial Septal Defect In Children – Symptoms And Treatment
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A hole in the heart is probably the scariest diagnosis you might hear about your child. It can have a deep psychological effect on the entire family and your little one may not be able to experience the pleasures of a normal childhood. An Atrial Septal Defect or ASD is the third most common type of congenital heart defects and it affects around seven percent of CHD patients. Advances in treatment help patients (adults and children) live a normal and active life. Read further to know more about Atrial Septal Defect- its causes, symptoms, and treatment.
What is Atrial Septal Defect:
Atrial Septal Defect or ASD refers to a hole in the muscular wall (septum) that separates two upper chambers (atria) of the heart.
- Under normal circumstances, (with every heartbeat) oxygen-poor blood is pumped to the lungs through the right side of the heart. The left side of the heart receives this blood from the lungs and pumps oxygen-rich blood to the body.
- But when there’s a hole in the septum (the wall that separates the two upper chambers of the heart) blood from the left atrium flows from to the right atrium instead of flowing into the left ventricle (the lower chamber of the heart).
- This causes the lungs to receive oxygen-rich blood (which should have received oxygen-poor blood) and increases blood volume in the right atrium and the lungs.
- When left untreated, the patient may be at a risk of problems like high blood pressure in the lungs (pulmonary hypertension), heart failure (weakening of the heart) or stroke.
- Such patients are also likely to develop Eisenmenger Syndrome- a problem that occurs when blood from the right atrium flows to the left leading to low oxygen levels (in the blood).
Depending on the position and size of the hole, ASD can be categorized into three types:
- Secundum: This occurs when the hole is in the middle of the septum. It is a very common form of ASD and often closes on its own,
- Primum: This occurs when the hole is in the lower part of the septum. This defect needs surgical intervention
- Sinus Venosus: This occurs when the hole is in the upper part of the septum. Surgical intervention is needed to close this hole.
[ Read: Ventricular Septal Defect In Children ]
Causes Of Atrial Septal Defect In Children:
ASD is a congenital defect, i.e. it is present from birth, although it may remain undetected until the child reaches adulthood. Some of the possible causes include:
1. Genetic Defect:
Around 10% of Atrial Septal Defect is caused by a genetic defect. Children of parents with a congenital heart defect are genetically predisposed to ASD. Another example of genetic defect is the fact that children with Down’s syndrome are often born with a congenital heart defect. However, there’s a lot of research going on to know the exact link between genetics and ASD. When within the womb, every child has an opening between the upper heart chambers to allow blood from flowing into the lungs. This opening gradually closes after birth. When the hole does not close or is larger than normal, the child is affected with ASD.
2. Other Causes:
Sometimes factors like the mother’s exposure to alcohol, drugs, or diseases like diabetes and rubella during pregnancy may also increase the child’s risk for Atrial Septal Defects.
[ Read: Congenital Heart Disease In Kids ]
Symptoms Of Atrial Septal Defect:
It is difficult to identify ASD unless there’s a large hole in the septum causing shortness of breath and fatigue. Kids with ASD often seem healthy and normal until the doctor monitors the heartbeat through a stethoscope. And in some cases, the murmur isn’t loud enough to be diagnosed easily. Some common atrial septal defect symptoms include:
- Shortness of breath
- Frequent lung problems
- Heart palpitations
- Swelling of legs and feet
- Fatigue
Thus, a heart murmur is the only clear signal that indicates a congenital heart defect. But not all murmurs are a sign of a problem- only a doctor would be able to identify the second beat that flows with the normal heartbeat. If an abnormal heartbeat is suspected, the patient may be referred to a cardiologist who carries out several tests to look for signs of ASD. He usually suggests an echocardiography (ECG) to identify the hole and determine its size. It also shows if the right atrium is enlarged because of the added pressure. An electrocardiogram (EKG) is also performed to monitor electric activity of the heart and look for irregularities in the heartbeat. In some cases, the doctor may recommend a process called cardiac catheterization where a small tube called catheter is inserted into a vein in the arm or thigh. A dye in this tube looks for abnormalities in the heart and check for pressure in the heart. Minor defects can also be repaired through cardiac catheterization.
[ Read: Cardiac Catheterization for Kids ]
Treating Atrial Septal Defect:
Not all holes in the heart need treatment- small holes close on their own. Small holes that do not close are also not a cause of worry and do not need treatment. Large holes that do not close or narrow naturally may need surgical intervention. An open heart surgery is recommended to close large holes, especially when detected in early childhood. Depending on the size of the hole, the surgeon may either use a patch or sew to close.
Some ASD can be treated with cardiac catheterization. This process helps to treat the patient without stopping the heart or using the cardiopulmonary bypass process. Catheter procedures are less complicated when compared to open heart surgery. A tiny needle is all that’s inserted inside and hence recovery is fast. An open heart surgery is a low-risk treatment in most cases and is effective as well. Children are kept for some 3 to 4 days under observation. Doctors and nursing staff explain about postoperative care to patients and parents of patients. Regular checkups are scheduled to monitor progress.
What If Atrial Septal Defect Is Left Untreated?
When left untreated, the continuous pressure on the lungs and heart may render them weak and susceptible to failure.
Living With ASD:
Children can live a normal life after Artial Septal Defect treatment. They do not need special care but may need an occasional checkup as they progress in life. Only those patients treated for ASD as an adult, or those who’ve undergone a catheter procedure may need regular checkup.
The signs, symptoms and treatment we’ve mentioned here are derived from common experiences. Share your story if you know of a different experience.
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