Atrial septal defect in children (ASD) is a heart aneurysm. Cardiac ASD: Diagnosis and Treatment of Atrial Septal Defect in Newborns

Atrial septal defect in newborns is an extremely rare disease that is classified as a congenital heart malformation (CHD).

It entails a huge number of consequences.

How to recognize the problem in time and how to deal with it? We will tell in this article.

Atrial septal defect is a congenital anomaly of the heart (congenital defect). With an incomplete defect, there is hole between partitions, and with full - there is no partition at all. The disease is characterized by the presence of a message between the right and left atria.

The disease can be detected by ultrasound quite by accident, as many people are asymptomatic.

Causes of development and risk factors

Atrial septal defect is a genetic disorder. If the child has close relatives suffering from heart disease, it is necessary to pay more attention to his health.

Also this disease may develop due to external causes. During pregnancy, you should give up smoking and alcohol, take medications only under the supervision of your doctor. Congenital malformation may occur if the child's mother during pregnancy was ill with diabetes mellitus, phenylketonuria or rubella.

Forms

Defects are distinguished by the size and shape of the holes between the atria:

• Primary.

  It is usually characterized by a large size (from three to five centimeters), localization in the lower part of the septum and the absence of a lower edge. The underdevelopment of the primary interatrial septum and the preservation of the primary message are attributed precisely to this form of defect. Most often, patients have an open antroventricular canal and splitting of the tricuspid and bicuspid valves.

• Secondary.

  It is characterized by an underdeveloped secondary septum. Usually this is a small damage (from one to two centimeters), which is located in the region of the mouths of the vena cava or in the center of the septum.

• The complete absence of a barrier.

  Such a defect is called a three-chambered heart. This is due to the fact that due to the complete absence of the septum, a single common atrium is formed, which may be associated with anomalies of the anterior ventricular valves or with asplenia.

One of the options for interatrial communication is called an open oval window, which is not attributed to this defect, since it is just an underdevelopment of the orifice valve. With an open oval window, hemodynamic disturbances do not occur, therefore, in this case, a surgical operation is not required.

Complications and consequences

Small defects are quite difficult to detect- Some people learn about their disease only in old age. With a large defect, life expectancy can be reduced to 35-40 years.

This problem over time leads to depletion of regenerative resources of the heart, which can cause the development of pulmonary diseases, heart failure, and also lead to frequent fainting or even a stroke.

Symptoms

In childhood and adolescence, it is often quite difficult to recognize a small and medium defect, since it does not bring any obvious inconvenience. A large defect is much easier to recognize, since quite pronounced symptoms appear with it:

• shortness of breath that occurs during physical exertion;
• susceptibility to respiratory tract infections;
• pallor or even cyanosis of the skin;
• weakness, fatigue;
• violation of the heart rhythm.

If the patient observes one of the above symptoms, or parents pay attention to the child's capriciousness, tearfulness, lack of desire to play for a long time with other children, then you should contact to a pediatrician or therapist. Next, the doctor will conduct an initial examination and, if necessary, give a referral for further examination.

Learn about the danger from another article - it is important for all parents of children at risk of congenital heart disease to know this.

What is the difference between a ventricular septal defect in a fetus and an atrial defect? Check out the articles.

Diagnostics

Various methods are used to detect the disease. For further guidance, you should contact a pediatrician or a general practitioner who, based on an analysis of the complaints of the patient or his parents, can refer you to a cardiologist.

First, the patient's life history is collected (does his relatives have congenital heart defects, how did the mother's pregnancy proceed), and then give referral for further tests: urinalysis, biochemical and general blood tests. Based on the results obtained, it is possible to find out how other internal organs function, and whether this is related to the work of the heart.

Also held general examination, auscultation (listening to the heart), percussion (percussion of the heart). The last two methods allow you to find out if there are changes in the shape of the heart and whether the noises characteristic of this defect are heard. After the studies, the pediatrician or therapist decides whether there are grounds for further diagnosis.

If the doctor suspects a patient has a congenital heart disease, more complex research methods are used:

• A chest x-ray can show changes in the shape of the heart.
• Electrocardiography (ECG) makes it possible to observe in the patient violations in the conduction and rhythm of the heart, as well as an increase in the right sections.
• Echocardiography (EchoCG), or ultrasound. When using a two-dimensional (Doppler) method, you can see where the septal defect is located and its size. In addition, this method allows you to see the direction of the discharge of blood through the hole.
• Probing (insertion of a catheter) helps to determine the pressure in the cavities of the heart and blood vessels.
• Angiography, venticulography and magnetic resonance imaging (MRI) are prescribed in cases where other research methods were not indicative.

After the diagnosis, the attending physician decides whether the patient needs surgery or conservative treatment will be sufficient.

Treatment methods

One of the ways to treat minor defects that do not complicate the life of the patient is conservative method of treatment. In addition, this type of treatment is also used in cases where an operation that was not carried out on time was the result of the development of diseases such as myocardial ischemia and heart failure.

Surgery is recommended for patients aged 1 to 12 years. This is due to the fact that at this age the body has already adapted to the changes that have occurred in the body due to an atrial septal defect, and there is no longer a possibility of self-closing of the defect. There are currently two ways to close a defect.

Open operation

If the size of the hole does not exceed four centimeters, you can perform open heart surgery. During the operation, a heart-lung machine is used, most often with cardiac arrest.

Depending on the size of the defect, the method of its elimination is also determined: suturing the defect (no more than 120 millimeters) or installing a patch from one's own pericardium.

The recovery period lasts about a month. At this time, it is necessary to monitor nutrition and refrain from physical activity.

Endovascular occlusion (closed)

This type of surgical intervention is through the femoral vein a catheter with an occluder (plate) is inserted, which is then directed to the right atrium. Next, the occluder closes the hole, "fills" it.

This method of performing the operation has several advantages over the open operation: no need for general anesthesia, few injuries, fast recovery period- just a few days.

Forecasts and preventive measures

In order to prevent the development of an atrial septal defect in children, the mother must register on time at the antenatal clinic during pregnancy.

You should avoid smoking, drinking alcohol, adhere to proper nutrition and take medications only as prescribed by a doctor. It is also worth telling the gynecologist who is leading your pregnancy about the presence of relatives suffering from congenital heart disease.

Despite the fact that this disease has a positive prognosis, it is necessary to take timely treatment measures so that various complications do not appear in the future.

Today, identifying an atrial septal defect in children is quite simple, heart disease in newborns in most cases detected during ultrasound examination. If the disease was not detected immediately after birth, but you have suspicions, you should consult a doctor.

Often, people with this defect live for many years before it is discovered. But when a young child is diagnosed, parents are shocked. For them, this is akin to a death sentence - the pathology is heart!

Of course, there is nothing pleasant in the disease, but in reality it is not as terrible as it might seem at first glance. Worst of all, doctors rarely explain this to young parents, and the fear of the unknown is growing rapidly ...

Causes of ASD in children

As you know, the human heart consists of the right and left atria, separated by a septum. Oxygen-enriched arterial blood enters the left atrium from the pulmonary arteries, and "waste" venous blood is transported into the right from the superior and inferior vena cava. The septum just prevents them from mixing, but in some cases a hole forms in it, and then an atrial septal defect (ASD) is diagnosed.

This is one of the many congenital heart defects that can develop alone or in combination with other pathologies (ventricular septal defect, mitral valve insufficiency, abnormal flow of the pulmonary veins into the right atrium instead of the left, and others).

It is impossible to determine what exactly caused such a violation, but it is definitely formed during the period of intrauterine development, when the main organs of the fetus are laid. Scientists identify a number of factors contributing to the formation of ASD:

• Rubella during early pregnancy (in the first trimester).
• Smoking and alcohol consumption during conception and childbearing.
• Taking certain medications during pregnancy.
• hereditary predisposition.
• Gene mutations.

Atrial septal defect in children: symptoms and signs

A newborn with ASD looks no different from other children. Vice does not manifest itself at an early age. It occurs in different ways, but predominantly an atrial septal defect is detected after 20 years, although there are a few cases when people lived to old age, unaware of the presence of this pathology.

ASD is diagnosed using special examination methods, among which may be ultrasound of the heart (echocardiography), chest x-ray, injection of a contrast agent, pulse oximetry, ECG, MRI. The presence of pathology is indicated, in particular, by an increase in the size of the heart (especially the right atrium), inflammation of the valves, the presence of blood clots, blood stasis in the lungs, thickening of the right ventricle, and arrhythmia.

A therapist can also suspect the likelihood of an atrial septal defect in a child by listening to heart rhythms. But still, pathological noises are not always heard in this case.

Doctors advise parents to pay attention to the health of the baby and contact the pediatrician for further examination if the child is prone to lung diseases (bronchitis, prolonged cough), pneumonia often forms and an asthmatic component is present, and if the following symptoms are present or combined in children:

• lethargy, pallor, thinness, chronic fatigue, apathy;
• fatigue, especially when performing physical activities, even mild ones;
• tachycardia, violation of the pulse and heart rhythm;
• shortness of breath, feeling of lack of air;
• blue skin in the nasolabial triangle;
• swelling in the lower body.

Atrial septal defect in children and open foramen ovale

ASD in children is often combined with other heart defects. Often parents confuse it with a condition such as a patent foramen ovale (PFO). You have to understand the difference between them.

During the entire period of intrauterine development, the left and right atria are connected to each other by a special opening in the septum, which is called the oval window. It is necessary for the implementation of blood circulation in the body of the fetus. After childbirth, this “hole” closes on its own within a year, since the child’s blood circulation begins to occur differently, that is, there is no longer a need for a window. In some cases, the oval window continues to remain open, for which scientists cannot yet find an explanation. LLC tends to spontaneously close some time after childbirth, but often, nevertheless, there is a need for an operation to close it.

An atrial septal defect is a channel passing through the septum, which normally should not be there, that is, it is a congenital anomaly in the structure of the heart. Depending on the location and size of the lumen, different types of ASD are distinguished: “central defect” or “defect without upper or lower edge”, primary and secondary. The most common defect is a "lighter" secondary type, located in the upper or middle section of the septum. A small atrial septal defect sometimes also heals on its own, but much more often it has to be closed operatively.

Why ASD is dangerous: prognosis, complications

This is bad news: the operation is almost inevitable, and doctors advise not to postpone it. According to medical statistics, in the absence of such treatment, only half of all people with ASD survive to 50 years of age. But the good news is that such an operation does not require urgency (with the exception of severe conditions), often doctors take a wait-and-see attitude and observe a sick child. Another comforting argument: cardiac surgery has accumulated vast experience in performing such operations, and they show excellent efficiency, despite the fact that complications after the operation are not excluded, which we will talk about a little later.

In the presence of a hole in the interatrial septum, with each contraction of the heart, a portion of a different blood composition is thrown from the left atrium into the right atrium. As a result, the right atrium is stretched and enlarged, and the lungs also suffer due to the increased load on them (after all, the amount of blood that has to be purified is constantly increasing). Due to the constant work in such a stressful mode of the heart and lungs, various painful conditions are formed, which entail rather high risks. Among the possible consequences of ASD, in particular, the following are distinguished:

• Development of arrhythmia.
• Heart failure.
• Pulmonary hypertension, Eisenmenger's syndrome.
• Increased risk of strokes.
• High risk of premature death.

Atrial septal defect in children: treatment

Treatment of ASD can prevent undesirable consequences, and in the case of complications that have already formed (when the pathology is detected at the age of about 40 years and later), stop their further progression. An exception is the situation when the disease is severely neglected, and irreversible changes in the lungs have occurred - such patients can no longer be operated on.

Doctors emphasize that the sooner the operation to close the ASD is performed, the sooner the parents will forget about this problem and the lower the risks for the child in the future. However, there is no need to hurry. The child must be carefully examined, and based on the results, together with the doctor, a decision should be made regarding the timing and methods of the operation.

Today in surgical practice, two methods are used for this:

1. Classical open heart surgery. Under general anesthesia, the chest is opened, and the pathological opening is “sutured”: a patch is applied to it, which over time will become overgrown with connective tissue, becoming related to the septum and giving it the necessary integrity. During the operation, the patient is connected to a heart-lung machine. Of course, this is a highly traumatic manipulation that requires a long recovery period and carries other dangers. However, in some cases (in particular, in the primary type of ASD and when it is combined with other heart defects), this method is the only one possible for use.
2. The endoscopic method is more modern and safer. Through the femoral artery, with the help of a catheter, a special occluder is brought to the heart - a device in the form of a closed mini-umbrella, which, after delivery to the destination, opens, forming a mesh dome. It closes a hole in the septum, which later overgrows according to the same principle as in the previous case. Obviously, such a treatment is preferable and has many advantages, but it is not without drawbacks. In particular, this method can be used only for secondary atrial septal defects of small size. And in this case, complications are not excluded: infection at the puncture site in the thigh, an allergic reaction to a contrast agent injected into the artery, damage to the artery. But within 2-3 days after the operation, the patient completely returns to normal and can continue his usual lifestyle.

It is impossible to cure the defect with medication, but drug therapy is also used - both separately and in combination with surgical methods. Medicines can reduce the risk of thrombosis and inflammation, and improve heart rate. Mainly, these are blood-thinning, antibacterial, diuretic drugs.

Let's recap. Of course, it is very difficult to remain calm and optimistic when a heart defect is found in your own baby. However, you should assess the situation soberly. The problem is completely solvable! Moreover, cardiac surgeons are well-acquainted and completely master the ways of solving it.

God forbid that in your case the septum overgrown on its own, and the operation was avoided. But even if this does not happen, it's okay: get examined, look for a good specialist - and the baby will live a full life!

Especially for - Elena Semenova

A congenital heart defect in which there is a hole in the septum separating the atrial chambers is called an atrial septal defect (ASD). With such a heart disease, children cannot normally endure stress, their heart rhythm may go astray. Treatment is carried out by surgical methods.

ASD is the area of ​​communication between the chambers of the heart. It should be distinguished from an open oval window. The latter looks like a small oval window that the fetus has in the womb. There is a hole because the child does not use the lungs to breathe. When a person is born, it closes. For more than half it occurs in the first week of life, and for others up to 6 years, but for some it remains open for life.

ASD is a pathology of the development of the interatrial septum, which normally should not be. If the hole is up to 4 mm or 5 mm in size, then it does not negatively affect the work of the heart and, in general, health. In this case, no operation is required.

If the dimensions are from 5 mm or more, then this is already considered a heart disease. Usually, up to 2 years, no problems and symptoms are noted in children, but if the defect is about 8 mm in size and up to 1 cm, then the child has problems in the form of developmental delay. Shortness of breath appears, the child quickly gets tired for no apparent reason, often gets sick. In this case, the treatment is carried out only by the surgical method.

Atrial septal defect in children is divided into:

1. Primary ASD or secondary.
2. Combined.
3. Single or multiple.
4. No barriers.

A secondary defect is recorded as an independent disease or combined with other heart defects, if the formation and development of the venous sinus is disturbed, anomalies of the pulmonary veins occur.

The disease is divided by localization into:

1. Upper.
2. Lower.
3. back.
4. Front.

The holes themselves can be of different sizes. If a person has a large hole, then the symptoms are pronounced, and the manifestation of the pathology is early. With an average hole, the problem may not be found in childhood, but in adolescence or adulthood. With a small hole, the disease proceeds without obvious symptoms.

Important! Pathology can develop independently or in combination with other CHD: VSD, coarctation of the aorta, and others.

With such a disease, a large amount of blood enters the vessels of the lungs through a defect, but since the pressure is low, the discharge of blood is also small. Pulmonary hypertension develops slowly, usually appears in adults.

Additionally, it is worth noting that the defect can be significantly reduced in size or even close on its own, especially if the hole size is less than 8 mm. In this case, the operation on the heart can not be performed. Subsequently, such people are no different from absolutely healthy people.

The reasons

ASD is a hereditary problem, the form of severity depends on genetics and the influence of other harmful factors. The main cause of ASD in newborns is a failure in the development of the heart during embryogenesis. Often the problem is formed in the 1st trimester.

Normally, the heart consists of several parts that during development correctly become and connect to each other. If such a process is disturbed, then a defect is formed in the partition.

Possible causes of ASD:

1. Bad ecology.
2. hereditary predisposition.
3. Viral diseases that are transferred during pregnancy.
4. Diabetes.
5. The use of medicines.
6. Drinking alcohol
7. Addiction.
8. Toxicosis.
9. The father is over 45 and the mother is over 35.

An ASD is often found in children with Down syndrome, cleft lip, or kidney abnormalities.

Symptoms

With small defects, the clinic is often not detected, there are no serious health problems. Newborns sometimes have cyanosis during crying or anxiety.

Signs of heart problems in children begin at an older age. Initially, their activity is the same as in all children, but after a few years, weakness and shortness of breath begin.

With medium and large defects, symptoms occur already in the first periods after birth. The skin becomes pale, the heart in newborns beats strongly, cyanosis appears, shortness of breath at rest. Toddlers are malnourished, may break away from feeding to inhale. During feeding, they often choke. Such children lag behind in development and weight gain from others.

When a child is 3-4 years old, heart failure may develop, nosebleeds, dizziness appear, physical labor becomes unbearable. Severe CH leads to deformity of the terminal phalanges of the fingers, which resemble drumsticks in appearance. Children diagnosed with ASD often get the flu and other respiratory illnesses.

Important! In adults, ASD gives the same symptoms, but they appear stronger and more diverse, which is caused by a greater load on the heart.

It is worth noting that if a doctor diagnoses CHD with an ASD, then such a person is not taken into the army.

Complications

There are a number of complications that can be caused by pathology:

1. Infectious endocarditis - the disease is provoked by an infection, it develops due to the discharge of blood, which injures the endocardium.
2. Stroke is a common problem when CHD complications begin.
3. Arrhythmia.
4. Pulmonary hypertension.
5. Ischemia - not enough oxygen is supplied to the heart muscle.
6. Rheumatism.
7. secondary pneumonia.
8. Acute heart failure occurs due to disruption of the right ventricle. With stagnation of blood in the abdominal part, the patient's stomach begins to swell, appetite disappears and vomiting appears.

Any complication entails high mortality and without proper therapy, only half of the patients survive to 50 years of age.

Diagnostics

With diagnostics, the doctor initially conducts a conversation with the patient, a general examination, after which additional methods of examination are used. With the help of auscultation, splitting of the II tone is revealed, when listening, systolic murmur and weak breathing can be noted.

To confirm the diagnosis of ASD, the results of instrumental examinations are used:

• An ECG is performed, which shows signs of hypertrophy of the heart chambers, a failure in conduction.
• Phonocardiography is used to confirm auscultatory findings and record all heart sounds.
• An x-ray is taken to reveal a change in the shape and size of the heart, a large amount of fluid in the heart.

• EchoCG allows you to obtain data on anomalies and their nature, shows ASD, establishes localization, size.
• Catheterization is performed to measure the pressure in the vessels and heart chambers.

These are the main diagnostic methods, but other additional methods can be used.

Conservative treatment

Important! With a small defect, the hole may close on its own at any time in infants. If the pathology does not manifest itself, and the hole is up to 1 cm, then the operation is not performed, close monitoring of the child and echocardiography every year is sufficient.

If an infant or older child develops the symptoms described above, then parents should consult a doctor. Treatment is performed surgically or conservatively.

If the patient has insignificant symptoms, then drugs are used for therapy that improve heart function and normalize blood supply. Among the drugs used are:

1. Glycosides - reduce the heart rate, increase the very strength of contractions, normalize blood pressure. Used "Digoxin", "Strophanthin".
2. Diuretics remove excess fluid from the body, lower blood pressure. In particularly difficult cases, the drugs "Lasix", "Furosemide" are used, which are administered intravenously, and in other situations, "Spironolactone" or "Indapamide" are used.
3. ACE inhibitors improve hemodynamics. Captopril, Lisinopril are used.
4. Antioxidants strengthen the vascular walls, remove free radicals from the body. Used to prevent heart attack and thrombosis. It is recommended to take vitamins A, C, E, zinc and selenium.
5. Anticoagulants reduce blood clotting, stop the development of blood clots. Used "Warfarin", "Heparin".
6. Cardioprotectors are needed to protect the myocardium from destruction, have a good effect on hemodynamics, and normalize the work of the heart. An effective medicine is considered "Panangin", "Mildronate".

Surgery

Today, the safest and most effective method of treatment is endovascular plastic surgery. This operation is carried out quickly and painlessly. Used to treat children. During the operation, large vessels are punctured, through which a special “umbrella” is brought to the ASD, after which it is opened. After a while, it begins to overgrow with tissues and closes the hole.

This plasty allows you to restore the integrity of the septum and stop the discharge of blood. This is the safest and least traumatic way to treat congenital heart disease today. Another method of treating pathology is also used, in which open heart surgery is performed.

Initially, the patient is given anesthesia. The body temperature decreases. The heart is then disconnected from the bloodstream and the patient is connected to a heart-lung machine. The chest and pleural cavity are cut, then the pericardium is dissected. Next, the heart is incised and the defect is removed. If the hole is less than 1.2 cm, it is simply sutured. If the defect is larger, it is closed with an implant. After the intervention, the child is sent to the intensive care unit for 24 hours, and then to the hospital ward for 10 days.

Important! A person with ASD will live, but the number of years depends on the size of the defect, the presence of other heart defects. If the pathology is diagnosed and treated in time, then the prognosis is positive.

Atrial septal defect (ASD) is the second most common congenital heart disease.

With this defect, there is a hole in the septum that separates the right and left atrium into two separate chambers. In the fetus, as we said above, this hole (open oval window) not only exists, but is also necessary for normal blood circulation. Immediately after birth, it closes in the vast majority of people. In some cases, however, it remains open without people being aware of it. The discharge through it is so insignificant that a person not only does not feel that “something is wrong with the heart”, but can also calmly live to a ripe old age. (Interestingly, thanks to the capabilities of ultrasound, this defect in the interatrial septum is clearly visible, and in recent years, articles have appeared that show that among such adults and healthy people who cannot be classified as patients with congenital heart disease, the number of migraine sufferers is significantly higher - severe headaches (this data, however, has yet to be proven).

In contrast to non-closure of the open foramen ovale, true atrial septal defects can be very large. They are located in different parts of the septum itself, and then they speak of a “central defect” or “a defect without an upper or lower edge”, “primary” or “secondary”. (We mention this because the type and location of the hole may also depend on choice of treatment).

If there is a hole in the septum, a shunt occurs with blood flow from left to right. With ASD, blood from the left atrium partially moves into the right with each contraction. Accordingly, the right chambers of the heart and lungs are overfilled, because. they have to pass through themselves a larger, extra volume of blood, and even once already passed through the lungs. Therefore, the pulmonary vessels are filled with blood. Hence the tendency to pneumonia. Pressure, however, is low in the atria, and the right atrium is the most "distensible" chamber of the heart. Therefore, it, increasing in size, copes with the load for the time being (usually up to 12-15 years, and sometimes more) quite easily. High pulmonary hypertension, which causes irreversible changes in pulmonary vessels, never occurs in patients with ASD.

Newborns and infants, and young children in the vast majority grow and develop absolutely normally. Parents may notice their tendency to have frequent colds, sometimes ending in pneumonia, which should alert them. Often these children, in 2/3 cases girls, grow up pale, thin and somewhat different from their healthy peers. They try to avoid physical exertion as much as possible, which in the family can be explained by their natural laziness and unwillingness to tire themselves.

Complaints about the heart can and usually appear in adolescence, and often after 20 years. Usually these are complaints about "interruptions" in the heart rhythm that a person feels. Over time, they become more frequent, and sometimes lead to the fact that the patient is already incapable of normal, ordinary physical activity. This does not always happen: G.E. Falkovsky once had to operate on a patient at the age of 60, a professional driver, with a huge atrial septal defect, but this is an exception to the rule.

To avoid such a "natural" course of the defect, it is recommended to close the hole surgically. Unlike VSD, an atrial defect will never grow on its own. The operation for ASD is performed under cardiopulmonary bypass, on an open heart, and consists in suturing the hole or closing it with a patch. This patch is cut out of the heart shirt - the pericardium - the bag surrounding the heart. The size of the patch depends on the size of the hole. It must be said that ASD closure was the first open-heart surgery and was done more than half a century ago.

Sometimes an atrial septal defect can be combined with an abnormal, abnormal flow of one or two pulmonary veins into the right atrium instead of the left. Clinically, this does not manifest itself in any way, and is a finding when examining a child with a large defect. This does not complicate the operation: just a patch is larger and is made in the form of a tunnel in the cavity of the right atrium, which directs the blood oxidized in the lungs to the left parts of the heart.

Today, in addition to surgery, in some cases it is possible to safely close the defect using X-ray surgery technology. Instead of suturing the defect or sewing in a patch, it is closed with a special device in the form of an umbrella - an occluder, which is passed through the folded catheter and opened after passing through the defect.

This is done in the X-ray surgery room, and everything related to such a procedure, we described above when we touched on probing and angiography. Closing a defect with such a “non-surgical” method is far from always possible and requires certain conditions: the anatomical location of the hole, the sufficient age of the child, etc. Of course, if they are present, this method is less traumatic than open heart surgery. The patient is discharged after 2-3 days. However, it is not always feasible: for example, in the presence of abnormal vein drainage.

Today, both methods are widely used, and the results are excellent. In any case, the intervention is elective, not urgent. But you need to do it in early childhood, although it is possible earlier, if the frequency of colds and, especially, pneumonia, becomes frightening and threatens with bronchial asthma, and the size of the heart increases. In general, the sooner the operation is done, the sooner the child and you will forget about it, but this does not mean that with this defect you should especially hurry.

An atrial septal defect (ASD) is a hole in the wall between the right and left atrium. This is a congenital heart defect. An ASD that is small enough may close on its own in early childhood.

If the atrial septal defect is large enough, it cannot heal itself, and without surgical treatment leads to the development of heart failure, due to the reflux of blood from the left sections to the right and overload of the pulmonary circulation and the right sections of the heart.

Symptoms of ASD

In most cases, newborns with ASD do not have any symptoms of this heart disease. In adults, signs of an atrial septal defect usually appear by the age of 30, but in some cases, manifestations of ASD may not be observed until older age.

Symptoms of an atrial septal defect include:

• Heart murmurs (on auscultation)
• Shortness of breath, especially on exertion
• Fatigue
• Swelling of the legs, feet and abdomen
• heartbeat
• Frequent lung infections
• Stroke
• Blueness of the skin (cyanosis)

When to See a Doctor

You should see a doctor if any of the following symptoms occur:

• Blueness of the skin
• Dyspnea
• Fatigue, especially after exercise
• Swelling of the legs, feet, abdomen
• palpitations

All these symptoms indicate the presence of heart failure and other complications of an atrial septal defect.

Causes of ASD

The exact and clear causes of heart defects are unknown. Heart defects themselves, including ASD, arise due to a violation of the development of the heart in the early stages of fetal formation. An important role is played by external environmental factors and genetic factors.

With an atrial septal defect, blood, due to the fact that the myocardium of the left heart is "stronger" than the myocardium of the right heart, enters through the opening of the defect from the left atrium to the right. This blood is just from the lungs, that is, it is enriched with oxygen. In the right atrium, it mixes with oxygen-poor blood and enters the lungs again. With a significant size of the defect, the lungs and right sections of the heart are overloaded with blood. In the absence of treatment, the right parts of the heart expand, hypertrophy of the myocardium of the right atrium and ventricle occurs, with its gradual weakening. In some cases, this can lead to pulmonary congestion and pulmonary hypertension.

Comparison of atrial septal defect with non-closure of the foramen ovale

The foramen ovale is a natural opening in the atrial septum, which is necessary for the blood flow of the fetus in the womb. This is due to the peculiarities of fetal circulation. After birth, this hole usually closes up. With its non-closure, they speak of such a defect as non-closure of the oval window. Depending on the size of this hole, there will be manifestations of this defect.

Risk factors for ASD

There are no exact causes of an ASD, like most other congenital heart defects, but researchers have identified a number of key risk factors that can lead to an ASD in a child. These can be, for example, genetic factors, so if you or someone in your family has a congenital heart disease, you should undergo genetic counseling to determine the risk of the defect in your unborn child.

Among the risk factors that play a role in the occurrence of ASD during pregnancy, the following are distinguished:

• Rubella.

  This is a viral disease. If a woman had rubella during pregnancy, especially at an early stage, then there is a risk of congenital heart defects, including ASD, as well as other developmental anomalies in the newborn.

• Taking certain drugs and alcohol during pregnancy.

  Some drugs, especially if taken in early pregnancy, when the main organs of the fetus are being laid, as well as alcohol intake, can increase the risk of developmental anomalies, including ASD.

Complications of ASD

With a small ASD, a person may never notice any problems at all. Small atrial septal defects may close on their own during infancy.

With a larger size of this heart disease, there can be life-threatening complications:

• Pulmonary hypertension.

  If a large atrial septal defect is left without surgical correction, there is an overload of blood in the right heart with the development of stagnation in the pulmonary circulation and pulmonary hypertension (increased blood pressure in the pulmonary circulation).

• Eisenmenger syndrome.

  In rare cases, pulmonary hypertension can lead to irreversible changes in the lungs. This complication, called Eisenmenger's syndrome, usually develops after a long period of time in only a small number of ASD patients.

Other complications of atrial septal defect

Other complications of ASD, in the absence of surgical treatment, include:

• Right heart failure
• Heart rhythm disorders
• Low life expectancy
• Increased risk of stroke

Timely surgical treatment can help prevent all these complications.

Atrial septal defect and pregnancy

Most women with an ASD, in which the size of the defect is small, can get pregnant without any problems. However, if the size of the atrial septal defect is large, or the woman has complications of this defect such as heart failure, arrhythmias, or pulmonary hypertension, then the risk of complications during pregnancy increases. Women with Eisenmenger's syndrome are strongly advised by doctors to refrain from pregnancy, as it can be life-threatening.

In addition, the risk of congenital heart defects in children if the mother or father of the child has a congenital heart disease, including ASD, is higher than in others. Patients with heart disease, whether operated on or not, are advised to consult their doctor before deciding to become pregnant. In addition, before deciding on pregnancy, you should stop taking certain drugs that can be risk factors for ASD, so in this case, you should also consult a doctor.

Diagnosis of ASD

An atrial septal defect may be suspected at regular physical examinations. Usually, the doctor first learns about the possibility of an ASD during auscultation, when heart murmurs are heard. In addition, ASD can also be detected by ultrasound of the heart (echocardiography), which is performed for any other reason.

If the doctor detects heart murmurs during auscultation, special research methods are required to clarify the type of heart disease:

• Echocardiography (ultrasound of the heart).

  It is also a non-invasive and safe research method that allows you to evaluate the work of the heart muscle, its condition, as well as the conduction of the heart.

• Chest X-ray.

  A chest x-ray can look for enlarged heart or extra fluid in the lungs. This may be a sign of heart failure.

• Pulse oximetry.

  This method of research allows you to determine the saturation of the blood with oxygen. A special sensor is placed on the tip of the finger, which records the level of oxygen in the blood. Low blood oxygen saturation indicates heart problems.

• Cardiac catheterization.

  This is an x-ray method, which consists in the fact that using a thin catheter, which is inserted through the femoral artery, a special contrast agent is injected into the bloodstream, after which a series of x-rays is taken. This allows the doctor to assess the condition of the structures of the heart. In addition, this method allows you to determine the pressure in the chambers of the heart, on the basis of which you can indirectly judge the pathology of the heart.

• Magnetic resonance imaging (MRI).

  MRI is a method that allows you to get a layered structure of organs and tissues, while without x-ray radiation. This is an expensive diagnostic method, and is usually used in cases where echocardiography does not give an accurate answer.

Treatment of ASD

An atrial septal defect does not require urgent surgical treatment (except when its complications have a risk of threatening the patient's life). If an ASD has been identified in a child, then the doctor may first suggest monitoring his condition, since often the atrial septal defect can heal itself. In some cases, when an ASD does not heal itself, but the hole is small enough, it may not interfere with the patient's normal life, and in this case, surgical correction may not be required. But most often, ASD requires surgical treatment.

The timing of surgical correction of this heart defect depends on the health of the child and the presence of other congenital heart defects.

Medical treatment of ASD

It should be immediately noted that no drug leads to the fusion of an atrial septal defect. But conservative treatment can reduce the manifestation of ASD, as well as the risk of complications after surgery. Among the drugs that can be used in patients with ASD, we can note:

• Drugs that regulate the rhythm of the heart.

  Among them are beta-blockers (inderal, anaprilin) ​​and digoxin.

• Drugs that reduce blood clotting.

  This is the so-called. Anticoagulants, which reduce blood clotting, reduce the risk of a complication of ASD such as a stroke. These drugs include, most commonly, warfarin and aspirin.

Surgical treatment of ASD

Many cardiac surgeons recommend surgical treatment of ASD in childhood to prevent possible complications in adulthood. In both children and adults, surgical treatment consists in closing the defect by applying a "patch" that prevents blood from flowing from the left side of the heart to the right side. To do this, one of the methods of intervention can be carried out:

• Cardiac catheterization.

  This is a minimally invasive method of treatment, which consists in inserting a thin probe through the femoral vein under X-ray control, the end of which is brought to the defect site. Further, a mesh patch is installed through it, which closes the defect in the septum. After some time, this mesh grows into tissue, and the defect is completely closed. Such an intervention has a number of advantages - a shorter postoperative period and a lower complication rate. In addition, this method of treatment is easier to tolerate by the patient, as it is less traumatic. Among the complications of this method of treatment can be identified:
  • Bleeding, pain, or infection at the site of the catheter.
  • Damage to a blood vessel (rare complication)
  • Allergic reaction to the radiopaque substance that is used during catheterization.

• Open surgery.

  This type of surgical treatment of heart defects is performed under general anesthesia and consists of a traditional chest incision, connecting the patient to a heart-lung machine. In this case, a heart incision is made and a patch of synthetic material is sewn in. The disadvantage of this method is a longer postoperative period and a greater risk of complications.