It is a congenital defect in which there is a hole in the wall between the heart’s upper chamber i.e. atria. During the development of a baby, the interatrial septum develops to separate the left and right atria. However, a hole in the septum called foramen ovale allows blood to flow from the right atrium to left atrium during fetal development.
After the birth, the pressure in right side of the heart drops as the lungs open and begin working causing the closure of foramen ovale. But in about 25% of the adults, it does not entirely seal. In such cases, any elevation of the pressure in the pulmonary circulatory system can open the foramen ovale.
In ASD the chambers of left side are under high pressure than the chambers of right side . in case of large ASD the extra blood from left atrium may cause volume overload in right side and if untreated , his condition may result into enlargement of right side of heart and finally heart failure.
Down syndrome – children’s having down syndrome are more likely to have ASD .
Smoking – smoking during pregnancy may lead to many septal defects including ASD.
Holt – Oram syndrome – it is an autosomal dominant disorder. Patients with this syndrome may also have cardiac conduction anomaly.
Ebsteins anomaly- it is a congenital heart defect.
Lutembacher’s syndrome – females are affected more as compared to males. Mitral stenosis is also a feature of this syndrome.
Types of ASD-
1. Secundum atrial septal defect- It involves fossa ovalis region of the interatrial septum . It is an isolated anomaly.
2. Primum atrial septal defect – It involves atrioventricular septum and represent a malformation of the endocardial cushions.
3. Sinus venosus atrial septal defect- It involves the posterior aspect of the atrial septum .
4. Coronary sinus atrial septal defect- It is associated with an absent coronary sinus and connection of left superior vena cava to left atrium.
Untreated ASD may lead following complications
Heart murmur is the primary symptom of ASD patient. Following symptom may manifest with aging
ASD is diagnosed with following
Evaluation – an evaluation is made of the severity of the individual’s pulmonary hypertension. If pulmonary hypertension is present the evaluation may include a right heart catheterization.
Surgical closure- it includes opening up of one atrium and closing the defect with a patch under direct visualization.
Catheter procedure- A percutaneous device closure method is the first line therapy used which involves passage of a catheter into the heart through the femoral vein guided by fluoroscopy and echocardiography. A percutaneous device is the one that has discs that can expand to a variety of diameters at the end of the catheter and thus causing the closure of the septal defect.
CardioSEAL – It uses a double umbrella made of dacron fabric supported by a metallic framework .
STARflex device- Along with the umbrella shaped dacron fabric it also feature a self centring mechanism of nitinol microsprings .
Sideris buttoned device – It is used for third and fourth generation patients.
Helex –it consist of nitinol wire with ultrathin expanded polytetrafluroethylne formed into 2 equal sized opposing disks that bridge the defect.
Another device which is used to close ASD is ASO i.e. Amplatzer Septal Occluder. An ASO have two self expandable round discs which are made up of Dacron fabric.
Complications faced by the patient: there might be slight chances of facing complications by the ASD closure devices which include malpositioning of the device , malfunctioning of the device ,
cardiac perforation , air embolism , arrthmia, incomplete closure , thrombus formation , device erosion and even some incidences of storke are also reported.
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