An Atrial Septal Defect, or ASD, is a hole in the wall between the right and left atria (atrial septum). In the presence of an ASD, blood flows from the higher pressure left atrium to the lower pressure right atrium.
When this happens, the oxygen-rich blood of the left atrium is redirected through the right side of the heart and back to the lungs. The right atrium, right ventricle, and pulmonary artery may enlarge due to the increased blood flow through these structures.
Long-term side effects of an untreated ASD include atrial arrythmias (loss or abnormality of rhythm), ventricular dysfunction, and pulmonary vascular obstructive disease (a condition in which the pulmonary arteries become thickened due to high blood flow). For these reasons, it is preferential to close even small ASDs early in life to prevent complications later in life.
Three Types of ASD
Secundum-type ASDs are the most common, comprising approximately 85% of all ASDs. In many cases, infants and young children are asymptomatic and the ASD may not be detected until school age or later. Approximately 20% of secundum-type ASDs close spontaneously in the first year of life. Often, a heart murmur, associated with the increase in blood flow across the pulmonary valve, is the symptom that causes a physician to investigate further. The diagnosis of an ASD is confirmed by echocardiography.
In a secundum-type ASD, the hole is located in the central part of the atrial septum. The methods of treatment for a secundum-type ASD consist of surgical repair or a catheter technique. Options for surgical repair involve suture closure (reserved for small ASDs) or patch closure. The patch material may be a portion of the patients own pericardium (the sac around the heart) or a synthetic material. The catheter technique involves closure of the ASD with a synthetic device that plugs the hole. The device is introduced through a heart catheter which is passed through a vein in the leg that leads up to the heart. Initially, the device is held in place by the natural pressures created within the atria. Over time, the device acts as a framework over which normal tissue grows.
Sinus venosus atrial septal defects constitute 5% to 10% of all ASDs. In a sinus venosus ASD the hole is located in the upper portion of the atrial septum. This type of ASD is often associated with anomalous drainage of the right, upper pulmonary veins. In other words, the pulmonary veins, which normally carry oxygenated blood from the lungs to the left atrium, drain into the right atrium instead. There is no chance for spontaneous closure of this type of ASD. For this reason, surgical repair is necessary for patients with this type of ASD.
Primum-type ASDs constitute between 5% and 10% of all ASDs. In a primum-type ASD the hole is located in the lower part of the atrial septum. Frequently, abnormalities of one or more heart valves (most often the mitral valve) are associated with this defect. Unlike the secundum-type ASD, symptoms of this type of ASD are seen during early childhood. Surgical repair is the only method of treatment for a primum type ASD since there is no chance of spontaneous closure.
What Is Normal Cardiac Anatomy?
When your child has a congenital heart defect, there's usually something wrong with the structure of his or her heart's structure.
Heart With Normal Cardiac Anatomy
When your child has a congenital heart defect, there's usually something wrong with the structure of his or her heart's structure.
The heart is composed of four chambers. The two upper chambers, known as atria, collect blood as it flows back to the heart. The two lower chambers, known as ventricles, pump blood with each heartbeat to the two main arteries (the pulmonary artery and the aorta). The septum is the wall that divides the heart into right and left sides. The atrial septum separates the right and left atria; likewise, the ventricular septum separates the two ventricles.
There are four valves that control the flow of blood through the heart. These flap-like structures allow blood to flow in only one direction. The tricuspid and mitral valves, also known as the atrioventricular valves, separate the upper and lower chambers of the heart. The aortic and pulmonary valves, also known as the arterial valves, separate the ventricles from the main arteries. Oxygen-depleted blood returns from the body and drains into the right atrium via the superior and inferior vena cavas. The blood in the right atrium then passes through the tricuspid valve and enters the right ventricle.
Next, the blood passes through the pulmonary valve, enters the pulmonary artery, and travels to the lungs where it is replenished with oxygen. The oxygen-rich blood returns to the heart via the pulmonary veins, draining into the left atrium. The blood in the left atrium passes through the bicuspid, or mitral, valve and enters the left ventricle.
Finally, the oxygen-rich blood flows through the aortic valve into the aorta and out to the rest of the body.
From Nemours' KidsHealth
- ECG (Electrocardiogram)
- Cardiac Catheterization
- When Your Child Needs a Heart Transplant
- If Your Child Has a Heart Defect
- Heart and Circulatory System
- Congenital Heart Defects Special Needs Factsheet
- Coarctation of the Aorta
- Congenital Heart Defects
- A to Z: Atrial Flutter
- A to Z: Patent Ductus Arteriosus (PDA)
- A to Z: Hypoplastic Left Heart Syndrome
- Atrial Septal Defect
- A to Z: Tetralogy of Fallot
- Patent Ductus Arteriosus (PDA)
- Heart Murmurs
- Ventricular Septal Defect
- Tetralogy of Fallot
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Ventricular Septal Defect
What Is a Ventricular Septal Defect?
A ventricular septal defect (VSD) — sometimes referred to as a hole in the heart — is a type of congenital heart defect. In a VSD, there is an abnormal opening in the wall between the main pumping chambers of the heart (the ventricles).
VSDs are the most common congenital heart defect, and in most cases they're diagnosed and treated successfully with few or no complications.
What Happens in a Ventricular Septal Defect?
The right and left ventricles of the heart are separated by shared wall, called the ventricular septum. Kids with a VSD have an opening in this wall. As a result:
- When the heart beats, some of the blood in the left ventricle (which has been enriched by oxygen from the lungs) flows through the hole in the septum into the right ventricle.
- In the right ventricle, this oxygen-rich blood mixes with the oxygen-poor blood and goes back to the lungs.
The blood flowing through the hole creates an extra noise, which is known as a heart murmur. The heart murmur can be heard when a doctor listens to the heart with a stethoscope.
VSDs can be located in different places on the septum and can vary in size.
What Causes a Ventricular Septal Defect?
Ventricular septal defects happen during fetal heart development and are present at birth. The heart develops from a large tube, dividing into sections that will eventually become the walls and chambers. If there's a problem during this process, a hole can form in the ventricular septum.
In some cases, the tendency to develop a VSD may be due to genetic syndromes that cause extra or missing pieces of chromosomes. Most VSDs, though, have no clear cause.
What Are the Signs & Symptoms of a Ventricular Septal Defect?
Whether a VSD causes any symptoms depends on the size of the hole and its location. Small VSDs usually won't cause symptoms, and might close on their own.
Older kids or teens who have small VSDs that don't close usually have no symptoms other than the heart murmur. They might need to see a doctor regularly to make sure the VSD isn't causing any problems.
Medium and large VSDs that haven't been treated in childhood may cause noticeable symptoms. Babies may have faster breathing and get tired out during attempts to feed. They may start sweating or crying with feeding, and may gain weight at a slower rate.
These signs generally indicate that the VSD will not close by itself, and heart surgery may be needed. This usually is done within the first 3 months of life to prevent other complications. A cardiologist can prescribe medicine to lessen symptoms before surgery.
What Problems Can Happen?
People with a VSD are at greater risk for developing endocarditis, an infection of the inner surface of the heart caused by bacteria in the bloodstream. Bacteria are always in our mouths, and small amounts get into the bloodstream when we chew and brush our teeth.
The best way to protect the heart from endocarditis is to reduce oral bacteria by brushing and flossing daily, and visiting the dentist regularly. In general, it's not recommended that patients with simple VSDs take antibiotics before dental visits, except for the first 6 months after surgery.
How Are Ventricular Septal Defects Diagnosed?
VSDs are usually found in the first few weeks of life by a doctor during a routine checkup. The doctor will hear a heart murmur as blood passes between the left and right ventricles. A murmur from a VSD has certain features that let a doctor know that's it's not due to other causes.
If your child has a heart murmur, your doctor may refer you to a pediatric cardiologist, a doctor who specializes in diagnosing and treating childhood heart conditions.
The cardiologist will do an exam and take your child's medical history. If a VSD is suspected, the cardiologist may order one or more of these tests:
- a chest X-ray: a picture of the heart and surrounding organs
- an electrocardiogram (EKG): a record of the heart's electrical activity. This is often the primary tool used to diagnose a VSD.
- a cardiac catheterization: this provides information about the heart's structures and the blood pressure and blood oxygen levels in its chambers. This test usually is done for a VSD only when more information is needed than the other tests can give. (It's sometimes also used to close certain kinds of VSDs.)
How Are Ventricular Septal Defects Treated?
Treatment depends on a child's age and the size, location, and severity of the VSD. A child with a small defect that causes no symptoms may only need to visit a cardiologist regularly to make sure that there are no other problems.
In most kids, a small defect will close on its own without surgery. Some might not close, but they won't get any larger. Kids with small VSDs usually don't need to restrict their activities.
Kids with medium to large VSDs likely will take prescription medicines to aid circulation and help the heart work more efficiently. Medicines alone, however, will not close the VSD, and in these cases, the cardiologist will recommend fixing the hole, either with cardiac catheterization or heart surgery.
Surgery usually is done within the first few weeks to months of a child's life. The surgeon makes an incision in the chest wall and a heart-lung machine will maintain circulation while the surgeon closes the hole. The surgeon can stitch the hole closed directly or, more commonly, will sew a patch of manmade surgical material over it. Eventually, the tissue of the heart heals over the patch or stitches, and by 6 months after the surgery, the hole will be completely covered with tissue.
Some kids with VSDs may take heart medicine before surgery to help ease symptoms from the defect. Those who have surgery for larger VSDs usually leave the hospital within 4 to 5 days after surgery if there are no problems.
Certain types of VSDs may be closed by cardiac catheterization. A thin, flexible tube (a catheter) is inserted into a blood vessel in the leg that leads to the heart. The cardiologist guides the tube into the heart to make measurements of blood flow, pressure, and oxygen levels in the heart chambers. A special implant, shaped into two disks formed of flexible wire mesh, is positioned into the hole in the septum. The device is designed to flatten against the septum on both sides to close and permanently seal the VSD.
After healing from an operation to repair the defect, a child should have no further symptoms or problems.
What Else Should I Know?
In most cases, kids who have VSD surgery recover quickly and without complications. But doctors will closely watch the child for signs or symptoms of any problems. Your child may have another echocardiogram to make sure that the heart defect has closed completely.
If your child is having trouble breathing, call your doctor or go to the emergency department immediately. Other symptoms that may indicate a problem include:
- a bluish color around the mouth or on the lips and tongue
- poor appetite or difficulty feeding
- failure to gain weight or weight loss
- listlessness or decreased activity level
- a long-lasting or unexplained fever
- increasing pain, tenderness, or pus oozing from the incision
Call your doctor if you notice any of these signs in your child after closure of the VSD.
Having your child diagnosed with a heart condition can be scary. But the good news is that your pediatric cardiologist will be very familiar with VSDs and how best to manage the condition. Most kids who've had a VSD corrected go on to live healthy, active lives.
Reviewed by: Steven B. Ritz, MD
Date reviewed: September 05, 2017