About 7 percent of congenital heart defects are atrial septal defects, which are holes in the wall (septum) between the left and right atria. If there is a large hole, oxygen-rich blood from the left atrium flows back into the right atrium and gets pumped back to the lungs again. This causes more work for the heart.

Facts about Atrial Septal Defects

• ASDs are more common in girls than boys.
• ASDs are classified by where they occur and how big they are
• Most ASDs do not produce symptoms and can go undetected until adulthood.
• By age 50, many people with an ASD have symptoms that impair their activities of daily living. Symptoms include:
  • shortness of breath
  • fainting
  • palpitations (fluttering in the chest)
  • inability to exercise without becoming over-tired
• An untreated atrial septal defect can lead to other medical conditions:
  • pulmonary hypertension – high pressures in the pulmonary arteries. These are found in 50 percent of untreated adults by the time they reach age 40.
  • Eisenmenger’s Syndrome
  • right-sided heart failure
  • atrial fibrillation or atrial flutter
  • stroke

Atrial septal defect is diagnosed through:

• Physical exam
• Echocardiogram

Treatment for atrial septal defects

When ASD is diagnosed, the opening is repaired.

• Risk of surgery is related to age and presence of pulmonary hypertension.
• People younger than age 25 who do not have pulmonary hypertension have a long-term risk similar to people without an ASD.
• In people greater than age 40 with ASD repair, symptoms and survival are improved but there may be associated complications:
  • atrial fibrillation, which occurs in 50 to 60 percent of adults over age 40 with or without ASD repair
  • blood clots, which occurs in 5 to 10 percent of adults with ASD, especially if they have atrial fibrillation. Medications will be prescribed to prevent blood clots.

Traditionally ASD is treated with heart surgery:

There are two types of surgical ASD repair:

• primary closure – the opening is repaired with sutures alone
• secondary closure – a tissue patch is used to close the opening

Non-surgical treatment: Cardiac implant

As part of the procedure, you will first undergo a cardiac catheterization. During this test, catheters (hollow, flexible, tube) will be inserted into the veins in your groins and advanced to your heart. A balloon is placed across the opening to determine the size and location of the hole in your heart. Measurements are taken of the pressure inside your heart chambers.

Sometimes an echocardiogram or transesophageal echocardiogram may also be used to better visualize the heart, chambers and ASD. But most frequently a tiny catheter with an echo transducer is placed in the heart for imaging.

If the cardiac catheterization shows your atrial septal defect is an appropriate size and in an appropriate location for closure with this device, the cardiologist will position the device to close the hole.

Two closure devices

AMPLATZER® device - used for ASD repair Photo used with permission from Amplatzer*

The AMPLATZER® device consists of two wire mesh discs filled with polyester fabric. It is folded into a special catheter, similar to the catheter used during your catheterization. The special catheter is inserted into a vein in the leg and advanced into the heart and through the hole. When the device is in proper position, the device is slowly pushed out the catheter until the discs of the device sit on each side of the hole (like a sandwich). Over time, heart tissue grows over the implant, becoming part of the heart.

CardioSEAL® device Photo used with permission from NMT Medical*

The CardioSEAL® device is a small double umbrella arms attached to Dacron fabric. It is folded into a special catheter, similar to the catheter used during your catheterization. The special catheter is inserted into a vein in the leg and advanced into the heart and through the hole. The device is slowly pushed out of the special catheter allowing each umbrella to open up and cover each side of the hole (like a sandwich) and close it. When the device is in proper position, it is released from the special catheter. Over time, heart tissue grows over the implant, becoming part of the heart.

For more information on the cardiac implant procedure, Click here.

Ask your cardiologist if you are a candidate for a non-surgical ASD repair.

Those with congenital heart disease are at risk for getting endocarditis, even if the heart was repaired or replaced through surgery.

Most children and adults with congenital heart disease should be monitored by a heart specialist and take precautions to prevent endocarditis throughout their life.

To protect yourself:

• Tell all doctors and dentists you have congenital heart disease. You may want to carry a card with this information.
• Call your doctor if you have symptoms of an infection (sore throat, general body achiness, fever). Colds and flus do not cause endocarditis. But infections, which may have the same symptoms, do. So, to be safe, call your doctor.
• Take good care of your teeth and gums to prevent infections. See your dentist for regular visits.
• Take antibiotics before you undergo any procedure that may cause bleeding:
  • any dental work (even a basic teeth cleaning)
  • invasive tests
  • most major or minor surgery
• Check with your doctor about the type and amount of antibiotics you should take.

How to find a doctor if you have septal defect

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, read more about our Heart Center outcomes.

Cleveland Clinic Heart Center cardiologists or surgeons:

Click here to find a Cleveland Clinic Heart Center Cardiologist or Surgeon who specializes in the diagnosis and treatment of patients with adult congenital heart disease

For younger patients:

• Visit The Center for Pediatric and Congenital Heart Diseases web site at: http://cms.clevelandclinic.org/childrenshospital/?id=82
• Click here to find a pediatric cardiologist or pediatric & congenital heart surgeon

For more information:

• Adult Congenital Heart Association website at http://www.achaheart.org/*
• The International Society for Adult Congenital Heart Disease website at http://www.isaccd.org/*
• The Canadian Adult Congenital Network has a website at http://www.cachnet.org/*
• American Heart Association*: Adult Congenital Defects* ; Congenital Cardiovascular Defects*

*a new browser window will open with this link. The inclusion of links to other web sites does not imply any endorsement of the material on the web sites or any association with their operators

© Copyright 2003-2006 The Cleveland Clinic Foundation. All rights reserved. Reviewed 9/06