ATRIAL SEPTAL DEFECT

ASD is an abnormal communication between the left and right atrias. ASDs account
for 9% of CHDs. There are three types:
stium secundum ASD: the most common type of ASD! abnormal opening in
the middle of the atrial septum.
stium primum ASD: abnormal opening at the bottom of the atrial septum!
increased association with cleft mitral "al"e and atrio"entricular defects.
Sinus "enosus ASD: abnormal opening at the top of the atrial septum!
increased association with partial anomalous pulmonary "enous return.
Pathophysiology and Etiology
#lood flows from the higher$pressure left atrium across the ASD into the
lower$pressure right atrium %left$to$right shunt&.
'ncreased blood return to the right heart leads to right "entricular "olume
o"erload and right "entricular dilation.
'ncreased pulmonary blood flow leads to ele"ated pulmonary artery pressures.
Clinical Manifestations
(sually asymptomatic.
Clinical symptoms "ary depending on type of associated defects:
o CH) %usually not until the third or fourth decade of life&.
o )re*uent upper respiratory infections %(+'s&.
o ,oor weight gain.
o Decreased e-ercise tolerance.
Diagnostic Evaluation
Auscultation: soft systolic e.ection murmur heard best at the left upper sternal
border! widely split/ fi-ed second heart sound.
Chest 0$ray: "aries! normal to right atrial and "entricular dilation/ increased
pulmonary mar1ings.
2C3: "aries! right a-is de"iation and mild +4H or right bundle$branch bloc1.
Two$dimensional echocardiogram with Doppler study and color flow mapping
to identify the site of the ASD and associated lesions and document left$to$
right flow across the atrial septum.
Cardiac catheteri5ation usually not needed for initial diagnosis! performed if
defect can be closed using an atrial occlusion de"ice %de"ice can be used only
in ostium secundum defects&.
Management
6edical management:
o 6onitor and reassess %spontaneous closure rate is small but may occur
up to age 7&.
o Treatment with anticongesti"e therapy %digo-in and 8asi-& may be
necessary if signs of CH) are present %usually not until third to fourth
decade of life if ASD unrepaired&.
o 'nfecti"e endocarditis prophyla-is for 9 months after surgery or atrial
occlusion de"ise is used.
Cardiac catheteri5ation for placement of an atrial occlusion de"ice for ostium
secundam defects.
Surgical inter"ention:
o ,rimary repair: suture closure of the ASD.
o ,atch repair of the ASD.
Complications
CH) %rare&.
'nfecti"e endocarditis.
2mbolic stro1e.
,ulmonary hypertension.
Atrial arrhythmias.