Atrial Septal Defect (ASD)
Information for teenagers and adults with an atrial septal defect
An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart - the right and left atria.
ASDs are one of the most common congenital heart conditions. Some are diagnosed in childhood, while others are not discovered until adulthood. Many people with an ASD feel completely well, particularly when they are young.
Most people with an ASD can lead active, healthy lives. However, the significance of an ASD varies considerably, and some people benefit from closure of the defect or ongoing follow-up with a cardiologist experienced in congenital heart disease.
How your circulation works
Normally, the right and left sides of the heart are separated. The right side receives blood returning from the body and pumps it to the lungs, while the left side receives oxygen-rich blood from the lungs and pumps it around the body.
With an ASD, some blood can pass through the opening between the atria. In most people, blood travels from the left atrium to the right atrium, resulting in extra blood passing through the right side of the heart and the lungs.
A small ASD may have very little effect. A larger ASD can gradually cause enlargement of the right side of the heart and, over many years, may contribute to abnormal heart rhythms, reduced exercise capacity or increased pressure in the lung circulation.
Are there different types of ASD?
Yes. The main types include:
Secundum ASD - the most common type, located near the centre of the atrial septum.
Primum ASD - located lower in the septum and often associated with abnormalities of the mitral and/or tricuspid valves.
Sinus venosus ASD - located near the veins returning blood from the lungs or upper body and often associated with abnormal drainage of one or more pulmonary veins.
The type of ASD is important because it influences whether the defect can be closed using a catheter procedure or requires surgery.
Does an ASD need to be closed?
Not every ASD needs treatment.
Small defects that do not cause enlargement of the heart may simply be monitored.
Closure is usually considered when an ASD is allowing enough extra blood through the lungs to cause significant enlargement of the right side of the heart. Closure may sometimes also be considered in other circumstances, depending on symptoms, pressures within the heart and lungs, and other individual factors.
Many secundum ASDs can be closed without open-heart surgery. A closure device is passed through a vein in the groin and positioned across the ASD during a cardiac catheter procedure.
Some ASDs are not suitable for device closure because of their size, position or anatomy. Primum and sinus venosus ASDs generally require surgery if closure is needed.
Your congenital cardiologist can determine whether your ASD needs treatment and, if so, which approach is most appropriate.
How to stay well
Keep up with your heart checks
Even if you feel well, follow-up may be important. Your cardiologist will advise how often you need to be reviewed.
People with a repaired ASD and no residual problems may eventually need only occasional review. Others - particularly those with pulmonary hypertension, abnormal heart rhythms, valve disease, residual shunting or more complex forms of ASD - require ongoing specialist congenital heart disease follow-up.
Stay active
For most people with an uncomplicated ASD, regular exercise is encouraged and few restrictions are necessary.
Exercise recommendations may be different if you have pulmonary hypertension, significant abnormal heart rhythms or other associated heart problems. Ask your cardiologist if you are planning particularly strenuous or competitive exercise.
Look after your teeth
Good dental hygiene is an important part of looking after your heart.
Most people with an ASD do not require antibiotics before routine dental treatment. Antibiotic prophylaxis may be recommended for a limited period after device or surgical closure, or in some people with a residual defect associated with prosthetic material. Your cardiologist or dentist can tell you whether this applies to you.
Don't smoke or vape
Smoking increases your lifetime risk of cardiovascular and lung disease. Avoid smoking and vaping and seek help to quit if needed.
Pregnancy
Most women with a small, repaired or uncomplicated ASD can have a successful pregnancy with relatively low cardiovascular risk.
It is still sensible to discuss pregnancy with your cardiologist beforehand, particularly if you have not had recent cardiac assessment.
Pregnancy requires more specialised assessment if you have significant pulmonary hypertension, abnormal heart rhythms, impaired heart function or another associated congenital heart condition.
Symptoms to tell your doctor about
Contact your doctor or cardiology team if you develop:
New or increasing shortness of breath
A noticeable reduction in your exercise capacity
Frequent or prolonged palpitations
New swelling of your ankles or abdomen
Unexplained fainting or near-fainting
New persistent fatigue
A significant change in your usual symptoms
Palpitations become more common as people with an ASD get older and can sometimes represent an abnormal rhythm such as atrial fibrillation or atrial flutter.
Emergency - get help immediately if
Seek urgent medical attention or call 000 if you develop:
Severe or sudden shortness of breath
Fainting associated with chest pain, breathlessness or sustained palpitations
A sustained rapid heartbeat associated with dizziness, chest pain or feeling very unwell
Sudden weakness or numbness of the face, arm or leg, difficulty speaking, loss of vision or other symptoms suggesting a stroke
Your regular check-ups
Clinical review
Your cardiologist will ask about exercise capacity, palpitations, breathlessness and other symptoms and check your blood pressure, heart and circulation.
ECG
An electrocardiogram records the electrical activity and rhythm of your heart.
Echocardiogram
An ultrasound of the heart can assess the size and function of the heart chambers, heart valves, pressures and blood flow through an ASD.
Heart rhythm monitoring
A Holter monitor or longer-term rhythm monitor may be recommended if you experience palpitations or there is concern about an abnormal heart rhythm.
Cardiac MRI or CT
These are not required for everyone but can provide additional information about heart size, blood flow, pulmonary veins or anatomy when an echocardiogram does not provide all the information required.
Cardiac catheterisation
This may be used when closing a suitable ASD with a device or when more detailed measurement of pressures and blood flow within the heart is required.
Questions for your doctor
What type of ASD do I have?
Is the ASD affecting the size or function of my heart?
Does my ASD need to be closed, or can it simply be monitored?
Do I have any restrictions on exercise, work, travel or pregnancy?
How often should I have a heart check-up?
ⓘ This information is intended as a general guide for teenagers and adults with an atrial septal defect. Individual congenital heart conditions vary, and your cardiologist can provide advice specific to your anatomy, previous treatment and current health.
