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Patient education: Atrial septal defects in children (The Basics)

Patient education: Atrial septal defects in children (The Basics)

What is an atrial septal defect? — An atrial septal defect, or "ASD," is a hole between 2 sections of the heart. The heart is divided into 4 sections, called "chambers." Children with an ASD have a hole between the 2 upper chambers called the "atria" (figure 1). Having a large- or medium-sized hole can change how blood flows through the heart. Plus, it can make the heart work harder than it should. This can cause health problems.

A child who has an ASD was born with it. They might only have an ASD, or have other heart problems, too. Some conditions that run in families cause ASDs.

An ASD can sometimes cause a heart murmur. This is an extra sound doctors or nurses hear when they listen to the heart with a stethoscope.

What are the symptoms of an ASD? — Most babies and children with ASDs have no symptoms. In these cases, the ASD is only found when the doctor or nurse hears a heart murmur at a routine check-up.

Symptoms are uncommon in babies and young children with ASDs, unless the ASD is very large. In these cases, symptoms of heart failure can develop. In babies, these might include fast breathing, losing interest in feeding, and not gaining weight normally. In older children, symptoms might include feeling short of breath, getting tired easily, and not growing well.

If a large- or medium-sized ASD is not found and treated, it can cause symptoms later in life, usually by age 40. These can include:

Abnormal heartbeat – The heart might feel like it is racing or skipping beats.

Trouble exercising or doing other physical activities – A person with an ASD might also get tired easily just from normal daily activities.

Trouble breathing

Skin that looks blue

People who have ASDs that are not treated also have a small risk of stroke later in life.

Should my child see a doctor or nurse? — If a baby has an ASD, a doctor or nurse might find it before birth (on an ultrasound done during pregnancy) or soon after birth. But this does not always happen. That's because ASDs often cannot be seen on ultrasound, and most babies don't have any symptoms that would cause the doctor to suspect an ASD right away.

See the doctor or nurse if your baby or child:

Seems to lose interest in feeding, or gets tired easily with feeds

Does not gain weight or grow as quickly as other children

Has fast or heavy breathing

Feels like their heart is racing or beating abnormally

Gets very tired or short of breath when they exercise

Will my child need tests? — Yes. If the doctor or nurse thinks your child might have an ASD, they can order a test called an "echocardiogram." This test uses sound waves to create a picture of the heart as it beats. It can show the size of the hole in your child's heart. It can also show exactly where the hole is and if there are other heart problems.

How is an ASD treated? — If a baby or child has a small ASD, doctors might wait to see if the hole closes on its own. If this happens, the child does not need surgery. Small ASDs usually close by the time a child is 2 to 5 years old.

Medium or large ASDs are less likely to close on their own and usually need to be treated. But if the ASD isn't causing symptoms, doctors usually wait until the child is 2 years old to close it. This is because there is still a small chance the hole will close on its own. If the ASD is causing symptoms, doctors usually do not wait to close it.

Doctors can close ASDs with:

A procedure called "transcatheter closure" – In this treatment, a doctor places a thin tube into a blood vessel in an arm or leg. Then, they move the tube through the blood vessel to the heart. When the tube gets to the hole in the heart, the doctor uses the tube to put in a small device that closes the hole.

Surgery to patch the hole

More on this topic

Patient education: Heart murmurs (The Basics)
Patient education: Echocardiogram (The Basics)
Patient education: Patent foramen ovale (The Basics)

This topic retrieved from UpToDate on: Oct 01, 2023.
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