Having a doctor listen to your heart is a routine part of every checkup, right? Here's the reason why: Listening to the thumping of your heart can give doctors the heads-up on some problems with your ticker, like an atrial septal defect.
Atrial septal defect (pronounced: ay-tree-ul sep-tul dee-fekt), or ASD for short, is a heart condition that teens can have. People who have an atrial septal defect may find themselves wondering: What is it? Why do I have it? And what does it mean for me?
What Is an Atrial Septal Defect?
The heart has four chambers. The two lower chambers are the ventricles: the left ventricle and the right ventricle. The upper chambers are the atria, and there are also two of them — the left atrium and the right atrium.
In a person without a heart defect, blood that's in need of oxygen flows to the right atrium, then to the right ventricle, then pumped to the lungs to receive oxygen. The oxygenated blood then returns to the left atrium, flows into the left ventricle, and then heads out to the body through the aorta, a large blood vessel that carries blood from the heart to the smaller blood vessels in the body.
In a person with an atrial septal defect, there's an opening in the wall between the right atrium and the left atrium (this wall is called the atrial septum). As a result, some oxygenated blood from the left atrium flows through the hole in the septum into the right atrium, where it mixes with oxygen-poor blood and increases the total amount of blood that flows toward the lungs. The increased blood flow from the right side of the heart to the lungs creates a swishing sound, which is known as a heart murmur. A heart murmur is often the first tip-off to a doctor that a teen has an ASD.
ASD is a type of congenital heart disease, which means that a person is born with it. About 8 out of 1,000 babies born have heart disease, and 6% to 8% of those babies have an ASD. How do people find out if they have an ASD? It's usually found during a checkup or routine physical exam. Because the murmur caused by an ASD can be difficult to hear, the condition may not be diagnosed right away. An ASD can be discovered in a person as an infant, child, teen, or even as an adult.
Most teens with an ASD are asymptomatic, which means that they don't have any problems or symptoms from their ASD. Whether a person has symptoms from an ASD usually depends on the size and severity of the hole in the atrial septum. About 1 in 4 people with a small hole between the atria don't require treatment because the hole closes on its own over time.
What Causes an Atrial Septal Defect?
ASDs occur during a baby's development in the mother's womb and are present at birth. Before birth, the heart develops from a large tube, dividing into sections that will eventually become its walls and chambers. If a problem occurs during this process, a hole in the wall that divides the left atrium from the right may result.
For most people with an ASD, no one knows exactly why it happens. In some cases, the tendency to develop an ASD may be inherited, or genetic.
Signs and Symptoms
Most teens who have ASDs seem healthy and have no symptoms. Usually, a teen with an ASD grows normally and feels well. Most don't need to take any medications. Rarely, teens with an ASD may show the following signs:
- fatigue and tiredness during activity
- abnormal heartbeat
- stroke (this is very rare)
If an ASD isn't treated in childhood, people with larger ASDs may develop a problem called pulmonary hypertension (pronounced: pul-muh-ner-ee high-per-ten-shun), which means high blood pressure in the lungs. This occurs because these holes in the septum cause too much blood to flow through the lungs, which gradually damages the lung blood vessels. If the defect isn't diagnosed and treated, this blood vessel damage can become permanent, causing the pressure in the lung vessels to rise dangerously. Fortunately, most teens with ASD are treated long before the heart defect causes physical symptoms.
Diagnosis and Treatment
After hearing the heart murmur that suggests a hole in the atrial septum, a doctor may refer a teen to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart disease in kids and teens.
In addition to doing a physical examination, the cardiologist will take a medical history by asking you about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, and other issues relating to the heart. The cardiologist may then order one or more of the following tests:
- a chest X-ray, which produces a picture of the heart and surrounding organs
- an electrocardiogram (EKG), which records the electrical activity of the heart
- an echocardiogram (echo), which uses sound waves to create a picture of the heart
Once a person is diagnosed with an ASD, treatment will depend on age, the size of the hole, and where it's located in the heart.
For teens with very small ASDs, the cardiologist may not feel any treatment is needed. In other cases, the doctor may recommend follow-up visits for observation. If you have a small ASD, don't worry that you'll have to sit on the sidelines — your doctor may recommend you take a few precautions, but teens with smaller untreated ASDs can participate in all sports and activities.
In most teens with ASD, though, the cardiologist will recommend having the hole fixed.
Many teens with ASDs who need treatment can be treated with cardiac catheterization (pronounced: car-dee-ack cath-uh-turr-eye-zay-shun). In cardiac catheterization, a thin, flexible tube called a catheter is inserted into a blood vessel in the leg that leads to the heart. A cardiologist guides the tube into the heart and inserts a device shaped like a dumbbell (two mesh discs connected by a short mesh waist) into the hole in the heart wall. The waist of this device fills the hole in the heart, while the two discs secure it in place. There is no surgical scar, just a small mark in the groin area where the catheter went into the blood vessel. Usually the person can go home the very next morning.
If you have had this procedure, your doctor will probably recommend that you take it easy for a few days afterwards and may want you to stay out of gym class for a few weeks. Your doctor may also ask you to take one aspirin each day for about 6 months after the device is implanted to prevent small clots from forming on the device and being sent into the arteries of the body. Over time, the normal tissue of the heart grows over the device and the aspirin is no longer necessary.
In some cases, when the ASD is very large or close to the wall of the heart, a device cannot be safely used and surgery is needed to close the defect. If surgery is necessary, a person will receive general anesthesia so he or she doesn't feel pain or move around during the surgery.
ASD surgery involves making a cut in the chest so a surgeon can stitch the hole in the atrial septum closed or sew a patch of manmade surgical material (such as Gore-Tex) over the defect. Eventually, the tissue of the heart heals over the patch or stitches, making the area smooth and nearly normal in appearance. Teens who have surgery for ASDs usually leave the hospital within 3 to 4 days after surgery, if there are no problems.
Open-heart surgery does leave a permanent scar on the chest. It will be sore at first and your doctor will likely prescribe a pain reliever, such as acetaminophen or ibuprofen. You may feel numbness, itchiness, tightness, and burning around the cut, although these feelings shouldn't be severe.
Once a scar is healed, there's no need to keep it covered. If you want to minimize its appearance, you can use an over-the-counter cosmetic concealer (after your doctor gives the OK — you'll need to wait for a while after surgery to do this).
For 6 months following surgery or catheterization closure, ASD patients will need to take antibiotics before a visit to the dentist or if they need certain other kinds of surgery, such as tonsil removal. This is to prevent bacteria from getting into the bloodstream and causing bacterial endocarditis (pronounced: en-doe-kar-dye-tus), an infection of the inner surface of the heart. Six months after surgery, though, most people who have had their ASDs corrected no longer need to worry about bacterial endocarditis.
After an ASD is closed with a device or surgery, and it's had plenty of time to heal, most teens have no further symptoms or problems.
Taking Care of Yourself
It takes about 6 weeks for a chest incision to heal.
The first few days at home after ASD surgery, you'll be advised to hang out in bed or on the couch doing quiet activities such as reading, sleeping, and watching TV. Within a week or two, you'll probably feel better. Your doctor will advise you on when to go back to school, and during the 6-week healing period you may need to sit out gym class or sports.
About 6 weeks after surgery (if you don't have other problems and your doctor gives the go-ahead), you should be fully recovered and able to return to your normal activities.
In the weeks following the catheterization or surgery, your doctor will check on your progress and may repeat an electrocardiogram, a chest X-ray, or an echocardiogram at these visits.
In most cases, teens who have had ASD surgery or cardiac catheterization recover quickly without problems. But some signs and symptoms may indicate a problem. If you have trouble breathing or feel your heart racing, tell a parent or another adult so you can get medical treatment right away. Also, if you don't feel like eating; if you've lost weight; if you have a fever; or if you have increasing pain, tenderness, or pus oozing from your incision, you should seek medical help.
Most people who have an ASD corrected during their teenage years have a normal life expectancy and go on to live otherwise healthy lives. After the recovery period, people who have had an ASD will be able to exercise, play sports, and do the other things they love — and perhaps do them even better than before!
Reviewed by: Gina Baffa, MD
Date reviewed: September 2006
