Atrial Septal Defect (ASD)

Overview

What is atrial septal defect (ASD)?

If your child has an atrial septal defect, or ASD, he or she has a hole in the wall of the heart that separates its two upper chambers, the left and right atrium. The hole is formed when the heart wall, called the atrial septum, does not seal completely during a baby’s development. This condition is sometimes known as “a hole in the heart.” ASD is a congenital heart defect, which means children are born with it.

The location on the septum (wall) and size of the hole can vary from child to child. Some ASDs are so small they heal themselves as a child grows, but others may require closure with either a heart catheterization or surgery.

Rarely, an atrial septal defect is part of a more complicated heart condition that might involve other heart defects.

Why is ASD a health concern?

Normally, the septum seals off the two atria from each other completely. But the presence of an ASD allows blood from the higher-pressure left atrium to seep into the right atrium. This causes extra blood to be sent from the right side of the heart back into the lungs.

If your child has ASD, he or she may have an increased risk of stroke and lung infections caused by the extra blood pushing through the lungs.

ASD is more common in girls, although the reason why is still unknown. ASD is usually diagnosed before a child is old enough to go to school.

Programs & Treatments

How do we treat atrial septal defect (ASD)?

If your child has an ASD, your pediatric cardiologist will want to carefully monitor him or her. You may have frequent appointments and repeated tests to help track the condition. Often, the hole will close on its own without a medical intervention. However, if the hole has not closed up by the time a child starts school, a cardiologist will schedule either a cardiac catheterization or open-heart surgery to close the hole.

If your child’s ASD does not improve on its own, the condition can usually be repaired by cardiac catheterization. This is a minimally invasive surgery where a small incision is made in a child’s groin and a patch is gently snaked up the leg veins into the heart, where it can then be guided across the hole, then opened up like a flower to seal it. Children stay in the hospital overnight and are asked to take it easy for the next week. Watch a video about what to expect for your child’s heart catheterization.

Less commonly, when the hole is too large for cardiac catheterization surgery or in the wrong location, open-heart surgery may be required to repair it. A cardiac surgeon will stitch the septal hole together or patch the hole with surgical material. In this case, your child will typically stay in the hospital for a few days while the incision heals.

Learn why Children’s Hospital Colorado is the best place for your child’s heart surgery.

Signs & Symptoms

What are the signs and symptoms of atrial septal defect (ASD)?

Your child's symptoms will depend on the size and location of the septum hole. Most children with atrial septal defects (ASD) have no outward symptoms, and they grow and gain weight normally.

Patients with larger, more severe ASDs may experience poor growth and weight gain, decreased appetite, fatigue and shortness of breath. Recurring lung problems and pneumonia are also potential signs of the condition. Some children faint, particularly after exercise or activity.

Diagnosis & Tests

How do our doctors diagnose atrial septal defect (ASD)?

Most often, atrial septal defects (ASD) are first identified by a child’s pediatrician during a checkup. All the extra blood flow into the lungs due to the ASD causes a signature murmur, or “swooshing” sound a doctor can hear while listening to a child’s heart.

If a doctor suspects a child might have ASD, he or she will request more tests to confirm the size and location of the hole. Common tests include:

• EKG 
• ECHO