Atrial Septal Defect in Children

Definition

Atrial septal defect is a type of congenital heart defect in which there is an opening in the septum which is a wall between the right and left atria (which are the top two chambers of the heart). In most cases, small holes do not cause any concerns and can close on it own; however, large holes can damage the heart and lungs and require surgery.

Symptoms

Shortness of Breath: Difficulty breathing or feeling unable to get enough air.

Irregular Heartbeat (Arrhythmias): Abnormal heart rhythm, which may feel like skipped beats, a racing heart, or a slow heartbeat.

Heart Palpitations: A noticeable sensation of a fast, fluttering, or pounding heartbeat.

Lung Infections: Such as pneumonia.

Poor Growth.

Exams and Tests-

Abnormal heart sounds upon auscultation.

Chest X-rays- An image of the heart and surrounding organs.

ECG (Electrocardiogram) - A record of heart's electrical activity.

Echocardiogram- A test that uses sound waves to show pictures of the heart and how it’s working.

TEE (Transesophageal Echocardiogram) is a type of heart ultrasound where a probe is passed in the esphagus to get clearer, closer images of the heart.

Treatment-

Treatment of an ASD will depend on a child's age and the size, location, and severity of the defect. The small holes can close on its own over time but larger holes require intervention. Based on the types, sizes of the holes the doctor uses either Cardiac Catheterization or Heart Surgery to repair the ASD.

Cardiac Catheterization-A closure procedure for an Atrial Septal Defect is a minimally invasive treatment where a doctor uses a thin tube called a catheter to place a small closure device (like a patch or plug) inside the heart to seal the hole.The catheter is usually inserted through a vein in the groin and guided to the heart. The device stays in place and the heart tissue grows over it, closing the hole.

Heart Surgery- When the ASD is large, Cardiac Surgeons perform surgery to close the holes. Open-heart surgery is a type of surgery where the chest is opened and the heart is exposed to repair the defects. For ASD, the surgeon directly closes the hole in the heart using stitches or a patch. It's done under general anesthesia and requires a heart-lung machine to keep blood flowing during the operation

My Son's Medical Journey

At five months old, my son developed severe flu-like symptoms during winter. During episodes of crying, he was short of breath and his skin colour began turning purple, and I took him to our local hospital. Initial chest X-rays revealed an enlarged heart, leading to an urgent transfer to a specialized children’s hospital for advanced care.

Diagnosis and Treatment

Cardiologists conducted head to toe physical exam, an electrocardiogram (ECG), echocardiogram, and blood tests. He heard murmur (an abnormal heart sound) upon auscultation of his heart. The echocardiogram identified multiple atrial septal defects (ASDs) holes in the wall separating his heart’s top chambers. This congenital defect explained his symptoms, including heart murmur, breathlessness, fatigue, and poor growth.

A pediatric cardiac surgeon performed open-heart surgery to patch the defects. During the procedure, repairing the atrial holes disrupted his heart’s electrical activity, necessitating a temporary pacemaker to stabilize his rhythm. The temporary venous pacemaker provided critical support for seven days post-surgery while his heart recovered.

Recovery and Outcome

After ten days in the hospital—monitored closely for complications like arrhythmias or infection—he was discharged. Today, he thrives with a fully repaired heart, thanks to timely intervention and advances in pediatric cardiac care.

References-

KidsHealth. (n.d.). Atrial septal defect (ASD). Nemours KidsHealth. Retrieved from https://kidshealth.org/en/parents/asd.html

Mayo Clinic. (n.d.). Atrial septal defect (ASD) - Symptoms and causes. Mayo Clinic. Retrieved April 2, 2025, from https://www.mayoclinic.org/diseases-conditions/atrial-septal-

defect/symptoms-causes/syc-20369715

"Atrial Septal Defect." MedlinePlus, U.S. National Library of Medicine, 27 Feb. 2024, medlineplus.gov/ency/article/000157.htm. Accessed 13 Apr. 2025.

Assessed and Endorsed by the MedReport Medical Review Board