Congenital heart diseases, or in other words, congenital heart defects, refer to heart abnormalities present at the time of birth. As a result of these abnormalities, the walls, valves, or blood vessels of the heart may be affected.
There are many types of congenital heart disease. These conditions can range from simple conditions that do not cause any symptoms to serious illnesses that threaten life. Congenital heart diseases can be examined in three basic categories, taking into account the affected heart structure, valve defect, wall defect, and blood vessel defects.
Heart valve defects can cause blockage or leaks by blocking the normal flow of blood in the heart. This can prevent the heart from properly pumping blood to other parts of the body.
Defects in the heart’s vessels are disorders that can prevent blood from returning to the heart or from reaching other parts of the body from the heart. Various disorders may occur as a result of these problems that cause interruption of blood flow.
Heart wall defects, on the other hand, occur as a result of developmental problems that occur in the wall (septum) structures that divide both the auricles (atrium), which is the superstructure of the heart, and the ventricle, which are large chambers under the heart, into two as right and left. In these cases, the blood in the heart may escape after it is pumped or it may switch to another part that should not be. Pressure on the heart increases due to the wall defect and the heart may need to work more. As a result of this situation, an increase in blood pressure may occur.
Atrial septal defect (ASD) is one of the most common congenital heart defects and can occur in approximately of children. It states that the wall (septum) between the atria, which are the structures known as the atria of the heart, is not fully closed and the interaction between the right and left atrium continues.
ASDs are divided into various subtypes:
Ostium Secundum Defect
The most common subtype of atrial septal defects is ostium secundum defect.
Ostium Primum Defect
Ostium primum defect defines the lower part of the wall than ostium secundum. Care should be taken as this type of asd may accompany other congenital heart diseases.
Sinus Venosus Defect
This less common type of ASD refers to a defect in the upper parts of the septum. The sinus venosus defect may also be accompanied by abnormal connections between veins around the heart.
Coronary Sinus Defect
The coronary sinus describes the structure through which blood flows in the heart’s veins. Coronary sinus defect refers to the wall abnormality between this structure and the left atrium.
What are the symptoms of ASD (Atrial Septal Defect)?
Many babies born with atrial septal defect may not have any symptoms at the beginning, but various signs and symptoms may occur after aging:
-Shortness of breath, especially during physical activity
-Murmurs detected while resting the heart with a stethoscope
-Edema in the abdomen and lower extremities
-Palpitations or abnormal rhythm of the heart
What causes ASD (Atrial Septal Defect)?
Atrial septal defect, one of the most common forms of congenital heart diseases, is a problem detected more frequently in women compared to men. Genetic factors and various conditions related to the expectant mother during pregnancy are the main underlying causes in most congenital heart defects.
Specific genetic problems are responsible for approximately 10% of these disorders. ASD may accompany diseases such as Down syndrome, which can be transmitted between family members.
The expectant mother’s use of alcohol or substances during pregnancy or having diseases such as diabetes, lupus or rubella may also be effective in the development of congenital heart disease.
If rubella infection occurs especially in the first months of pregnancy, there may be an increased risk of developing congenital heart disease in the child.
How is the diagnosis of ASD (Atrial Septal Defect)?
Murmurs detected during routine physical examinations may cause physicians to suspect that the patient may have a congenital heart defect. Many examinations are used to identify these problems.
In the diagnostic approach of atrial septal defect, various imaging methods contribute to the determination of the size of the defect. Transthoracic echocardiography is one of the basic imaging tests in the diagnosis of ASD. Echo examination provides a video image of the heart by using sound waves. With the help of these images, physicians can examine the chambers of the heart and measure the pumping power of the heart. Defects in the heart’s valve and wall structures can also be viewed with echocardiography. This examination is important for both diagnostic and treatment planning.
A chest x-ray helps to view the patient’s heart and lung conditions. Various heart defects that may be associated with the patient’s symptoms can be detected on these x-ray radiographs.
Electrocardiogram examination (ECG) is a cardiological test that allows the work of the heart to be transferred on paper and to detect rhythm problems through electrodes placed in the chest area.
Radiological examinations such as computed tomography (CT) and magnetic resonance imaging (MRI) allow examination of the structures within the heart and chest.
How is the ASD (Atrial Septal Defect) treatment?
ASD treatment is planned considering the type and width of the defect in the person, how the heart is affected and other associated health conditions. In patients with atrial septal defect, the size of the opening is first evaluated in treatment planning. Defects of 5 millimeters and below usually tend to close spontaneously within the first year of life.
Most of the defects above 1 centimeter are treated with a medical or surgical intervention. In adult ASD patients, if there is a small defect and there are no signs of heart failure, the patient can be followed up only with regular observation without intervention.
drug therapy does not provide closure of the heart wall defect in ASD patients, but this may be effective in reducing the symptoms and signs that result. Drug treatment is also used to prevent unwanted situations after surgical intervention. Beta blockers, which regulate heart rhythm and contractile power, and anticoagulant drugs that reduce clot formation are among the pharmacological agents that can be used in ASD treatment planning.
Repair procedures performed percutaneously (through the skin) are a treatment method that can be preferred in patients with secundum type ASD. A long, thin tube structure catheter is used in this closure using various devices. When the device, which is delivered to the defect area through the vein through the catheter, enters the heart, it is opened and the defect is wrapped. The defect can be closed with the tissue growing on this device over time. After this treatment method, patients may need to use antiplatelet drugs for at least 6 months with the knowledge and prescription of physicians.
Surgical interventions may be required in the treatment of large secundum type ASD and other types of ASD. In the surgical treatment method, the right atrium of the heart is entered, the defect is reached and a tissue patch is used to close the defect. This tissue is usually obtained from the person’s own pericardium (the membrane tissue surrounding the heart). In some secundum type atrial septal defects, the defect can be reached with surgical interventions and only the defect can be sutured.