Atrial Septal Defect

An atrial septal defect (ASD) — sometimes called a hole in the heart — is a type of congenital heart defect. It is an abnormal opening in the wall between the atria, the upper filling chambers of the heart.

Through the hole in the heart, blood from the left atrium can flow into the right atrium. This increases the amount of blood flowing toward the lungs. The increased blood flow to the lungs creates a swishing sound, known as a heart murmur. The murmur, along with other specific heart sounds, often is a doctor’s first clue that a child has an ASD.

The specialists at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, are able to diagnose and treat ASDs successfully.

As leading providers of pediatric heart care in Louisville and Southern Indiana, our specialists are experienced in successfully repairing atrial septal defects or identifying when the condition will resolve itself as your child grows.

The board-certified and fellowship-trained specialists at Norton Children’s Heart Institute have the skills and experience to provide a pinpoint diagnosis and develop a customized treatment plan for you and your child.

An illustration of atrial septal defect

What Causes a Hole in the Heart?

Children who have an ASD are born with it. The defect happens while the heart is developing during pregnancy. The heart develops from a large tube. The tube divides into sections that will eventually become the walls and chambers of the heart. If something goes wrong during this process, a hole can form in the wall (septum) that separates the left atrium from the right atrium.

In some cases, the tendency to develop an ASD might be inherited. Genetic syndromes can cause extra or missing pieces of chromosomes that can be associated with ASDs. Most ASDs, though, have no clear cause. It’s also not clear why ASDs are more common in girls than in boys.

Atrial Septal Defect Symptoms

The size and location of an ASD determine the symptoms it causes. Most kids who have ASDs seem healthy and appear to have no symptoms. Most feel well, and grow and gain weight normally.

Children with larger, more severe ASDs might experience:

An ASD that isn’t treated in childhood can lead to health issues later, including an abnormal heart rhythm (atrial arrhythmia) and the heart having difficulty pumping blood.

Atrial Septal Defect Diagnosis

A doctor who suspects that a child has atrial septal defect may refer the child to a pediatric cardiologist.

The cardiologist might order one or more of these tests:

  • Chest X-ray: An image of the heart and surrounding organs
  • Electrocardiogram (ECG or EKG): A record of the heart’s electrical activity
  • Echocardiogram: An ultrasound video of the heart and the blood flow through its chambers; this test often is the main tool used to diagnose an ASD

Atrial Septal Defect Treatment

Treatment will depend on a child’s age and the size, location and severity of the defect.

Norton Children’s Heart Institute specialists may determine that a very small ASD doesn’t need treatment and will close on its own. In these cases, the cardiologist may recommend follow-up visits for observation.

Usually, if an ASD hasn’t closed on its own by the time a child starts school, the cardiologist will recommend fixing the hole, either with cardiac catheterization or heart surgery.

Norton Children’s Heart Institute physicians will evaluate the ASD to determine if it needs to be fixed surgically. If surgery is necessary, they usually recommend having it done early in childhood.

What Else Should I Know?

In the weeks after surgery or cardiac catheterization, the cardiologist will check on your child’s progress. Your child might have another echocardiogram to confirm the hole in the heart has closed completely.

Most kids recover from treatment quickly and will need only regular follow-up visits with their cardiologist. You might even notice that within a few weeks your child is eating more and is more active.

However, some signs and symptoms are causes for concern. If your child is having trouble breathing, call the doctor or go to an emergency room immediately.

Also call the doctor if your child has any of these symptoms:

  • A bluish color around the mouth or on the lips and tongue
  • Poor appetite or difficulty feeding
  • Failure to gain weight or weight loss
  • Listlessness or decreased activity
  • A lasting or unexplained fever
  • Increasing pain, tenderness or pus oozing from the surgery site

Having your child diagnosed with a heart condition can be scary. Your child’s pediatric cardiologist will be very familiar with ASDs and how best to manage the condition. Most kids who’ve had an ASD corrected go on to live healthy, active lives.

Why Choose Norton Children’s Heart Institute

No other congenital heart surgery program in Kentucky, Ohio or Southern Indiana is rated higher by the Society of Thoracic Surgeons than the Norton Children’s Heart Institute Pediatric Cardiothoracic Surgery Program.

  • Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • Our board-certified and fellowship-trained pediatric cardiovascular surgeons are leaders in the field as clinicians and researchers.
  • More than 5,000 children a year visit Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, for advanced heart care.
  • Norton Children’s Heart Institute successfully performs more than 17,500 procedures a year.
  • The Society of Thoracic Surgeons rated Norton Children’s Heart Institute among the best in the region after studying years of our patients’ outcomes and our ability to treat a range of pediatric heart conditions, including the most severe.
  • Norton Children’s Heart Institute has satellite outpatient offices in Ashland, Bowling Green, Campbellsville, Elizabethtown, Frankfort, London, Madisonville, Murray, Owensboro, Paducah and Shepherdsville in Kentucky; as well as Corydon, Jasper, Madison and Scottsburg in Indiana; 28 tele-echocardiography locations in Kentucky and Southern Indiana; and six fetal echocardiography locations across Kentucky.
  • The American Board of Thoracic Surgery has awarded the cardiothoracic surgeons at Norton Children’s Hospital with subspecialty certification in congenital heart surgery.
  • The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.
  • Our multidisciplinary approach to pediatric heart surgery brings together our specialists in cardiothoracic surgery, cardiology, anesthesiology, cardiac critical care and other areas to create a complete care plan tailored for your child.
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