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| {{Infobox_Disease | | | __NOTOC__ |
| Name = Atrial septal defect |
| | {{Atrial septal defect}} |
| Image = Gray468.png |
| | '''For patient information click [[Atrial septal defect (patient information)|here]]''' |
| Caption = Heart of human [[embryo]] of about thirty-five days |
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| Width = 180px |
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| DiseasesDB = 1089 |
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| ICD10 = {{ICD10|Q|21|1|q|20}} |
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| ICD9 = {{ICD9|745.5}}-{{ICD9|745.6}} |
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| ICDO = |
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| OMIM = 108800 |
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| MedlinePlus = |
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| eMedicineSubj = med |
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| eMedicineTopic = 3519 |
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| MeshName = Atrial+Septal+Defects |
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| MeshNumber = C14.240.400.560.375 |
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| }}
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| {{SI}}
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| {{WikiDoc Cardiology Network Infobox}}
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| '''Editors-In-Chief:''' Claudia Hochberg, M.D.; [[User:C Michael Gibson |C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-525-6884 | | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]; {{KD}} '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] |
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| '''Associate Editors-In-Chief:''' {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]
| | {{SK}} ASD |
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| {{Editor Join}}
| | ==[[Atrial septal defect overview | Overview]]== |
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| ==[[Atrial septal defect overview | Overview]]== | | ==[[Atrial septal defect anatomy|Anatomy]]== |
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| ==[[Atrial septal defect embryology | Embryology]]== | | ==[[Atrial septal defect classifications | Classification]] == |
| | [[Atrial septal defect ostium secundum | Ostium Secundum Atrial Septal Defect]] | [[Atrial septal defect ostium primum | Ostium Primum Atrial Septal Defect]] | [[Atrial septal defect sinus venosus | Sinus Venosus Atrial Septal Defect]] | [[Atrial septal defect coronary sinus | Coronary Sinus]] | [[Atrial septal defect patent foramen ovale | Patent Foramen Ovale]] | [[Atrial septal defect common or single atrium | Common or Single Atrium]] |
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| ==[[Atrial septal defect pathophysiology | Pathophysiology]]== | | ==[[Atrial septal defect pathophysiology | Pathophysiology]]== |
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| ==[[Atrial septal defect epidemiology | Epidemiology]]== | | ==[[Atrial septal defect epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Atrial septal defect risk factors|Risk Factors]]== |
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| ==[[Atrial septal defect genetics | Genetic]]== | | ==[[Atrial septal defect natural history|Natural History and Prognosis]]== |
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| ==[[Atrial septal defect types | Types of atrial septal defects]] == | | ==[[Atrial septal defect complications|Complications]]== |
| [[Atrial septal defect ostium primum | Ostium primum atrial septal defect]] | [[Atrial septal defect ostium secundum | Ostum secundum atrial septal defect]] | [[Atrial septal defect patent foramen ovale | Patent foramen ovale]] | [[Atrial septal defect sinus venosus | Sinus venosus atrial septal defect]] | [[Atrial septal defect common or single atrium | Common or single atrium]]
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| ==[[Atrial septal defect diagnosis | Diagnosis]]== | | ==[[Atrial septal defect diagnosis | Diagnosis]]== |
| | | [[Atrial septal defect history and symptoms|History and Symptoms]] | [[Atrial septal defect diagnosis physical examination | Physical Examination]] | [[Atrial septal defect chest x-ray | Chest X Ray]] | [[Atrial septal defect electrocardiogram | Electrocardiogram]] | [[Atrial septal defect echocardiography | Echocardiography]] | [[Atrial septal defect transcranial doppler ultrasound | Transcranial Doppler Ultrasound]] | [[Atrial septal defect MRI | MRI]] | [[Atrial septal defect CT | CT]] | [[Atrial septal defect cardiac catheterization |Cardiac Catheterization]] | [[Atrial septal defect exercise testing|Exercise Testing]] | [[ACC/AHA guidelines for evaluation of unoperated patients with atrial septal defects|ACC/AHA Guidelines for Evaluation of Unoperated Patients]] |
| [[Atrial septal defect diagnosis physical examination | Physical examination]] | [[Atrial septal defect diagnosis physical examination| Auscultation of the heart]] | [[Atrial septal defect chest x-ray | Chest X-ray]] | [[Atrial septal defect electrocardiography | Electrocardiography]] | [[Atrial septal defect echocardiography | Echocardiography]] | [[Atrial septal defect trans-cranial doppler ultrasound | Trans-cranial doppler ultrasound]]== | |
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| ==== MRI====
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| Cardiac MRI can be helpful in diagnosing [[ASD]]s and can be used to determine defect size, quantify the shunt fraction and detect associated anomalous pulmonary venous connections.
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| ==Treatment== | | ==Treatment== |
| Once an individual is found to have an [[atrial septal defect]], a determination of whether it should be corrected has to be made.
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| Criteria for closure include right ventricular dilatation, [[pulmonary artery]] pressures of 50% or less than systemic pressures, history of a cryptogenic stroke.
| | [[Atrial septal defect medical therapy|Medical Therapy]] | [[Atrial septal defect indications for surgical repair in adults| Indications For Surgical Repair]] | [[Atrial septal defect surgical closure | Surgical Closure]] | [[Atrial septal defect minimally invasive repair| Minimally Invasive Repair]] | [[Atrial septal defect percutaneous closure | Percutaneous Closure]] | [[Atrial septal defect robotic repair | Robotic ASD Repair]] | [[Atrial septal defect post surgical follow up|Post Surgical Follow Up]] |
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| Surgical mortality due to closure of an [[ASD]] is lowest when the procedure is performed prior to the development of significant pulmonary hypertension. The lowest mortality rates are achieved in individuals with a pulmonary artery systolic pressure of less than 40 mm Hg.
| | ==Special Scenarios== |
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| If [[Eisenmenger's syndrome]] has occurred, there is significant risk of mortality regardless of the method of closure of the [[ASD]]. In individuals who have developed [[Eisenmenger's syndrome]], the pressure in the [[right ventricle]] has raised high enough to reverse the shunt in the atria. If the [[ASD]] is then closed, the [[afterload]] that the [[right ventricle]] has to act against has suddenly increased. This may cause immediate [[heart failure|right ventricular failure]], since it may not be able to pump the blood against the [[pulmonary hypertension]].
| | [[Atrial septal defect pregnancy|Pregnancy]] | [[Atrial septal defect decompression sickness |Diving and Decompression Sickness]] | [[Atrial septal defect paradoxical emboli | Paradoxical Emboli]] | [[Atrial septal defect pulmonary hypertension|Pulmonary Hypertension]] | [[Atrial septal defect Eisenmenger's syndrome|Eisenmenger's Syndrome]] | [[Atrial septal defect atmospheric pressure|Atmospheric Pressure]] |
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| Closure of an [[ASD]] in individuals under age 25 has been shown to have a low risk of complications, and individuals have a normal lifespan (comparable to a healthy age-matched population). Closure of an [[ASD]] in individuals between the ages of 25 and 40 who are asymptomatic but have a clinically significant shunt is controversial. Those that perform the procedure believe that they are preventing long-term deterioration in cardiac function and preventing progression of [[pulmonary hypertension]].
| | ==Case Studies== |
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| Methods of closure of an [[ASD]] include surgical closure and percutaneous closure.
| | [[Atrial septal defect case study one|Case #1]] |
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| ===Evaluation prior to correction=== | | ==Related Chapters== |
| Prior to correction of an [[ASD]], an evaluation to determine if [[pulmonary hypertension]] is present and whether it is reversible. Closure of an [[ASD]] may be recommended for prevention purposes, to avoid such a complication in the first place. [[Pulmonary Hypertension]] is not always present in adults that are diagnosed with an [[ASD]] in adulthood.
| | * [[Atrioventricular septal defect]] |
| | * [[Congenital heart disease]] |
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| If there is a suspicion that [[pulmonary hypertension]] is present, the evaluation may include a right heart catheterization. This involves placing a catheter in the venous system of the heart and measuring pressures and oxygen saturations in the [[superior vena cava|SVC]], [[inferior vena cava|IVC]], [[right atrium]], [[right ventricle]], [[pulmonary artery]], and in the wedge position. Individuals with a [[pulmonary vascular resistance]] (PVR) of less than 7 wood units show regression of symptoms (including [[New York Heart Association Functional Classification|NYHA functional class]]). On the other hand, individuals with a [[pulmonary vascular resistance|PVR]] of greater than 15 wood units have increased mortality associated with closure of the [[ASD]].
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| If the pulmonary arterial pressure is more than 2/3 the systemic systolic pressure, there should be a net left-to-right shunt of at least 1.5:1 or evidence of reversibility of the shunt when given pulmonary artery vasodilators prior to surgery. If [[Eisenmenger's]] physiology has developed, it must be demonstrated that the right-to-left shunt is reversible with pulmonary artery vasodilators prior to surgery.
| | [[CME Category::Cardiology]] |
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| ===Surgical ASD closure===
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| Surgical closure of an [[ASD]] involves opening up at least one [[atrium (anatomy)|atrium]] and closing the defect with a patch under direct visualization.
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| ===Percutaneous ASD closure===
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| Percutaneous closure of an [[ASD]] is currently only indicated for the closure of ostium secundum [[ASD]]s with a sufficient rim of tissue around the septal defect so that the closure device does not impinge upon the [[superior vena cava|SVC]], [[inferior vena cava|IVC]], or the [[tricuspid valve|tricuspid]] or [[mitral valve|mitral]] valves. The Amplatzer Septal Occluder is commonly used to close [[ASD]]'s. The ASO consists of two self-expandable round discs connected to each other with a 4-mm waist, made up of 0.004–0.005´´ nitinol wire mesh filled with Dacron fabric. Implantation of the device is relatively easy. The prevalence of residual defect is low. The disadvantages are a thick profile of the device and concern related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
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| Percutaneous closure is the method of choice in most centers.<!--
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| --><ref>{{cite journal | author = Bjørnstad P | title = Is interventional closure the current treatment of choice for selected patients with deficient atrial septation? | journal = Cardiol Young | volume = 16 | issue = 1 | pages = 3-10 | year = 2006 | id = PMID 16454871}}</ref>
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| [[Image:ASD-ampatzl-anim.gif|left|Amplatzer Septal Occluder]]
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| <br clear="left"/>
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| ==Associated conditions==
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| Due to the communication between the atria that occurs in [[ASD]]'s, disease entities or complications from the condition, are possible.
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| ===Decompression sickness===
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| [[ASD]]s, and particularly [[PFO]]s, are a predisposing risk factor for [[decompression sickness]] in divers because a proportion of venous blood carrying inert gases, such as [[helium]] or [[nitrogen]] does not pass through the lungs.<!--
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| --><ref>{{cite journal | author = Lier H, Schroeder S, Hering R | title = [Patent foramen ovale: an underrated risk for divers?] | journal = Dtsch Med Wochenschr | volume = 129 | issue = 1-2 | pages = 27-30 | year = 2004 | id = PMID 14703578}}</ref><!--
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| --><ref>{{cite journal | author = Saary M, Gray G | title = A review of the relationship between patent foramen ovale and type II decompression sickness. | journal = Aviat Space Environ Med | volume = 72 | issue = 12 | pages = 1113-20 | year = 2001 | id = PMID 11763113}}</ref>
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| The only way to release the excess inert gases from the body is to pass the blood carrying the inert gases through the [[lung]]s to be exhaled. If some of the inert gas-laden blood passes through the [[PFO]], it avoids the lungs and the inert gas is more likely to form large bubbles in the arterial blood stream causing ''decompression sickness''.
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| ===Paradoxical emboli===
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| Venous [[thrombus|thrombi]] (clots in the [[vein]]s) are quite common. Embolization (dislodgement of thrombi) normally go to the lung and cause [[pulmonary embolism|pulmonary emboli]]. In an individual with [[ASD]], these emboli can potentially enter the arterial system. This can cause any phenomenon that is attributed to acute loss of blood to a portion of the body, including [[cerebrovascular accident]] (stroke), infarction of the [[spleen]] or [[intestine]]s, or even a distal extremity (i.e.: finger or toe).
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| This is known as a ''paradoxical'' embolus because the clot material paradoxically enters the arterial system instead of going to the lungs.
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| ===Migraine===
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| Some recent research has suggested that a proportion of cases of [[migraine]] may be caused by [[Patent foramen ovale|patent foramen ovale]]. While the exact mechanism remains unclear, closure of a [[PFO]] can reduce symptoms in certain cases.<!--
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| --><ref>{{cite journal | author = Adams H | title = Patent foramen ovale: paradoxical embolism and paradoxical data. | journal = Mayo Clin Proc | volume = 79 | issue = 1 | pages = 15-20 | year = 2004 | id = PMID 14708944}}</ref><!--
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| --><ref>{{cite journal | author = Azarbal B, Tobis J, Suh W, Chan V, Dao C, Gaster R | title = Association of interatrial shunts and migraine headaches: impact of transcatheter closure. | journal = J Am Coll Cardiol | volume = 45 | issue = 4 | pages = 489-92 | year = 2005 | id = PMID 15708691}}</ref>
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| This remains controversial. 20% of the general population have a [[PFO]], which for the most part, is asymptomatic. 20% of the female population have migraines. And, the [[placebo effect]] in migraine typically averages around 40%. The high frequency of these facts makes statistically significant relationships between [[PFO]] and migraine difficult (i.e., the relationship may just be chance or coincidence).
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| ==See also==
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| *[[Atrioventricular septal defect]]
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| *[[Cardiac output]]
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| *[[Congenital heart disease]]
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| *[[Heart sounds]]
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| *[[Pulmonary hypertension]]
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| *[[Vascular resistance]]
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| **[[Pulmonary vascular resistance]]
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| *[[Ventricular septal defect]]
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| ==References==
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| {{Reflist|2}} | |
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| ==External links==
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| * [http://heartcenter.seattlechildrens.org/conditions_treated/atrial_septal_defect.asp Atrial Septal Defect information] from Seattle Children's Hospital Heart Center
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| * [http://www.pediatricheartsurgery.com Pediatric Heart Surgery]
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| * [http://www.youtube.com/user/Redmond111 The Congenital Heart Surgery Video Project]
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| * [http://www.youtube.com/watch?v=PbQhiv6OB0E Pediatric Cardiac Surgery: Atrial Septal Defect Repair]
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| {{Congenital malformations and deformations of circulatory system}}
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| {{Electrocardiography}}
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| {{SIB}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Congenital heart disease]] | | [[Category:Congenital heart disease]] |
| | | [[Category:Pediatrics]] |
| [[tr:Atriyal septal defekt]] | | [[Category:Embryology]] |
| | | [[Category:Disease]] |
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