An atrial septal defect (ASD) is a hole in the middle of the heart wall (septum) that separates the upper-right and upper-left chambers (atria) of the heart. An ASD causes oxygen-rich blood and oxygen-poor blood to mix, which can lead to problems such as high-blood pressure or an increased risk of stroke.
The size of the defect may vary from small to large, but some ASDs can close on their own, usually during a child’s first three years of life. However, if the defect remains and a significant amount of blood is passing through the hole, it may need to be treated. At Boston Children’s, we can treat many ASDs with cardiac catheterization or minimally invasive cardiac surgery with the aim of reducing pain and helping children recover quickly.
Less oxygen-rich blood is pumped throughout the body because the hole between the left and right atria diminishes blood flow to the left ventricle, the main pumping chamber. The right ventricle ends up working harder and can weaken because it is now pumping oxygen-poor and oxygen-rich blood.
An ASD on its own or in combination with other congenital heart defects (CHDs), such as hypoplastic left-heart syndrome (HLHS), can cause the right side of the heart to enlarge from working too hard. A child who has an ASD coupled with high blood pressure in the lungs or the CHD tetralogy of Fallot can experience a decrease in blood saturation levels.
Another kind of hole can form between the heart’s two upper-chambers. It is called a patent foramen ovale (PFO). Unlike an ASD, which is a defect that affects only some children, everyone is born with a PFO. It closes on its own after birth in most people. A PFO that doesn’t close can increase the risk of stroke.
Most children who have an ASD do not experience symptoms until school age. But symptoms can be present as soon as after birth in children who are born prematurely or in children who have other CHDs, such as mitral valve disease.
Often, children who have an ASD are referred to a cardiologist because their pediatrician detected a heart murmur while listening to their heart. If your child does have symptoms, they can include:
Although a pediatrician can detect an ASD by hearing a heart murmur, sometimes the condition is not diagnosed for many years. Depending on the type of heart murmur your doctor hears, they may recommend one or more or the following tests for your child:
If your child’s ASD is large or causing circulation problems or poor health, your family will probably be advised to consider closing the ASD through treatment. Our team of specialists at Boston Children’s Benderson Family Heart Center will aim to treat your child with the least possible invasive procedure.
Most of the time ASDs can be safely closed with cardiac catheterization. If your child has this nonsurgical procedure, a long thin tube (a catheter) that leads a small umbrella-shaped closure device will be inserted through their leg vein. The catheter will guide the closure device to their heart, where the device will open to cover the ASD with a patch.
Your child should feel little-to-no discomfort during the procedure; they are given deep sedation or general anesthesia. They typically go home the day of the catheterization.
Cardiac catheterization patches the hole caused by an atrial septal defect and enables the heart to pump blood normally: the left side pumping only oxygen-rich blood and the right side pumping only oxygen-poor blood.
If catheterization cannot close your child’s ASD, open-heart surgery will be recommended to place a patch over the hole. Most hospitals repair an ASD with a sternotomy; surgeons access the heart through the sternum (breastbone). The procedure leaves a visible scar on the upper chest and the sternum will have to be wired together to help the bone heal. Sometimes the thymus gland has to be removed to give surgeons a complete view of the heart. Recovery in the hospital after a sternotomy can last four to five days, and it can take three months for the sternum to heal.
At Boston Children’s, we also offer two minimally invasive cardiac surgery approaches that avoid certain aspects of a sternotomy:
Boston Children’s is one of just a few pediatric hospitals to offer this approach. Our surgeons will make an incision under the armpit, keeping your child’s sternum intact and leaving a relatively smaller incision scar. The thymus also doesn’t need to be removed. Your child will experience less pain than they would after a sternotomy, and their recovery time in the hospital will be shorter: possibly two to three days. With an accelerated recovery, they’ll be able to resume physical activities and contact sports as soon as possible after surgery.
The axillary and posterolateral are two ways to perform a minimally invasive thoracotomy and repair an ASD.
If your child is not eligible for a thoracotomy, they might be able to avoid a full sternotomy if they are a candidate for a mini-sternotomy. This approach requires a smaller incision to the sternum, either the upper or lower portion. It leaves a small scar on the chest, and your child should feel less pain after surgery. They could leave the hospital within two to three days and should recover within a month.
Whereas a full sternotomy splits the entire breastbone, a mini-sternotomy makes a smaller incision, on either the upper or lower portion of the sternum.
In this webinar, Boston Children’s heart specialists explain surgical options for ASD repair and how their team strives to improve patient recovery.
Our specialists have extensive experience treating atrial septal defects and will review all treatment options with your family. No matter what your decision is, your family will have all the time and resources you need to think it over, and we are always available to answer any questions.
Working with the Enhanced Recovery After Cardiac Surgery (or ERAS Cardiac) Program, our team will always focus on maximizing safety, minimizing pain, and shortening your child’s length of stay at the hospital and their overall recovery. And once your child is home, our team will continue to follow their progress and heart health into adulthood.
