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Atrial septal defect
Atrial septal defect can cause which complications?
Small atrial septal defects generally are asymptomatic, whereas medium to large atrial septal defects may result in pulmonary hypertension and right heart failure. The impact of an atrial septal defect on hemodynamics mainly depends on the amount of shunting, which in turn is determined by the size of the defect. It also relates to the compliance of the left and right ventricles and the relative resistance of the systemic and pulmonary circulation. Continued increase in pulmonary blood flow leads to pulmonary congestion, increasing right heart volume load. Pulmonary vascular compliance decreases, evolving from functional to organic pulmonary hypertension. This in turn continuously increases right heart system pressure until it surpasses the pressure of the left heart system, causing the original left-to-right shunt to reverse to a right-to-left shunt, leading to cyanosis. Atrial septal defects are generally asymptomatic but with the progression of the condition, symptoms such as exertional dyspnea, arrhythmias, and right heart failure may occur. In the advanced stages, about 15% of patients with severe pulmonary hypertension exhibit a right-to-left shunt and cyanosis, leading to the formation of Eisenmenger syndrome.
Can people with atrial septal defect go to the plateau?
A mild atrial septal defect, such as one smaller than 3mm, allows for a normal life without any impact. In fact, some people only discover this condition during medical exams in their seventies or eighties. Therefore, it is safe for these individuals to travel to high altitudes. However, a larger atrial septal defect often causes symptoms like tightness in the chest, palpitations, and difficulty breathing after hypoxia or intense exercise. These patients have poorer compensatory abilities and are advised against going to high altitudes to avoid high altitude sickness. If such patients need to go to high altitude, it is recommended that they consider surgery before doing so.
Can someone with an atrial septal defect go swimming?
Atrial septal defect is not uncommon in our daily lives. Many patients with atrial septal defects often ask their doctor if they can swim. This has to be analyzed based on specific circumstances. If the atrial septal defect is not severe, and it's just a minor atrial septal defect, generally it does not affect the patient's daily activities, such as swimming or running. However, if the atrial septal defect is severe, especially if it has led to heart failure and heart enlargement, in this situation, one should definitely not engage in strenuous activities such as swimming or running.
Is atrial septal defect common?
Atrial septal defect accounts for about 20%-30% of all congenital heart diseases and is more common in females. Many cases are mild in children and are not discovered until adulthood. Atrial septal defects can be classified based on anatomical abnormalities into patent foramen ovale, primary atrial septal defect, and secondary atrial septal defect. A patent foramen ovale generally does not cause shunting between the two atria. A primary atrial septal defect is located at the lower part of the atrial septum, is semicircular in shape, and is often larger, frequently associated with malformation of the mitral or tricuspid valves resulting in regurgitation. A secondary atrial septal defect is situated in the middle of the atrial septum at the fossa ovalis or near the superior and inferior vena cava. The symptoms of an atrial septal defect vary with the size of the defect; minor cases may be asymptomatic, while severe cases can result in heart failure.
Can atrial septal defect heal by itself?
Atrial septal defect is a relatively common congenital heart disease in infants and toddlers. It is indeed possible for a child's atrial septal defect to close on its own. Some atrial septal defects can close as the child grows. Depending on the severity, atrial septal defects can be categorized into small defects. Generally, if the defect is less than 5 millimeters, it is possible for the defect to close as the child develops. If it has not closed by the age of two, it generally will not close on its own thereafter.
What are the symptoms of an atrial septal defect?
Atrial septal defect is the most common congenital heart disease in adults, accounting for 20%-30% of adult congenital heart diseases, with a higher incidence in females than males, with a male to female ratio of about 1:1.5-3. There is also a familial tendency. Apart from larger defects, children with atrial septal defects generally show no symptoms. As they age, symptoms gradually appear, with exertional dyspnea being the main symptom, followed by supraventricular arrhythmias, especially atrial flutter and fibrillation, which exacerbate the symptoms. Some patients may develop right heart failure due to excessive right ventricular volume load. In the late stages, about 15% of patients develop severe pulmonary hypertension, resulting in a right-to-left shunt and cyanosis.
Imaging manifestations of atrial septal defect
The imaging characteristics of ventricular septal defects are as follows: 1. Small defects: Normal cardiac silhouette, or left ventricular hypertrophy, with mild pulmonary congestion. 2. Medium defects: Left ventricular hypertrophy or biventricular hypertrophy, enlarged pulmonary artery segment, smaller aortic knob. 3. Large defects: Both ventricles enlarged, left atrium enlarged, prominent pulmonary artery segment, significant pulmonary congestion. When pulmonary hypertension with right-to-left shunting occurs, the pulmonary artery segment is markedly prominent, but the lung fields are clear, and the heart shadow is smaller than before.
Do infant atrial septal defects heal by themselves?
Atrial septal defect is a common congenital heart disease, accounting for about 1/1500 of newborns, and is most commonly found in infants and children. The impact of atrial septal defects on hemodynamics mainly depends on the amount of shunting. Some studies confirm that atrial septal defects smaller than six millimeters can close on their own without external intervention. Therefore, when an atrial septal defect is discovered, it is necessary to regularly recheck the cardiac echocardiography to determine the size of the defect. If the atrial septal defect decreases in size as the patient ages, there is a possibility of self-healing. If the area of the patient's atrial septal defect does not change or gradually increases, regular echocardiography rechecks are needed, and cardiac catheterization may be performed if necessary.
The difference between ventricular septal defect and atrial septal defect
The difference between a ventricular septal defect and an atrial septal defect mainly lies in their locations. A normal heart is divided into four chambers, which are the left ventricle, right ventricle, left atrium, and right atrium. Each chamber is separated by a septum, much like walls between rooms in a house. Due to certain reasons, such as congenital heart defects, there may be openings or defects in these walls, known as septal defects. An atrial septal defect refers to a defect between the right atrium and the left atrium, whereas a ventricular septal defect pertains to a defect between the left and right ventricles. The murmur of atrial septal defects is relatively softer, as the pressure difference between the atria is smaller, and the defect is located higher up. In contrast, the murmur of ventricular septal defects is louder due to the greater pressure difference between the ventricles and is located lower down, approximately between the third and fourth ribs. The murmur of atrial septal defects is found between the second and third ribs. Moreover, since the pressure difference in ventricular septal defects is greater, the impact on the heart is relatively more significant.
Can medication be taken for atrial septal defect?
Patients with small atrial septal defects and no related symptoms, pulmonary hypertension, or ventricular enlargement generally do not need specific medication. If symptoms do occur, interventional or surgical treatment should be chosen. Medication is necessary only if there is accompanying heart failure, pulmonary infection, or arrhythmias such as atrial fibrillation. In the case of infections like pneumonia or infective endocarditis, appropriate antibiotics or antiviral medications should be actively used. When heart failure occurs, medications to control arrhythmias, such as vasodilators, diuretics, and agents to control ventricular rate, are required.