What does atrial septal defect mean?

Written by Li Hai Wen
Cardiology
Updated on September 12, 2024
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Atrial septal defect is a relatively common type of congenital heart disease encountered clinically. In simple terms, the human heart has four chambers: the left atrium, right atrium, left ventricle, and right ventricle. Between the left and right atria, there is a structure called the atrial septum, which separates the two atria. If there is a hole in this septum, this condition is referred to as an atrial septal defect. Atrial septal defects are common congenital heart conditions, and when the defect is severe, it often accompanies heart failure and other complications. Under such circumstances, it is crucial to visit a cardiologist for a formal assessment to determine the necessity and approach to treatment.

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Written by Tang Li
Cardiology
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How does septal defect shunt?

Atrial septal defect is the most common congenital heart disease in adults, accounting for 20%-30% of all adult congenital heart conditions. The impact of an atrial septal defect on hemodynamics primarily depends on the amount of shunting. Due to higher pressure in the left atrium compared to the right atrium, a left-to-right shunt is formed. The amount of shunting depends on the size of the defect, as well as the compliance of the left and right ventricles and the relative resistance in the systemic and pulmonary circulations. Diseases that affect the compliance of the left ventricle, such as hypertension and coronary artery disease, can increase the extent of the left-to-right shunt. A continuous increase in pulmonary blood flow leads to pulmonary congestion, increasing the load on the right heart. Pulmonary vascular compliance decreases, progressing from functional pulmonary arterial hypertension to organic pulmonary arterial hypertension. As right heart system pressure continuously increases and eventually exceeds the pressure in the left heart system, the original left-to-right shunt reverses to become a right-to-left shunt, resulting in cyanosis.

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Cardiology
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How severe is an atrial septal defect considered to be?

Atrial septal defect (ASD) is a relatively common congenital heart disease in clinical practice. From a medical perspective, the severity of ASD depends on whether the patient is an adult or a child. For adults with ASD, generally speaking, defects larger than 20 millimeters are considered large atrial septal defects, which are more severe. If the defect size is between 10 and 20 millimeters, it is often classified as a moderate atrial septal defect. Defects smaller than 4 millimeters are considered small atrial septal defects. Generally, small and moderate atrial septal defects are not severe. For children, an atrial septal defect larger than 10 millimeters is considered a large atrial septal defect, which is more severe. Sizes between 5 and 10 millimeters are classified as moderate atrial septal defects. Defects smaller than 5 millimeters are considered small atrial septal defects, which generally are not severe.

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Cardiology
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Symptoms of an infant's room septal defect

Symptoms of ventricular septal defect in infants are as follows: 1. Symptoms: If the mother had intrauterine infections within the first three months of pregnancy, was exposed to significant amounts of radiation, took teratogenic medications, or had metabolic disorders, these factors could contribute to the condition. The patient is prone to recurrent respiratory infections and exhibits symptoms of palpitations, shortness of breath, fatigue, and excessive sweating. If these symptoms worsen after physical activity or crying and are accompanied by cyanosis, congenital heart disease should be considered. Cyanosis can intensify during severe crying episodes, pneumonia, or heart failure in infants, and may be accompanied by a hoarse voice. 2. Physical signs: Notable findings include a bulging in the precordial area and diffuse apical impulse. A soft, systolic murmur can be heard between the second and third ribs along the left margin of the sternum.

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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.

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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.