An atrial septal defect (ASD) is a hole in the wall (septum) between the heart’s two upper chambers (the left and right atrium). The left side of the heart typically pumps oxygen-rich blood to the body, while the right side pumps oxygen-poor blood to the lungs. In a child with an ASD, blood can cross the hole (ASD) from the left upper chamber (left atrium) to the right upper chamber (right atrium) and into the lungs. This extra blood flow to the lungs can make the heart and lungs work harder and may damage them over time.
All babies are born with this natural hole, which is important while the baby is in the womb, as it directs oxygen-rich blood from the mother’s placenta to the baby’s brain and heart. This hole typically closes within a few days after birth. In one in five healthy individuals, the small opening may remain, and this is known as a Patent Foramen Ovale (PFO).
The impact of the defect depends on the amount of blood passing through it, which varies based on the defect's size and the child's age.
Small ASDs and PFOs do not require treatment. Although large defects may decrease in size as the child grows, small defects do not enlarge. Large defects allowing excessive blood into the lungs should be closed to prevent lung damage and premature heart wear.
Atrial septal defects are congenital, and whilst the exact cause of these defects is often unknown, they are associated with both environmental and genetic factors.
Children with an ASD usually have no symptoms if the hole is small. If the ASD is large, common symptoms include shortness of breath, poor weight gain, palpitations and an increased susceptibility to infection. Even larger defects might be only detected when a murmur is heard during a medical examination.
Medical treatment with diuretics and anti-arrythmia medications can be used to treat the symptoms of ASD, but definitive therapy requires closing it either via surgery or interventional catheterisation using a device.
This is the traditional treatment, where the defect is closed with stitches or a patch made of dacron cloth or the patient's own heart lining (pericardium). Patients can typically return home after five days and resume full activities within a month.
A minimally invasive option, keyhole surgery, is now available. Under anaesthesia, a catheter is inserted through a groin blood vessel to the defect. A device attached to a wire is collapsed, inserted into the catheter and advanced to the defect. As the device reaches the end of the catheter, it springs open, clamping onto the atrial septum to seal the defect. The wire is then detached, and the catheter is removed. Endocarditis prophylaxis is recommended for six months following device closure.
Special diets are not generally required for those with heart disease, but a balanced one is important. Maintaining a normal weight is crucial as excess weight increases the heart's workload.
Infants, particularly those with an ASD, may have increased nutritional needs and might require a special formula.
Good dental hygiene is essential for all children and adults, and we recommend regular dental check-ups.
Based on current guidelines, there is no need for antibiotics before dental procedures for ASD.
Exercise is beneficial, even for those with heart conditions. It improves heart function and overall well-being, and is associated with increased life expectancy and reduced heart disease risk in later life. It also aids in weight control and reduces blood pressure.
Different types of exercise, such as static (e.g. weightlifting) and dynamic (e.g. running), have varying effects on the body and heart. Children with heart conditions should consult their doctor to determine safe levels and types of exercise, especially in school settings where physical activities can be intensive.
Most children with heart disease can follow the standard vaccination schedule. However, those with immune deficiencies, such as DiGeorge syndrome or an isomerism, or those who are receiving immunosuppression, such as post-transplantation, may require a modified vaccination schedule.
Before travelling, especially long distances or to unusual destinations, we recommend to:
Children with heart disease are generally not more prone to infections. However, some may be susceptible to chest infections or have associated immune deficiencies, particularly those with holes in their heart (ASD, VSD, PDA). Viral infections are common and usually resolve without antibiotics, but medical advice should be sought in case of uncertainty.
Not all children with heart disease require medication. Those who do may need it for fluid reduction, aiding heart pumping, rhythm control or blood thinning.
While these medications are generally safe, side effects can occur, especially with other illnesses or medication changes. Any unusual symptoms or side effects should be promptly reported to the doctor.
Most women with heart disease can have a normal pregnancy and delivery. Exceptions may include those with severe cyanosis or pulmonary hypertension, where pregnancy can pose significant risks.
It is essential to seek medical advice before pregnancy so that the process can be monitored and any necessary treatment can be provided early.
The risk of heart disease in offspring varies, and some evidence suggests that vitamin intake before and during early pregnancy may help reduce risk.
