Atrial Septal Defect

What Is an Atrial Septal Defect (ASD)?

An atrial septal defect is an opening or hole in the wall that sits between the heart’s two upper chambers. The heart’s upper chambers are called the right and left atria. Some people refer to atrial septal defect as having a hole in your heart.

Atrial septal defect (ASD) is a congenital disease. This means that children and babies who have ASD have it as soon as they’re born. ASD doesn’t develop later in life. If you have a hole in the wall in the lower two chambers of your heart, you have a ventricular septal defect.

Some babies have an ASD but don’t have any other heart problems. Some babies with ASDs have other congenital heart defects. Girls are two times more likely to have ASDs than boys, but doctors don’t know why.

Types of Atrial Septal Defects

There are a few different kinds of ASDs. The type of ASD your baby has will depend on where the hole inside her heart is located:

  • Secundum ASD is when your baby has a hole in the middle of her atrial septum (the wall that separates the right and left atria inside the heart).
  • Primum ASD is when your baby has a hole in the lower part of her atrial septum (wall). The lower part of the atrial septum is close to the tricuspid and mitral valves.
  • Sinus venosis is when your baby has a hole in the upper part of her atrial septum (wall). The upper part of the atrial septum is between the heart’s coronary sinus and left atrium (chamber).
  • Coronary sinus ASD is when your baby has a hole in the wall that’s between the coronary sinus and left chamber (atrium).

Patent Foramen Ovale (PFO)

Many people confuse ASDs with another kind of heart defect called patent foramen ovale (PFO). A PFO is an opening between your heart’s right and left atria (or chambers). But a PFO is not a type of ASD. This is because people who have PFOs aren’t missing any of their septal tissue. (Septal tissue that makes up the inside of the heart wall). Instead, their septal tissue just didn’t close properly when the heart was developing.

What Causes ASD?

Babies start to develop hearts during the first eight weeks of pregnancy. In a developing embryo, the heart starts out as a hollow tube that splits into four chambers. Walls called septa separate each of these chambers. These walls often have openings as a fetus grows. But the openings usually close just before or after birth. If these openings don’t close, this means the septum has a hole in it. Having a hole inside your heart is called an ASD.

Some congenital heart problems are passed down in families through genes. Most ASDs care caused by random mutations in a baby’s genes. In other words, ADS happen by chance. Doctors don’t know why ASD happens.

Symptoms of Atrial Septal Defects

Luckily, many children with ASDs have no symptoms and are healthy. If the hole inside your baby’s heart is large, she may have symptoms. These can include:

  • Getting tired easily
  • Growing slowly
  • Having fast breathing
  • Having shortness of breath
  • Getting respiratory infections often
  • Having abnormal heart rhythms (arrhythmias)

Because these symptoms are common to lots of other diseases, many people confuse ASD symptoms with other conditions. Be sure to take your child to a doctor for a correct diagnosis.

Atrial Septal Defects, Migraines, & Strokes

Some older children and adults who have ASDs get migraine headaches. But doctors don’t know if ASDs cause these migraines.

Older children and adults with ASD may also have a higher chance of getting strokes. However, doctors don’t fully understand the relationships between ASD and strokes. Doctors don’t think that closing the hole or taking anticoagulants (blood thinners) will lower adults’ chances of getting stroke.

How Is ASD Diagnosed?

Many doctors will listen to your child’s heart using a stethoscope. One of the first signs of ASD is having a heart murmur. Heart murmurs sound different from a normal heartbeat. This is because blood is flowing abnormally through the heart. 

Your child may also need to visit a pediatric cardiologist (heart doctor) to find out exactly what’s wrong. A pediatric cardiologist has special training in caring for children with heart problems.

Doctors can also use special tests to find out if your child has ASD. These tests include:

  • Chest X-ray.Chest X-rays show pictures of your child’s heart and lungs. Doctors sometimes use chest X-rays to diagnose ASD because an X-ray will show if your child’s heart is larger than normal (an enlarged heart). Chest X-rays can also show changes in your child's lungs. This is because ASD causes blood to flow differently than it normally does. 
  • Electrocardiogram (ECG).An electrocardiogram (or ECG) shows electrical activity inside your child’s heart. ECGs can also find abnormal heartbeats (called arrhythmias) and can also see if your child’s heart muscle is stressed. ASDs can cause both arrhythmias and heart stress.
  • Echocardiogram (echo).An echocardiogram (or echo) uses sound waves to show a picture of your child’s heart and heart valves while they’re moving. Echo tests can diagnose ASDs because they show how much blood flows through the hole in your child’s atrial septum. Echo tests can also see how big this hole is.
  • Cardiac catheterization.In this test, doctors use a thin, flexible tube called a catheter and place it close to your child’s heart. Doctors use contrast dye to get very clear pictures of your child’s heart. In some children, doctors also use cardiac catheterization to close your child’s ASD.

Treatment

After a doctor diagnoses your child with ASD, your child’s doctor will check to see if the hole is closing on its own. If the hole hasn’t closed by the time your child starts school, your child will usually need treatment. Doctors will look at the size of the hole to help you decide whether or not your child needs treatment.

Treatments for ASD can include the following:

  • Medicine. Many children with ASD don’t have symptoms and don’t need medication. But it still might be a good idea for some children to take it. But medicine can help some children's hearts work better. For example, water pills (diuretics) help a child’s heart work better by flushing extra fluid out of a child’s body through the kidneys.
  • Surgery. Your child may need surgery to fix their ASD. Surgeons use stitches or a special patch to close the hole inside your child’s heart wall. Your child will be asleep under general anesthesia.
  • Device closure. Doctors use a small, flexible tube called a catheter along with another tool called a septal occluder. The doctor will carefully push the catheter through your child’s blood vessels all the way into her heart. Then, your doctor will use the septal occluder to stop blood from flowing through the ASD hole.

Atrial Septal Defects & Long-Term Health Problems

Over time, large ASDs can cause lung problems if the ASD isn’t treated. Extra blood passes through the hole in your child’s heart and then into your child’s lungs. This extra blood may hurt the tiny, delicate blood vessels inside your child’s lungs.

How Can I Help My Child With ASD?

All children who have ASD need to be under the care and supervision of a pediatric cardiologist. Most children who have the hole in their heart closed will live healthy lives. After your child’s hole is closed, the doctor may ask your child to take antibiotics. Taking antibiotics will help prevent your child from getting an infection inside her heart lining (bacterial endocarditis).

Children with ASDs usually stay very healthy if their hole is diagnosed and closed when they’re young. In these cases, children usually don’t need a lot of follow-up care.

If children with ASDs have health problems, it’s usually because doctors didn’t diagnose the ASD until the child was older. Older children and adults with ASD can also have health problems if their ASD was never closed. Older children can also have health problems if they had complications after the hole inside their heart was closed.

Some children get high blood pressure in their lungs. This is called pulmonary hypertension. If your child has pulmonary hypertension, she should get follow-up care at a hospital that specializes in congenital heart disease.

Talk with your child's doctor about any long-term health problems your child may have.

When Should I Call My Child’s Doctor?

You should call your child’s doctor if your child is showing new symptoms, or if her symptoms are getting worse. Symptoms to watch for include the following: 

  • Your child is getting more and more tired.
  • Your child’s breathing is fast.
  • It’s hard for your child to breathe.
  • Your child has racing heartbeats or palpitations.

Important Things to Know About Atrial Septal Defects

  • An atrial septal defect is a hole or opening inside the heart. The hole is located in the wall that separates the heart’s two upper chambers (called the septum).
  • Symptoms of ASD can including getting tired easily, breathing quickly, feeling short of breath, growing poorly, having irregular heartbeats (arrhythmias), or getting respiratory infections often.
  • Atrial septum defects (holes inside the heart) can be large or small.
  • Some atrial septum defects (holes inside the heart) close on their own.
  • Doctors can treat and fix large atrial septum defects. They can also treat atrial septum defects that cause symptoms.
  • Most children who have their atrial septum defect treated will live long, healthy lives.

Next Steps

Finding out that your child has an atrial septal defect can be scary and overwhelming. Before you visit a doctor to talk about your child’s condition, keep these tips in mind:

  • Before your appointment, write down any questions you’d like your doctor to answer.
  • Know why you’re making the appointment and what you want to gain from the appointment.
  • After your child’s appointment is over, write down the names any new diagnoses the doctor gave your child. Also, write down the names of any new medications, tests, or treatments the doctor recommends.
  • If your doctor is prescribing a new medicine or treatment, know why. How will this medicine or treatment help your child? Be sure you know if the medicine has any side effects.
  • Ask if your child can get other types of treatment for ASD.
  • If your doctor is recommending a special test or procedure, know why. Be sure to learn about what the test results will tell you.
  • Know what could happen if your child doesn’t take medicine or get the test or procedure your doctor is recommending.
  • If your child will have a follow-up appointment, be sure to write down when and where the appointment will be. Write down the reason your child needs that follow-up appointment.
  • Know how to contact your doctor’s office after business hours. It’ll be important to contact your child’s doctor after hours if your child gets sick and you have questions or need help.

Providers

Douglas C. Appleby, MD

Douglas Appleby MD, DHA is a native of Charleston, SC. He received his medical degree from the Medical University of South Carolina, completed his General Surgery residency at the University of Kentucky, and his Cardiothoracic Surgery fellowship at the University of Utah. He then entered private practice in South Carolina and was instrumental in st... Read More

Specialties:

Cardiothoracic Surgery

Locations:

University Hospital 801-585-6740

Aaron W. Eckhauser, MD, MSCI

I joined the University of Utah, Division of Pediatric Cardiothoracic Surgery in 2012. I am board certified by the American Board of Surgery and the American Board of Thoracic Surgery. My clinical interests are focused on caring for all patients, from neonates to adults, with congenital heart defects. I have a special interest in pediatric heart... Read More

Specialties:

Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Jason P. Glotzbach, MD

Dr. Jason Glotzbach is an Assistant Professor of Surgery in the Division of Cardiothoracic Surgery at the University of Utah.  While his clinical practice spans all aspects of adult cardiac surgery, he has a special interest in aortic disease.  Dr. Glotzbach received his undergraduate degree in History from Princeton University and his medical degr... Read More

Specialties:

Adult Cardiac Surgery, Aortic Aneurysm Surgery, Aortic Dissection, Cardiothoracic Surgery, Coronary Artery Bypass Surgery, Heart Failure, Heart Valve Surgery, Minimally Invasive Heart Surgery, Thoracic Endovascular Aortic Repair, Transcatheter Aortic Valve Replacement (TAVI or TAVR)

Locations:

University Hospital 801-585-6740

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Antigoni Koliopoulou, MD

Dr. Antigone Koliopoulou has expertise in adult cardiac and general thoracic surgery, with a primary interest in heart transplantation and in temporary and chronic mechanical circulatory support (MCS). In relation to this field Dr. Koliopoulou has authored numerous peer-reviewed publications and is a co-investigator in ongoing clinical trials. Her ... Read More

Specialties:

Cardiothoracic Surgery

Locations:

University Hospital 801-587-9348

Stephen McKellar, MD, MSc

Dr. McKellar is a native of Salt Lake City and received his Bachelor of Arts from the University of Utah and his Doctor of Medicine from the George Washington University School of Medicine. He completed his General Surgical and Cardiothoracic Surgical training at the Mayo Clinic in Rochester, Minnesota in a combined, integrated training program. ... Read More

Specialties:

Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Minimally Invasive Lung & Esophageal Surgery, Valvular Heart Disease

Locations:

University Hospital 801-587-9348

Craig H. Selzman, MD

Patient Rating:

4.7

4.7 out of 5

Dr. Craig Selzman is a Professor of Surgery and Chief of the Division of Cardiothoracic Surgery at the University of Utah who specializes in the care of patients requiring heart surgery. He earned his undergraduate degree at Amherst College and medical degree at Baylor College of Medicine. He received his General and Cardiothoracic Surgery training... Read More

Specialties:

Adult Cardiac Surgery, Adult Congenital Heart Disease, Aortic Dissection, Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Artery Bypass Surgery, Coronary Revascularization, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Heart Valve Surgery, Lung Transplant, Marfan Syndrome and other Aortic Disorders, Minimally Invasive Heart Surgery, Surgical Ventricular Restoration, Valvular Heart Disease

Locations:

University Hospital
Cardiovascular Center
801-587-9348

Vikas Sharma, MD

Dr. Vikas Sharma is an Assistant Professor of Surgery in the Division of Cardiothoracic Surgery at the University of Utah. While his clinical practice spans all aspects of adult cardiac surgery, he has a special interest in Arrhythmia Surgery and Adult congenital heart disease. Dr. Sharma received his medical degree and cardiothoracic training in I... Read More

Specialties:

Adult Cardiac Surgery, Adult Congenital Heart Surgery, Aortic Dissection, Arrhythmia Surgery, Cardiothoracic Surgery, Coronary Artery Bypass Surgery, Heart Valve Surgery, Minimally Invasive Heart Surgery, Transcatheter Aortic Valve Replacement (TAVI or TAVR)

Locations:

University Hospital
Cardiothoracic Surgery

John R. Stringham, MD

JOHN STRINGHAM, MD, is originally from Nashville, Tennessee. He earned his medical degree from Vanderbilt University School of Medicine. He completed a general surgery residency at the University of Colorado which included time working at the Trauma Research Center. He then completed a thoracic surgery fellowship at the University of Virginia in Ch... Read More

Specialties:

Cardiothoracic Surgery, Esophageal Surgery, Lung Transplant, Minimally Invasive Lung & Esophageal Surgery

Locations:

Huntsman Cancer Hospital 801-213-5788

Thomas K. Varghese Jr., MD, MS

Patient Rating:

4.9

4.9 out of 5

Dr. Thomas Varghese Jr. is the Head of the Section of General Thoracic Surgery, Division of Cardiothoracic Surgery at the University of Utah. He is the Program Director of the Cardiothoracic Surgery Residency, Co-Director of the Thoracic Oncology Progam at the Huntsman Cancer Institute, and an Associate Professor in the Department of Surgery, Unive... Read More

Specialties:

Cardiothoracic Surgery, Esophageal Surgery, Minimally Invasive Lung & Esophageal Surgery

Locations:

Huntsman Cancer Hospital 801-587-4470

Leland Collard, PA-C

With over 20 years experience as an Advanced Practice Clinician, Ike joined the Univerisity of Utah Cardiothoracic service in 2017.  He is a pioneer in minimally invasive techniques for vein and radial artery harvesting in the state of Utah.  He continues to provide expert minimally invasive harvesting skills and techniques.  Ike returns to Utah fr... Read More

Specialties:

Cardiothoracic Surgery

Locations:

University Hospital
Cardiovascular Center
801-213-2200

A. Cole Johnson, PA-C

Cole has been a Certified Physician Assistant since 2010.  He has worked in Cardiothoracic Surgery for five years and is expert in endoscopic harvesting techniques.  Cole has brought with him experience in quality patient management.  He is an excellent diagnostician and truly cares for his patients.  He is certified by the National Commission on C... Read More

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

A location has not yet been added by this physician.

Thomas Lewis, PA-C

Thomas has worked in the health care field for many years.  Prior to becoming a Physician Assistant in 2009, he worked as a Critical Care Paramedic.  He has been a Cardiothoracic Physician Assistant since becoming a PA in 2009.  Thomas offers exceptional experience in the operating room, and in all aspects of patient care, from minimally invasive h... Read More

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

University Hospital

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

Huntsman Cancer Hospital
Clinic 1A, Thoracic
801-213-4266

Erik P. Sivertsen, PA-C

Erik joined the Cardiothoracic Service at the University in 2017.  He has brought with him four years of cardiothoracic experience from private practice in Asheville, North Carolina.  Erik is proficient in advanced minimally invasive techniques.  He has over seven years experience as a physician assistant.  Prior to becoming a Physician Assistant, ... Read More

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

University Hospital
Cardiovascular Center
801-581-8421

Nathan C. Sontum, PA-C, MHS

Nathan earned his Masters degree in Health Sciences from Drexel University in 2009.  Since 2010 he has been at the University of Utah and the VA Hospital working as a Certified Physician Assistant in Cardiothoracic Surgery.  During his tenure on the Cardiothoracic Service, Nathan has offered exceptional patient care and education.  He is skilled in... Read More

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Specialties:

Cardiothoracic Surgery

Locations:

A location has not yet been added by this physician.

Scott A. Tatum, PA-C

Scott came to the University almost 9 years ago from private practice. As a trainer and consultant for Endoscopic Vein harvesting, he has effectively introduced and incorporated new technology and procedures into the University healthcare system. As the senior physician assistant in the division of cardiothoracic surgery, Scott has 17 years experie... Read More

Specialties:

Cardiothoracic Surgery, Physician Assistant

Locations:

A location has not yet been added by this physician.

Locations

University Campus
University of Utah Hospital
50 N Medical Drive
Salt Lake City, UT 84132
Map
801-581-2121
Primary Children's Hospital
100 N Mario Capecchi Dr
Salt Lake City, UT 84132
801-662-1000
Veterans Administration Medical Center
500 Foothill Drive
Salt Lake City, UT 84148
801-582-1565