Diagnosing And Treating An Atrial Septal Defect

Your heart’s left and right sides are separated by an inner wall of tissue called the septum. This wall helps to prevent oxygen-poor blood on the right side from mixing with oxygen-rich blood on the left side. If the portion of the wall that separates the atria has a hole in it, the condition is called atrial septal defect (ASD).

There are three types of ASD: secundum, primum, and sinus venosus. Secundum is the most common and is characterized by a hole in the middle of the atrial septum. If the hole is small, it will normally close by itself. Primum is a hole in the lower portion of the atrial septum. It rarely closes on its own and is often accompanied by problems with the tricuspid and mitral valves. Sinus venosus is a hole in the top portion near the area where the superior vena cava supplies the right atrium with blood.

Below, we’ll explain how atrial septal defects are treated. While open chest surgery has traditionally been necessary to repair the holes, minimally invasive techniques are now possible.

Catheter Procedure For Mid-Septum Holes

If the hole in the septum is small, treatment may not be necessary. That said, when treatment is necessary, the surgeon’s approach is dictated by the type of ASD suffered by the patient. Secundum defects (i.e. located in the middle of the wall) can be repaired by using a catheter. The catheter is equipped with a tissue patch or filter-like device. It is inserted into the groin and threaded to the site. After the catheter reaches the site, the patch (or device) is used to cover the hole. Within five or six months, the septum’s tissue will overgrow the patch.

Minimally Invasive Surgery for ASD

Sinus venosus and primum defects usually require surgery to repair. Sinus venosus ASDs (i.e. high in the atrial septum wall) are positioned in such a way that simply using a patch to cover the hole would impact blood flow between the chambers. The ASD must be patched so that the direction in which the blood flows is properly regulated.

Primum defects are more complex to resolve than secundum and sinus venosus ASDs. As noted earlier, they are often accompanied by tricuspid and mitral valvular problems. They may also involve a corresponding ventricular septal defect (i.e. hole in the septum between the ventricles). When primum defects present, patients will normally exhibit signs of heart failure. However, if diagnosed early, the septal holes (both atrial and ventricular), and any problems with the tricuspid and mitral valves can be repaired successfully.

It is estimated that approximately nine out of ten diagnosed cases of atrial septal defects are secundum ASDs. That means they can be resolved by using a catheter to deliver a tissue patch to the site. In the event that you suffer from a sinus venosus or primum defect, treatment (if necessary) will likely involve minimally invasive heart surgery.

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