Heart disease: the atrial septal defect

By Cristiano Antonino On Mar 9, 2023

In the presence of an atrial sept defect, the wall separating the atria in the heart, normally intact, has a defect that causes the heart organ to overwork

The atrial sept defect will see the presence of communication between the septum separating the atria

Normally, this wall is intact, and will separate the atria and prevent them from communicating.

This wall will divide venous blood, which returns from the body to the right atrium, from arterial blood, which returns from the lungs to the left atrium.

In the presence of an atrial sept defect, arterial blood, which is rich in oxygen, will mix with venous blood causing an increased workload for the right ventricle and the lungs.

As a result, the right ventricle will dilate.

Atrial sept defect is among the most common congenital heart diseases; and women are most affected.

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Depending on where it is located in the septum, the atrial sept defect can be divided into four types:

Ostium secundum interatrial defect, is the most common interatrial defect, it will be located in the central part of the interatrial septum. It will tend to close within the first year of life.
Ostium primum interatrial defect, will be located in the lower part of the septum.
Venous sinus interatrial defect, located at the outlet of the superior vena cava.
Coronary sinus interatrial defect, located at the outlet of the large coronary vein in the right atrium.

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Atrial sept defect will also be referred to as pulmonary shunt disease

The shunt is the direction of blood flow from left to right, this will depend on the size of the defect, the pulmonary resistance and the volumetric capacity of the right ventricle.

The shunt is defined as significant when it causes dilation of the right sections.

In the neonatal period, the size of the shunt will be small as there will be high pulmonary resistance and peripheral resistances will be low.

By the second month of life, there will be a decrease in pulmonary resistance and an increase in the shunt which will cause, if the defect is large, dilation of the atrium and ventricle and the pulmonary artery due to volume overload.

Generally, children with an interatrial defect will have no symptoms but may see sporadic onset of heart palpitation and breathlessness, particularly during exercise.

In more severe cases, however, they will have:

Atrial fibrillation or supraventricular tachycardias with the appearance of palpitations;
Occurrence of venous thrombi which, passing through the inter-atrial defect, will reach the left ventricle, from where they can dangerously head towards cephalic and/or caudal arterial districts.

It is essential to undergo auscultatory tests in order to be able to detect the presence of any murmurs.

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Other tests to be performed will include:

Chest X-ray and ECG; echocardiography.

If there is a significant shunt, the ECG may show right axial deviation, right ventricular hypertrophy or right ventricular conduction delay.

The chest X-ray will show cardiomegaly with dilatation of the right atrium and right ventricle, a prominent pulmonary main arterial segment and accentuation of the pulmonary vascular pattern.

Echocardiography will confirm the presence of an atrial septal defect, define the anatomical location and size of the defect, and assess the degree of right atrial and right ventricular volume overload.

An echocardiogram will make it possible to localise and quantify the inter-atrial defect and study its effects on the right atrium and ventricle and the pulmonary artery.

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The atrial sept defect, not being symptomatic, will not see any treatment

Medical treatment will be aimed at dealing with the respiratory infections from which those with inter-atrial defect are affected.

In adulthood, arrhythmias and decompensations may occur and will need to be treated with appropriate medical therapies.

To reduce the incidence of such events, and avoid cardioembolic episodes, percutaneous closure may be performed; however, only in the case of ostium secundum interatrial defects.

In patients with large ostium secundum interatrial defects or with margins inadequate for device placement, interatrial defect closure will be performed through a surgical approach.

Lesions of the atrioventricular conduction bundle may occur following surgery.

Supraventricular and atrial arrhythmias may occur; the most frequent will be atrial fibrillation, which tends to become chronic in later life.

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