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Journal of Medical Research and Clinical Reviews
Research Article
Atrial Septal Defect is a Congenital Heart Defect
ABSTRACT
Congenital heart defects are caused by a complex interaction of genetic and environmental factors. It is very rare for a congen-
ital heart defect to be identified. Atrial septal defect, often referred to by laypeople as a ‘hole in the heart’, is one of the most
common heart anomalies. It is a congenital heart defect that involves one or more openings between the left and right atria that
do not exist in a properly developed heart.
Key Words: ASD, Diagnosis, EC, Shunt, Health.
Introduction
ASDs (Atrial Septal Defect) represent the third most common
congenital defect (after PFO (Patent Foramen Ovale) and bicuspid
aortic valve) [1]. The most common sort of atrial septal defor-
mity in adults is a septum secundum deformity and this speaks
to 60–80% of atrial septal defects. These are regularly caused by
fragmented arrangement of the fossa ovalis and encompassed by
in-folded atrial divider that shapes the edges of the absconds. Sep-
tum primum defects are likely superior alluded to as atrio-ventric-
ular septal surrenders as they are commonly related with variations
from the norm of the atrio-ventricular valves, atrio-ventricular
conduction and cleared out ventricular outpouring tract. These are
most seen in patients with Downs’ syndrome. Sinus venosus ASDs
are due to either vena cava (most commonly the prevalent vena
cava) over-riding the inter-atrial septum and are related with odd
pneumonic venous return. Finally, coronary sinus ASDs are due
to insufficiency of the coronary sinus—atrial divider with seepage
straightforwardly into the cleared out chamber and are related with
diligent cleared out SVCs (superior vena cava).
ASDs vary in size [2]. If the ASD is expansive sufficient, the re-
lated left-to-right shunt will lead to rightsided volume over-bur-
den and aspiratory overcirculation. Constant right-sided volume
over-burden leads to pneumonic hypertension, right ventricular
brokenness, tricuspid regurgitation, and right atrial expansion. Pa-
tients with ASDs moreover frequently create atrial arrhythmias.
Hemodynamically critical ASDs are more often than not 10 mm
or bigger, have a shunt proportion more noteworthy than 1.5, and
Received Date: 06 March, 2025;
Accepted Date: 12 March, 2025;
Published Date: 14 March, 2025.
Siniša Franjić
Independent Researcher
*Correspondence: Siniša Franjić, Independent Researcher, Croatia.
Citation: Siniša Franjić. Atrial Septal Defect is a Congenital Heart Defect. J Med Res Clin Rev. 2025; 1(1): 1-4.
are related with right ventricular extension on imaging. It is pre-
scribed that as it were hemodynamically critical ASDs be closed.
Most secundum ASDs can be closed percutaneously. Primum and
sinus venosus ASDs cannot be closed percutaneously and require
surgical closure.
Presentation
The clinical introduction depends on the size of the defect and
degree of shunting [3]. The degree of shunting changes based on
the estimate of the deformity, right ventricle (RV), and aspiratory
vasculature compliance. Most of the time it presents as an capable
of being heard murmur in an asymptomatic child or the quiet has
been alluded to a pediatrician for other different reasons. Patients
with huge defects >10 mm with a shunt Qp: Qs >1.5 tended to
show with palpitations and exertional shortness of breath due to
broadening in the right-sided cardiac chambers (right chamber and
right ventricle).
In conclusion, we ought to see for the measure of the imperfection,
degree of shunting, estimate and work of the right ventricle, pul-
monary artery (Pa) weight, related injuries, and appropriateness of
percutaneous closure of the defect.
Defects
For secundum atrial septal surrenders in specific, pre-procedure
imaging plays an imperative part in deciding whether a imper-
fection is fitting for trans-catheter closure [1]. Our hone is to get
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3D TEE (Transesophageal echocardiography) estimations of the
deformity as this has been appeared to connect closely with 2D
swell measuring. Moreover, indeed huge surrenders (up to 44
mm) have been closed with transcatheter procedures, especial-
ly if the deformity is oval with a shorter minor pivot and sat-
isfactory edges. During pre-procedure evaluation of secundum
ASDs, imperative issues to pay consideration to are guaranteeing
all four pneumonic veins are visualized as there is an affiliation
of fractional atypical aspiratory venous return with secundum
ASDs. A sinus venosus deformity can be seen in the midesoph-
ageal bicaval (120°) view. In a perfect world, edges ought to be
visualized. The degree of mitral spewing forth ought to be sur-
veyed as post-ASD closure, this volumes and can decline note-
worthy mitral valve disease.
Cross sectional imaging (gated cardiac CT (computed tomog-
raphy) and MRI (Magnetic Resonance Imaging)) can be sup-
portive in understanding the three-dimensional life structures of
atrial septal surrenders as well as examining congenital incon-
sistencies related with them. This can be especially valuable in
the identification of complex ASDs that may require different
gadgets or lead to critical interaction with encompassing cardiac
structures, such that surgical closure might be more successful
and more secure. Whereas CT has prevalent spatial determination
and can be utilized to arrange for closure with virtual situation of
gadgets as well as 3D printing of complex absconds to help with
case arranging, MRI can be utilized for these purposes as well as
hemodynamic assessment of ASDs through calculation of cardi-
ac yield, shunt divisions, and Qp/QS by means of stage differ-
entiate imaging. Anatomically exact 3D recreations of ASD life
structures through pre-procedure cross-sectional imaging have
also permitted for expanding utilize of intraprocedural intra-car-
diac echocardiography or maybe than TEE for direction of clo-
sure. Generally, particularly for the purposes of beginning PFO
and ASD assessment, echocardiography in its different shapes
remains the backbone of demonstrative assessment as well as
procedural direction during percutaneous closure procedures.
True atrial septal defects can have a noteworthy degree of cleared
out to right shunting and are related with right sided volume
over-burden; subsequently, right sided chamber expansion, aspi-
ratory hypertension and atrial arrhythmias can be seen. The sign
for ASD closure incorporate the nearness of RVE, recommending
noteworthy cleared out to right shunting, indeed in the asymp-
tomatic child. A few patients with long-standing untreated ASDs
will create aspiratory vascular infection, that when extreme can
turn around shunting driving to cyanosis. Decision-making with
respect to closure is more complex and if pneumonic vascular
resistance is more prominent than 8 Woods’ units or two-thirds
systemic vascular resistance or mean Pa pressure more note-
worthy than two-thirds of systemic blood weight, closure is not
sought after in favor of treating basic pneumonic hypertension
to begin with. Iatrogenic ASD’s taking after distinctive methods
including transeptal catheterization may suddenly near but if it
causes significant shunting, counting systemic hypoxemia, clo-
sure is indicated.
Diagnosis
On chest radiograph, the heart may be extended since of right atrial
and right ventricular dilatation, with unmistakable quality of the
aspiratory supply route and expanded pneumonic vascular mark-
ings [4]. The electrocardiogram (ECG) may appear right ventric-
ular hypertrophy and right atrial broadening and deficient or total
right bundle department piece are common. In patients with the
ostium primum sort of ASD, cleared out pivot deviation is com-
mon and is thought to be a result of relocation and hypoplasia of
the cleared out bundle branch’s front fascicle. Echocardiography
uncovers right atrial and right ventricular broadening when show;
the ASD may be visualized straightforwardly, or its nearness may
be inferred by the exhibit of a transatrial shunt by Doppler stream
appraisal. The size and heading of shunt stream and an estimation
of right ventricular systolic weight can too be decided by resound
Doppler measurements.
Given the tall affectability of echocardiography, it is once in a
while fundamental to perform cardiac catheterization to affirm
the nearness of an ASD. Be that as it may, catheterization may be
valuable to survey aspiratory vascular resistance and to analyze
concurrent coronary course illness in more seasoned adults. In a
typical individual experiencing cardiac catheterization, the oxygen
immersion measured in the right chamber is comparative to that
in the prevalent vena cava. In any case, an ASD with left-to-right
shunting of well-oxygenated blood causes the immersion in the
right chamber to be much more prominent than that of the preva-
lent vena cava.
Interventions
The timing of intercession is based on the side effects, degree of
shunt, right ventricle dilatation, and pneumonic course weight [3].
Elevated aspiratory supply route weight with aspiratory vascular
resistance (PVR) >5 Wood units in patients is considered contrain-
dication for imperfection closure, and trial aspiratory hypertension
treatment is recommended.
Percutaneous closure is the to begin with alternative in secundum
ASD but based on the profit capacity of reasonable edges in echo-
cardiogram and estimate of the imperfection (max distance across
ought to not be more than 40 mm). As of late, a percutaneous ap-
proach adjusted for sinus venosus with atypical aspiratory venous
seepage with appropriate life systems permits stenting SVC and
diverting pneumonic venous stream to the cleared out chamber.
Concomitant arrhythmia is commonly tended to some time recent-
ly, amid, or after the strategy based on the arrhythmia burden, de-
gree of heart enlargement, and reaction to restorative therapy.
Oxygen Saturation
From different chambers of the heart, a little sum of blood can be
pulled back and its oxygen saturation measured [5]. Blood ought
to be 100% soaked with oxygen on the cleared out side of the
heart; when it returns to the heart by means of the vena cavae and
into the right chamber and right ventricle, its saturation is as a
rule almost 70%. A shunt of blood from the cleared out side of the
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heart to the right side, or bad habit versa, can happen since of a
communication between the two parts of the heart, eg atrial septal
deformity or ventricular septal imperfection. This will cause oxy-
genated blood to be blended with desaturated blood.
If, for case, there is a ventricular septal deformity, blood will pass
from the cleared out ventricle specifically to the right ventricle.
There will be a step up, hence, in oxygen saturation from the right
chamber to the right ventricle in extent to the sum of blood stream-
ing from the cleared out ventricle. Hence, the degree of shunt can
be found out which will demonstrate the measure of the imper-
fection and, more vitally, how much it is likely to influence the
persistent in afterward life. A huge shunt will require closure or the
persistent will create extreme aspiratory hypertension in afterward
years.
Catheterization
An ASD is one of the commonest inherent cardiac surrenders
seen in adults [6]. Patients frequently display with indications
of breathlessness or palpitation related to right heart failure and
pneumonic hypertension. The determination will more often than
not have been backed utilizing transthoracic and transoesophageal
echocardiography.
During cardiac catheterization, a right heart think about will be
performed to assess intracardiac weights, to look at for aspiratory
hypertension, to measure the intracardiac shunt, and to prohibit bi-
zarre pneumonic venous seepage. A ordinary examination would
involve:
•
Right heart catheterization and recording of the Pa pressure.
•
Right heart pullback.
•
An endeavor to cross the ASD and record cleared out atrial
saturation.
• Quantification of the shunt.
Secundum ASDs are presently commonly closed utilizing a per-
cutaneous approach and closure is regularly arranged at the same
time as the cardiac catheterization think about. If required, the
method can be imaged and guided utilizing transoesophageal or
intracardiac echocardiography.
PTFE
The application of prosthetic polytetrafluoroethylene (PTFE)
unites in cardiovascular surgery, especially in pediatric cardiac
surgery, is a broadly acknowledged surgical procedure for repair
or remaking of cardiovascular structures [7]. Recognizing the
condition of the postoperative prosthetic unite is imperative since
most patients with repaired congenital heart infection require deep
rooted cardiac care. Clinical thinks about report that PTFE unites
sometimes appear calcification and tiny intimal fibrin statement.
PTFE is a plastic polymer that during the past decade has ended
up well known in the fabricate of engineered vascular unites and
blood vessel prostheses. This fabric has an electronegative sur-
face charge, which in this regard imitates ordinary endothelium
and thus ought to result in diminished thrombogenicity. This low
inclination to thrombose, together with its appropriate mechani-
cal properties and weakness resistance, makes this fabric a great
candidate for the development of vascular join frameworks; be
that as it may, calcification of PTFE has risen as an critical issue
that influences its work and long-term solidness. Calcification is
characterized as the statement of calcium compounds, and comes
about in a misfortune of adaptability in biomaterials, in this man-
ner causing their mechanical failure and degradation.
VSD (ventricular septal defect) closure fix was utilized for TOF
(Tetralogy of Fallot), DORV (Double outlet right ventricle), and
PA/VSD (pulmonary atresia/ ventricular septal defect) (n = 29;
age, 7.9 ± 5.7 years; postoperative interim, 6.4 ± 5.0 years). RVOT
(right ventricular surge tract) reproduction was performed in pa-
tients with TOF, DORV, PA/VSD, and aortic valvular stenosis con-
ducted Ross operation. (n = 32; age, 8.1 ± 5.4 years; postoperative
interim, 6.1 ± 4.9 years). Atrial septal fix was utilized in atriopul-
monary association or intracardiac horizontal tunnel-type Fontan
alteration (n = 8; age, 8.1 ± 6.4 years; postoperative interim, 6.3 ±
6.3 years) to isolated the systemic from the aspiratory venous cir-
culation. Extracardiac conduit was utilized in 7 patients who had
experienced TCPC (add up to cavopulmonary association) (age,
4.1 ± 2.7 years; postoperative interim, 1.6 ± 0.4 years). A add up
to of 76 embedded PTFE unites were assessed. A 0.4 mm thick
PTFE fix was utilized for the VSD closure. RVOT remaking was
performed utilizing a 0.4 mm PTFE fix in an stretched tear setup or
by building a conduit with 0.4 or 0.6 mm PTFE together with au-
tologous pericardial tissue. The 0.4 mm PTFE fix was utilized for
the atrial septal fix for the atriopulmonary association or sidelong
tunnel-type Fontan method. For TCPC, the extracardiac conduit
was made of 0.8 mm PTFE unite. Four patients (2 patients with
RVOT reproduction and 2 patients with horizontal tunnel-type
Fontan procedure) experienced reoperation since of sequelae after
MDCT (Multidetector-row computed tomography) examination.
Explanted PTFE joins were assessed histologically.
ASD in Children
Atrial septal defect is usually located in the zone of the fossa ovalis
and named ostium secundum-type defect [8].
Less as often as possible, atrial septal deformity is of the sinus
venosus sort when it is found instantly underneath the entrance of
the predominant vena cava into the right chamber. This sort may
be related with halfway bizarre pneumonic venous association of
the right upper aspiratory veins to the right chamber or predomi-
nant vena cava.
Atrial septal deformity is recognized from obvious foramen ovale,
a little opening or potential opening between the atria in the range
of the fossa ovalis. In numerous newborn children and one-fourth
of more seasoned patients, the foramen ovale is not anatomically
fixed and remains a potential communication. In conditions that
raise cleared out atrial weight or increment cleared out atrial vol-
ume, the foramen ovale may extend open to the point of inade-
quacy, coming about in a communication that grants a left-to-right
shunt since of the higher cleared out atrial weight. A right-to-left
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credited.
shunt may happen through a obvious foramen ovale if the right
atrial weight is elevated.
Atrial septal defect is usually large and permits equalization of the
atrial weights. During diastole, weight is rise to in the atria and the
ventricles so that the course and the greatness of the shunt depend
as it were on the relative compliances of the ventricles.
Ventricular compliance is decided by the thickness and firmness of
the ventricular divider. Regularly, the right ventricle is more com-
pliant (i.e. more distensible than the cleared out ventricle), since it
is much more slender than the cleared out ventricle. At any filling
weight, the right ventricle acknowledges a more noteworthy vol-
ume of blood than the cleared out ventricle.
In most patients with atrial septal defect, the relative ventricu-
lar compliances permit a left-to-right shunt so that the aspiratory
blood stream is regularly three times the systemic blood stream.
Variables modifying ventricular compliance influence the great-
ness and course of the shunt. For illustration, myocardial fibrosis
of the cleared out ventricle, creating from coronary arterial dis-
ease, increases the left-to-right shunt. In differentiate, right ven-
tricular hypertrophy, as from related pneumonic stenosis, dimin-
ishes the volume of left-to-right shunt and, if noteworthy, leads to
a right-to-left shunt.
In atrial septal deformity, the right-sided cardiac chambers and the
pneumonic trunk are broadened. The clinical highlights of atrial
septal imperfection reflect the extension of these chambers and the
increased blood stream through the right-sided cardiac chambers
and lungs. In patients with atrial septal imperfection, the pneu-
monic arterial weight is more often than not ordinary during child-
hood.
Treatment
Most patients with ASDs stay asymptomatic [4]. In any case, if
the volume of shunted blood is hemodynamically noteworthy (in-
deed in the nonappearance of indications), elective surgical repair
is prescribed to anticipate the advancement of heart disappoint-
ment or constant aspiratory vascular illness. The imperfection is
repaired by coordinate suture closure or with a pericardial or man-
ufactured fix. In children and young adults, morphologic changes
in the right heart frequently return to typical after repair. Percuta-
neous ASD repair, utilizing a closure gadget sent through an in-
travenous catheter, is a less intrusive elective to surgery in chosen
patients with secundum ASDs.
Conclusion
Atrial septal defect is one of the most common congenital heart
defects in adults. The sinus venosus defect is located high on the
atrial septum near the superior vena cava ostium. Children with an
atrial septal defect usually have no symptoms, although they may
show mild physical underdevelopment and a tendency to respira-
tory infections. Most often, the finding of a systolic heart murmur
during a routine examination draws attention and prompts further
cardiac examination to establish the diagnosis. Pulmonary arterial
hypertension develops in patients with an atrial septal defect in
their forties. Shunt reversal may occur.
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