Background
- ASDs are not an uncommon congenital heart defect but one that commonly presents in adulthood
- Types of ASD include
- Central (secundum) (80%)
- Most common- patent foramen ovale
- The foramen ovale is a hole in the heart that is normal in utero, but closes postnatally
- Most common- patent foramen ovale
- Low (primum) (15%)
- Occurs together with an abnormality of the mitral valve (usually as part of an atrioventricular septal defect)
- High (sinus venosus)
- Usually associated with abnormalities of the right upper pulmonary vein
- Central (secundum) (80%)
Presentation
- Most are small and rarely present in childhood with symptoms/signs specific to ASD
- May be more prone to chest infection (extra blood flow to the lungs due to L-R shunt)
- Occasionally, large ASDs can present in babies/children
- breathless, struggle to feed/gain weight, recurrent chest infections
- reduced exercise tolerance
- More likely to present in adulthood
- eventually, strain on the right heart can cause symptoms of heart failure
- Exertional shortness of breath and palpitations (atrial arrhythmias e.g. AF or flutter)
- There may or may not be any signs of murmur
- If present, most commonly ejection systolic murmur (2nd IC space, left sternal edge)
- In severe cases a ‘grumbling’ diastolic murmur may also be heard (blood flowing across the tricuspid valve
- NB S2 is often also widely split (S1 can be split also)
Diagnosis
- Confirm with echocardiogram
Management
- Endovascular repair may be considered in symptomatic patients/those with large defects
Notes on Medicine/Surgery 