Atrial Septal Defect and Patent Foramen Ovale

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
    • 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

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
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