What you need to know about a hole in the heart (Atrial Septal Defect - ASD)

You must have been very scared when the doctor told you that your little one has a small sound in his heart, a 'heart murmur'. Or, are you in your 40s and still feeling short of breath and tired all the time, even with a little exercise? Perhaps the cause of both of these things is a small hole in the heart. In medical terms, we call this 'Atrial Septal Defect' or ASD. Don't be scared when you hear this name. This is a very common congenital heart condition. Let's talk about it all very simply and in a friendly way today.

Simply put, what is this hole in the heart (ASD)?

Okay, to understand this, let's think of our heart as a house with four rooms. This house has two rooms upstairs and two rooms downstairs. In medicine, we call these two rooms upstairs the atria . That is, the right atrium and the left atrium. There is a wall between these two upper chambers. We call this wall the atrial septum .

What normally happens is that the body's oxygen-poor, impure blood enters the right atrium, goes to the lungs, is purified (oxygenated), and returns to the left atrium. This oxygen-rich, clean blood is then pumped throughout the body.

Now imagine, what would happen if there was a small hole in the wall (septum) that separates the two upper chambers? Then, some of the oxygen-rich, good blood from the left chamber would flow through this hole into the right chamber. Then, this good blood would mix with the dirty blood from the right. As a result, an unnecessary amount of blood would accumulate on the right side, and the right side of the heart would have to work harder to pump that extra blood back to the lungs. That's what ASD is.

Are there main types of ASD?

Yes, there are four main types of atrial fibrillation, depending on where in the heart wall the hole is located. This is important to know, as treatment options sometimes depend on the type.

What are the symptoms of this condition?

Surprisingly, although ASD is a congenital condition, many people do not develop any symptoms until years later, perhaps into middle age. If the hole is very small (less than 5 millimeters), it may not have any significant effects on the heart or lungs, so there may be no symptoms.

Symptoms in young children

Often, the first sign that a young child has ASD is an abnormal heart sound (heart murmur) that the doctor hears during a stethoscope examination. That is the most common sign.

In addition, some children may also show symptoms like:

• Age-appropriate weight loss and growth retardation.
• Frequent respiratory infections (like colds, pneumonia).
• Getting tired quickly while playing.
• Difficulty breathing.
• Heart rhythm irregularities (arrhythmias) - but this is somewhat rare in children.

Symptoms in adults

If you have a large hole that was not detected during childhood, symptoms may begin to appear around the age of 40. This is because the right side of the heart and lungs have been working harder for years and are tired.

Adults may experience symptoms such as:

• Excessive fatigue for no reason.
• Difficulty breathing, such as when walking a short distance or climbing stairs.
• Feeling an abnormal heart rate (palpitations).
• Fast heartbeat (tachycardia).
• Swelling (edema) of the legs, ankles, and hands.
• Sometimes the lips and skin turn blue (cyanosis).

Why does this situation occur?

The exact cause of this is not yet known. However, most of these birth defects are caused by genetic changes that occur during the development of the baby in the womb. Changes in genes such as NKX2.5/CSX, GATA4, and TBX5 have been found to be associated with ASD.

Also, sometimes babies with ASD can have other heart defects or other genetic conditions, such as Down syndrome.

Factors that increase risk during pregnancy

If a pregnant mother has certain conditions, the baby may have a slightly increased risk of developing a congenital heart disease.

• The mother had diabetes before pregnancy.
• Developing viral infections such as the flu during pregnancy.
• Alcohol and tobacco use.
• Use of certain medications without the advice of a doctor.
• Use of drugs such as cocaine.

What complications can occur if left untreated?

A small hole won't cause much damage. However, if a large hole is left untreated for a long time, it can cause serious health problems. This is because the right side of the heart and the lungs are constantly working harder, which damages them.

• Right heart enlargement: If this continues, it can lead to heart failure.
• Heart rhythm disorders (Arrhythmia): About half of people with ASD over the age of 40 develop heart rhythm disorders (such as atrial fibrillation).
• Stroke: Sometimes, small blood clots that form in the heart can travel through this hole and into the brain, causing a stroke.
• Pulmonary Hypertension: High blood pressure in the blood vessels that carry blood to the lungs. This is a dangerous condition.
• Eisenmenger Syndrome: A serious complication that occurs when an ASD is accompanied by severe pulmonary hypertension.

How do doctors find this?

They will ask about your symptoms, perform a physical examination, and then perform several tests to check the function and structure of your heart.

In some cases, cardiac CT or MRI scans may also be necessary.

What are the treatments for this?

Although medications can be given to control some of the symptoms of an ASD, they can never close the hole. There are two ways to close the hole: surgery or non-surgical (percutaneous repair) closure of the hole.

• Small ASDs: Very small ASDs, especially in children, can sometimes close on their own. If they don't, and they're not causing any harm, your doctor may recommend "watchful waiting," which means doing nothing but checking frequently.

• Large ASDs: If the hole is large, it is best to close it, even if there are no symptoms. This can prevent serious complications that may occur in the future. Usually, if the right side of the heart is enlarged, or if a large amount of blood is leaking through the hole, treatment is definitely recommended.

Treatment methods

1. Percutaneous Device Closure: This is the most commonly used method now. A small tube (catheter) is inserted through a large vein in the leg, guided to the heart, and a small device (device) like an umbrella is inserted to close the hole. This does not require a large incision. The hospital stay is only one or two days. This method is not available for all types of ASD.

2. Open-Heart Surgery: This surgery is performed for holes that cannot be closed by the above methods or for holes that are associated with other heart defects. Here, the chest is opened and the hole in the heart is closed with stitches or a patch. This is now a very safe and successful surgery.

After treatment, your doctor will tell you to take blood thinners and antibiotics to prevent heart infections for about 6 months.

What is life like with ASD?

It's normal to feel scared when you or your child finds out that they have ASD. But the good news is that with today's advanced medical science, this condition can be successfully treated and people can live completely healthy, normal lives .

A child who has had a hole closed will be able to play, run, and play sports like other children after healing. Even as an adult, they can continue their normal activities after treatment.

The most important thing is to follow your doctor's instructions exactly and go to the clinics for checkups on time. In particular, being under the supervision of a congenital heart disease specialist like this is very important for your health.

Hole in the heart, Atrial Septal Defect, ASD, heart disease, birth defects, heart murmur, breathing difficulties, surgery