It is a defect defined as the connection of the two atria with each other, which allows abnormal blood flow (shunt) between the left and right upper chambers (atria - atria) in any region of the wall (atrial septum) between the two upper chambers of the heart. ASD is seen in 10-15% of congenital heart diseases and is the most common congenital heart disease in adults [1,2]. It is approximately twice as common in women as in men.
The baby's heart in the womb
Mother Since a baby in the womb does not breathe, the lungs do not work during this period. This means there is no need to pump blood into the lungs. At this stage, the blood must use a different route to circulate oxygen-rich blood from the mother to the baby's body without going to the lungs. The umbilical cord supplies oxygen-rich blood to the baby's right atrium. Most of this blood moves towards the left atrium through the foramen ovale. From here it goes to the left ventricle, which pumps blood to the body. Blood also passes to the right ventricle towards the right atrium, which pumps blood to the body through another bypass system (Ductus arteriosus, between the pulmonary artery and the aorta).
Heart of the newborn baby
When a baby's lungs begin to function, the circulation of blood through the heart changes and oxygen-rich blood comes from the lungs to the left atrium. At this point, blood circulation follows the normal circulation path.
Patent foramen ovale occurs when the foramen ovale in the heart does not close after birth. Foramen ovale is a hole in the wall between the right and left upper chambers of the heart (atrium) in the unborn baby during fetal development. This hole allows blood to bypass the fetal lungs, which cannot function until they are exposed to air. When a newborn baby enters the world and takes his or her first breath, the foramen ovale closes and within a few months it will be approximately 75 percent completely closed. When the foramen ovale does not close, it is called patent foramen ovale (PFO). PFO occurs in about 25 percent of the normal population, but in most cases people with PFO never know they have it. This condition often shows up during tests for other problems, but most Treatment of PFO is not required in this person because it is a latent condition that usually does not cause signs or symptoms.
Normal Heart Physiology in Adult
The heart is divided into two on the right and one on the left. It is divided into four chambers, two of which are The right side of the heart carries blood to the lungs via the pulmonary artery and its branches. Blood is oxygenated in the lungs, then the oxygen-rich blood returns to the left side of the heart through the pulmonary veins, then the left side of the heart pumps the blood to other organs and tissues of the body outside the lungs through the aorta and its branches.
There is a blood vessel in the heart. If there is an atrial septal defect…
An atrial septal defect (ASD) allows oxygenated blood to flow from the upper left chamber of the heart (left atrium) to the upper right chamber of the heart (right atrium). In the right atrium, it mixes with oxygen-poor, venous blood and is pumped to the lungs.
If the atrial septal defect is large, this extra blood volume can increase the pressure of the lung vessels and overwork the right side of the heart. If left untreated, the right side of the heart eventually becomes enlarged and weakened. If this process continues, it may cause severe pulmonary hypertension.
ASD CLASSIFICATION
ASD; They are examined under two groups: ostium secundum defects and atrio-ventricular canal defects (endocardial cushion defects).
- Ostium secundum type defects
1- Fossa ovalis type defects (62%)
2- Patent foramen ovale (6%)
3- Superior caval type (6%)
4- Inferior caval type (24%)
5- Unroofed coronary sinus (rare)
6- Confluent type
- Endocardial cushion defects
1- Ostium primum type
2- Common atrio-ventricular canal defects
LESIONS WITH ASD
ASD may also be present with other cardiac lesions:
Unlike ventricular septal defects, atrial septal defects do not close spontaneously.
If closure occurs, it usually occurs in the first year after birth and with relatively small defects (less than 6 mm).
Complications
Minor. An atrial septal defect never causes problems. Small atrial septal defects usually close in infancy. Larger defects can cause serious problems:
- Right heart failure
- Heart rhythm abnormalities (arrhythmias)
- Increased risk of stroke
Atrial septal defect and pregnancy
Most women with atrial septal defect can tolerate pregnancy without any problems. However, having a larger defect or having complications such as heart failure, arrhythmias, or pulmonary hypertension increases your risk of complications during pregnancy.
Treatment options for atrial septal defect
A small atrial septal defect that does not cause enlargement of the right heart chambers does not require treatment. If symptoms are present or there is dilatation of the right heart chambers, closure of the atrial septal defect is recommended. Treatment options for patients with a large atrial septal defect include:
Cardiac catheterization: For this procedure, an umbrella-shaped device that serves as a patch is placed through a catheter to a large diameter catheter in the groin area. It is entered through the leg vein and delivered to the heart, and then the umbrella is opened to close the hole.
Surgical:Defects that are not suitable for atrial septal defect catheterization, if the defect is very large or the necessary rim for the edges of the umbrella to attach to the defect. If there is no heart defect or the patient has other heart defects, surgery may be required to close the defect. For this, the standard median sternotomy approach can be applied routinely. Nowadays, minimally invasive surgical techniques are preferred, it can be performed with right submammary incision or armpit (infra-axillary) incision (right mini-thoracotomy) or video-assist-robotic technique.
If minimal Pulmonary stenosis or patent duct artery if an invasive approach is to be used Other lesions that may coexist with ASD, such as lesions, should be excluded.
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