The right and left atria are separated by interatrial septum. Normally there is no hole. Atrial septal defect is a congenital heart defect in which there is an opening in the atrial septum through the right atrium which communicates with the left. This defect occurs with a frequency of 3-20% of all congenital heart defects.
Atrial septal defects, which are in the bottom of the atrium and contiguous with the atrio-ventricular valves are considered to be primary. Openings in the upper or middle part of the atrial septum are called secondary.
The size of the defect can vary in different patients from one centimeter to the total absence of atrial septum. Approximately 15% of children this hole can be closed in the first year of life. In the future, virtually closing does not occur. Due to the compensatory capacity of the cardiovascular system abnormalities in this vice is slow. Only with large atrial septal defects symptoms of the disease in the first year of life. These patients, about one percent. In this part of the vice of blood from the left atrium into the right moves, which leads to an overload of the right heart. First is right ventricular hypertrophy, and later increases in pulmonary artery pressure. With long-term existence of the defect joined the changes in the lungs. In most patients the first signs of the disease may occur by age 16. Prior to that, they may only slightly behind in physical development.
Complaints of patients depend on the size of the defect and compensatory capacities of the cardiovascular system. This is usually shortness of breath, palpitations, fatigue on exertion. Unwillingness of the child to physical activity.
Diagnosis of ASD is based on the presence of the characteristic systolic murmur of moderate intensity. If an isolated defect, noise is never rude. At elektokardiogramme found the right heart overload. On radiographs are changes in the lungs. An echocardiogram detects the flow of blood from the left into the right atrium in the atrial septum. In advanced cases, the flow can change direction.
The indications for surgical treatment is determined by the size of the defect and clinical manifestations. In the first degree of pulmonary hypertension (increased blood pressure in the pulmonary artery) and the largest discharge of blood from the left into the right atrium at least 30% if there are no complaints and other forms of vice, the operation can not be done. Operations on the closure of ventricular septal defect performed in 1953. Their technique is well established. The defect is closed or sutured a patch of synthetic material or a biomaterial, it is preferable, since there are less likely to clot at the site of a patch.
Mortality in the surgical treatment of isolated atrial septal defect less than 0.5%. It increases slightly in the presence of concomitant heart disease in patients of older age groups. Within a month after the operation the child is in recovery treatment. Then he is allowed to attend school, but physical activity during the year is limited.