How dangerous is a hole in the heart of an ASD baby?

One of the most common heart holes is ASD, which any baby may be born with. ASD is one of the congenital heart diseases. Usually, this disease is also called a hole in the heart of the baby.

What is ASD or atrial septal defect? (ASD)

Generally, people know this disease as having a hole in the baby's heart. A hole may vary in size and may close on its own or require surgery. Atrial wall defect is one of the types of congenital heart defects that may be present at birth. As a baby's heart is formed in the fetus, several holes normally form in the wall between the heart's upper chambers (the atria). These holes are usually closed during pregnancy or shortly after birth. If one of these openings is not closed, a hole remains, and it is called an atrial septal defect. This hole increases the amount of blood that goes to the lung and over time may damage the blood vessels of the lung. Damage to the blood vessels in the lungs may cause problems such as high blood pressure in the lungs and heart failure in adulthood. Other problems may include abnormal heart rhythms and an increased risk of stroke.

How does ASD affect the heart?

Normally, the left side of the heart only pumps blood to the entire body, and the right side of the heart only pumps blood to the lungs. In a child with ASD, blood can pass from the left atrium to the upper right chamber (right atrium) through the opening between the upper chambers of the heart, to the pulmonary veins, and out of the heart. If the ASD is large, the extra blood being pumped into the pulmonary vessels causes the heart and lungs to work harder, and the pulmonary vessels can gradually become damaged. If the hole is small, it may not cause symptoms or problems. Many healthy adults still have a small hole left in the wall between the atria called a Patent Foramen Ovale (PFO).

How will having a hole in the baby's heart affect my child? Children with ASD often have no symptoms. If the hole is small, it won't cause symptoms because the heart and lungs don't have to work as hard. If the hole is large, the only abnormal finding may be a murmur (a sound heard with a stethoscope) and other abnormal heart sounds. In children with large ASDs, the main risk is the blood vessels in the lungs because more blood is pumped there than normal. Over time, usually years, this may cause permanent damage to the blood vessels in the lungs.

Symptoms of a hole in the baby's heart

Many babies born with atrial septal defect or ASD have no symptoms. Signs and symptoms can begin in adulthood. Signs and symptoms of atrial wall defects can include the following:

- shortness of breath, especially during exercise - fatigue - Swelling of legs or abdomen - Heartbeats or forgotten heartbeats - stroke - Heart murmur, a horrible sound heard through a stethoscope

Diagnosis of ASD

If a heart defect is suspected, the doctor may request one or more of the following tests, including: ### Echo of the child's heart This test is usually used to diagnose ASD or atrial septal defect. Sound waves are used to produce an image of the heart. This allows your doctor to see the chambers of your heart and measure their pumping power. This test also checks the heart valves and looks for signs of heart defects. Doctors can also use this test to evaluate your condition and determine your treatment plan. ### X-ray photo of the chest This will help the doctor see the condition of your heart and lungs. X-rays can detect conditions other than heart defects that may explain your signs or symptoms. ### ECG This test records the electrical activity of your heart and helps identify heart rhythm problems. ### Angiography (catheterization) of ASD or ASD A thin, flexible tube (catheter) is inserted into a blood vessel in the groin or arm and led to your heart. Through catheterization, doctors can diagnose congenital heart disease, test how well your heart is pumping, check heart valve function, and measure blood pressure in your lungs. However, this test is not usually necessary to diagnose an atrial septal defect. Doctors may also use catheterization techniques to repair heart defects. ### MRI MRI It uses a magnetic field and radio waves to create 3D images of your heart and other organs and tissues in your body. If echocardiography cannot definitively diagnose an atrial septal defect or related conditions, the doctor may order an MRI. ### CT scan It uses a series of x-rays to create detailed images of your heart. If echocardiography does not definitively detect an atrial septal defect, it can be used to detect a hole in the baby's heart and congenital heart defects.

Many atrial septal defects close on their own during childhood. For children who do not close, some small septal defects may not require treatment. But many septal defects eventually require surgery. ### Medical supervision and follow-up If you or your child has an atrial septal defect, your cardiologist may monitor it for a while to see if it closes on its own. Your doctor will decide when you or your child needs treatment, depending on your condition and whether you or your child has another congenital heart defect. ### Surgery Many doctors recommend correcting a moderate to large atrial septal defect diagnosed in childhood or adulthood to prevent further complications. However, if you have severe pulmonary hypertension, surgery is not recommended as it may worsen the condition. For adults and children, surgery involves closing the hole by sewing or patching the abnormal space between the atria. Doctors will evaluate your condition and determine which of the following two methods to use: Cardiac catheterization in ASD Doctors insert a thin and flexible tube (catheter) into a blood vessel in the groin and guide it to the heart using imaging techniques. Through the catheter, doctors insert a patch or mesh plug to close the hole. Cardiac tissue grows around the mesh and seals the hole permanently. These types of methods are only used to repair atrial septal defects in the secondary type. Some large secondary atrial septal defects may require open heart surgery. **Open heart surgery in ASD** This type of surgery is performed under general anesthesia and requires the use of a heart and lung machine. Through an incision in the chest, surgeons use patches to close the hole. This method is the only way to correct the primary atrial defect, venous sinus and coronary sinus. This procedure can be performed using small incisions (minimally invasive surgery) and using a robot for some types of atrial wall defects. ### Medicines Medications do not repair the hole, but they may be used to reduce some of the signs and symptoms associated with atrial septal defects. Medications may also be used to reduce the risk of complications after surgery. Medicines may include medicines to keep the heart beating regularly (beta blockers) or to reduce the risk of blood clots (anticoagulants).

In most cases, it is not possible to prevent a hole in the fetal heart. If you are planning to become pregnant, make a plan with your gynecologist. This planning should include the following: 1- **Measles immunity test.** If you are not immune, ask your doctor about vaccination. 2- **Taking care of your current health conditions and medications.** You should control some health problems such as diabetes or Fischler's blood during pregnancy. Also, the doctor may adjust or stop some medications before pregnancy. 3- **Check your family medical history.** If you have a family history of heart defects or other genetic disorders, consider talking to a genetic counselor to determine the possible risk. There are other types of baby heart perforation, which are explained in the following articles How dangerous is a perforated heart VSD in children? Treatment of children's VSD heart perforation **Dr. Saeed Bitarafan, pediatric and fetal cardiology specialist** To read more about ASD, you can use the link below.

https://www.mayoclinic.org/diseases-conditions/atrial-septal-defect/symptoms-causes/syc-20369715 https://en.wikipedia.org/wiki/Atrial\_septal\_defect