Diagnosis of Atrial Septal Defect (ASD): Generally, a child's doctor hears the heart murmur caused by ASD during a routine checkup or physical examination. ASDs are not always diagnosed as early in life as other types of heart problems, such as ventricular septal defect (a hole in the wall between the two ventricles). The murmur caused by an ASD is not as loud and may be more difficult to hear than other types of heart murmurs, so it may be diagnosed any time between infancy and adolescence (or even as late as adulthood). If a doctor hears a murmur and suspects a heart defect, the child may be referred to a pediatric cardiologist, a doctor who specializes in diagnosing and treating childhood heart conditions. If an ASD is suspected, the cardiologist may order one or more of the following tests:

• chest X-ray, which produces an image of the heart and surrounding organs
• electrocardiogram (EKG), which records the electrical activity of the heart and can indicate volume overload of the right side of the heart
• echocardiogram (echo), which uses sound waves to produce a picture of the heart and to visualize blood flow through the heart chambers. This is often the primary tool used to diagnose ASD.

Treatment

Once an ASD is diagnosed, treatment will depend on the child's age and the
size, location, and severity of the defect. In kids with very small ASDs,
the defect may close on its own. Larger ASDs usually won't close, and must
be treated medically. Most of these can be closed in a cardiac
catheterization lab, although some ASDs will require open-heart
surgery.
A child with a small defect that causes no symptoms may simply need to visit
a pediatric cardiologist regularly to ensure that there are no problems; often,
small defects will close spontaneously without any treatment during the first
years of life. In general, a child with a small ASD won't require restrictions
on his or her physical activity.
In most children with ASD, though, doctors must close the defect if it has
not closed on its own by the time a child is old enough to start school.
Depending on the position of the defect, many children with ASD can have it
corrected with a cardiac catheterization. In this procedure, a thin, flexible
tube called a catheter is inserted into a blood vessel in the leg that leads to
the heart. A cardiologist guides the tube into the heart to make measurements
of blood flow, pressure, and oxygen levels in the heart chambers. A special
implant can be positioned into the hole in the septum. The device is designed
to flatten against the septum on both sides to close and permanently seal the
ASD. In the beginning, the natural pressure in the heart holds the device in place.
Over time, the normal tissue of the heart grows over the device and covers it
entirely. This non-surgical technique for closing an ASD eliminates the scar on
the chest needed for the surgical approach, and has a shorter recovery time,
usually just an overnight stay in the hospital.
Because there is a small risk of blood clots forming on the closure device
while new tissue heals over it, children who undergo device closure of an ASD
may need to be on medications for several months after the procedure to prevent
clots from forming.
If surgical repair for ASD is necessary, a child will undergo open-heart
surgery. In this procedure, a surgeon makes a cut in the chest and a heart-lung
machine is used to do the work of the circulation while the heart surgeon closes
the hole. The ASD may be closed directly with stitches or by sewing a patch of
surgical material over the defect. Eventually, the tissue of the heart heals
over the patch or stitches, and by 6 months after the surgery, the hole will be
completely covered with tissue.
For 6 months following catheterization or surgical closure of an ASD,
antibiotics are recommended before routine dental work or surgical procedures
to prevent infective endocarditis. Once the tissue of the heart has healed over
the closed ASD most people who have had their ASDs corrected no longer need to
worry about having a higher risk of infective endocarditis.
Your doctor will discuss other possible risks and complications with you
prior to the procedure. Typically, after repair and adequate time for healing,
children with ASD rarely experience further symptoms or disease.