DMPP of the heart in newborns. Atrial septal defect: symptoms and treatment

The fetus in the womb develops under the influence of many factors, both external and internal. Sometimes wrong intrauterine development affects the health of the unborn baby. Some babies are born with congenital malformations internal organs, one of which is a defect atrial septum(DMPP).

With a slight development of ASD, there is a possibility that the interatrial septum will close itself within a year. However, the child often has other diseases along with ASD. of cardio-vascular system... The number of such patients is approximately 7-12%. In the case of a large opening in the septum between the atria, surgical intervention is necessary.

What is an atrial septal defect and what are the forms of the disease?

ASD is a congenital heart disease in which the right and left atrium communicate with each other. There are three types of atrial septal defect:

ASD is not always diagnosed at the time of birth. Often, the disease is asymptomatic, only on ultrasound of the heart in many adults a similar pathology is found. Congenital heart defects are common. For 1 million newborns, 600 thousand have heart problems, and the diagnosis of ASD is more typical for the female sex.

Causes of ASD of the heart

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Experts believe that the main role in the formation of an atrial septal defect play various violations intrauterine development of the fetus. ASD appears due to underdevelopment of the interatrial septum and defects of the endocardial ridges. Most often, fetal heart defects are formed during pregnancy under the influence of teratogenic factors:

rubella, chickenpox, herpes, syphilis, flu, etc. in the first trimester of pregnancy;
diabetes mellitus and other diseases of the endocrine system;
reception drugs that are toxic to the fetus;
X-ray and ionizing radiation;
severe toxicosis on early dates pregnancy;
harmful working conditions;
drinking alcohol, taking drugs, smoking;
living in environmentally polluted places.

There is an opinion that such a pathology can be inherited by a child from his parents. V medical practice there are many cases when close relatives in the families of sick children had a congenital heart disease.

Multiple heart defects occur due to chromosomal mutations in the process of conception. Often CHD is combined with atrioventricular block, Holt-Oram, Goldenhar, Williams syndromes and other hereditary diseases.

Symptoms in children

In each case, the symptoms of the course of the disease, sometimes with hemodynamic disturbances, are very different. The severity of symptoms directly depends on the size and location of the defect, the duration of the disease and the presence of secondary complications.

Transient cyanosis may occur in newborns. Cyanosis of the skin and mucous membranes appears during crying and anxiety. As a rule, experts associate this condition of the child with perinatal encephalopathy.

If a patient has an atrial septal defect expressed in the almost complete absence or rudimentary development of the septum, the first symptoms of the disease begin to appear already at the age of 3-4 months. Typical symptoms:

pale skin;
tachycardia;
weak weight gain, moderate growth retardation and physical development.

CHD in children is also one of the main factors in the development of respiratory diseases. Babies often suffer from bronchitis and pneumonia.

Due to hypervolemia of the pulmonary circulation, the disease proceeds with a long wet cough, shortness of breath and characteristic wheezing. Children under 10 years old suffer from dizziness, they quickly get tired during physical exertion and often faint.

If the defect of the interatrial septum does not exceed 10-15 mm, then, as a rule, the disease proceeds without any clinical signs heart disease. With age, the problem is aggravated, by the age of 20, patients develop pulmonary hypertension, heart failure occurs. In adult patients, cyanosis, arrhythmia, and sometimes coughing up blood are observed.

Diagnostic methods

A pediatrician can suspect the presence of CHD in newborns by listening to the heart with a stethoscope. If there are extraneous noises, the baby is sent for additional examination. To the main instrumental methods diagnostics of ASD in children include:

How to treat?

If the defect is insignificant, specialists simply monitor the child's condition during his first years of life. The well-known pediatrician Komarovsky adheres to this opinion. He recommends that parents not panic ahead of time, since in the overwhelming majority of cases, the lumen in the septum closes completely with age.

Surgery may be required only in cases where the disease progresses and negatively affects the health of the child. In other cases, applies drug treatment, which helps to reduce the risk of complications and relieve symptoms of the disease.

Conservative care (medicines)

If during the first years of life the window in the partition did not close on its own, then an operation is performed to eliminate the defect. The problem cannot be solved with the help of drugs. No medication can affect the closure of the hole.

In some cases, doctors still use conservative treatment ASD in babies. Special drugs improve the functioning of the cardiovascular system and provide a normal blood supply to all vital important organs... The following medications are used to treat children with ASD:

cardiac glycosides (Strofantin, Digoxin, etc.);
diuretics (Spironolactone, Indapamide, etc.);
ACE inhibitors;
vitamin and mineral complexes enriched with vitamins of groups A, C, E, selenium and zinc;
anticoagulants (Warfarin, Fenilin, Heparin);
cardioprotectors (Mildronat, Riboxin, Panangin and many others).

Surgical intervention

Before the operation begins, the child is given general anesthesia and the body temperature is lowered. Under conditions of hypothermia, the body requires less oxygen. Then the patient is connected to a heart-lung machine and the chest is opened.

The surgeon makes an incision in the heart, and then removes the existing defect. If the hole diameter is not more than 3 cm, the window is sutured. In case of large defects, tissue implantation is performed (synthetic material or pericardial area). On the last stage operations are stitched and bandaged. The patient is transferred to intensive care unit for a day. Treatment in a general ward usually takes no more than 10 days.

Today, there is a minimally invasive technique for eliminating the atrial septal defect. For cardiac catheterization, the doctor inserts a probe into a vein in the thigh area. Then, using the inserted catheter at the site of the septal lesion, the specialist installs a special mesh patch in order to close the hole.

Can the child have complications?

Any operation can lead to certain complications. Sometimes patients' body temperature rises above 38 degrees, discharge from the wound appears, the heartbeat rhythm changes, shortness of breath occurs with tachycardia and heart failure. The baby's lips and skin may turn blue. In this case, you must immediately apply for medical care... Such conditions are observed quite rarely, usually children recover quickly after surgery.

If you refuse treatment, the risk of blood clots, heart attacks and strokes, often fatal, will significantly increase. Timely diagnostics and properly selected treatment can eliminate defects in the development of the heart and prolong life.

Preventive measures

Modern medicine cannot affect the intrauterine development of the fetus, but much depends on future mother... Prevention of CHD primarily consists in careful preparation of a woman for pregnancy and adherence to healthy way life:

rejection of bad habits;
selection optimal conditions labor;
if necessary - change of place of residence.

Proper nutrition during pregnancy, good ecology and lack of chronic diseases reduces the risk of developing various pathologies The child has. Don't forget about vaccinations. Experts recommend that women who are preparing for an upcoming pregnancy get routine vaccinations against rubella, flu and others. dangerous infections... During pregnancy, it is necessary to regularly undergo ultrasound in order to start treatment of congenital heart defects on time.

Which are characterized by the presence of abnormal communication between the two atrial chambers. Atrial septal defects in children differ in the location of the opening. Central, upper, lower, posterior, anterior defects are common. Also, a defect can be qualified by its size from a small slit hole, for example, with non-closure oval window, until the complete absence of the oval window. There is also complete absence the atrial septum is the only atrium. Crucial for diagnosis and further treatment has a number of defects (from one to many). Defects are unequally located in relation to the place of confluence of the superior and inferior vena cava.

How does atrial septal defect manifest in children?

Clinically and symptomatically, only atrial septal defects with a size of 1 cm or more usually appear. As a result of the presence of interatrial communication, blood mixing in the atria occurs. Blood flows from the atrium with high systolic pressure (left) to the atrium with less pressure (right). The pressure level is important in determining the direction of blood discharge only in cases where the diameter of the defect does not exceed 3 cm.

With large atrial septal defects in children, there is no pressure component, however, the blood discharge, as a rule, goes from left to right, since the blood flow from the right atrium to the right ventricle encounters much less resistance during movement than the blood flow from the left atrium to the left ventricle. This is due anatomical features right atrium: thinner and more flexible wall of the atrium and ventricle; large area of the right atrioventricular opening compared to the left (10.5 and 7 cm), greater lability and capacity of the vessels of the pulmonary circulation.

As a result of the discharge of blood through the defect from the left atrium to the right, an increase in blood filling of the pulmonary circulation develops, the volume of the right atrium increases, and the work of the right ventricle increases. An increase in pulmonary artery pressure develops in 27% of cases and is observed mainly in older children. As a result of an increase in blood volume, an expansion of the pulmonary trunk and the left atrium is observed. The left ventricle remains normal in size, and with a large volume of atrial septal defect, it may be even smaller than normal.

In newborns, due to high pulmonary capillary resistance and low pressure in the left atrium, there may be periodic discharge of blood from the right atrium to the left compartment. In children early age the direction of blood flow can also easily change due to an increase in pressure in the right atrium (with great physical exertion, respiratory diseases, crying, sucking). V later stages diseases with an increase in pressure in the right chambers of the heart, due to the development of hypertension in the pulmonary circulation, a cross discharge occurs, and then a constant discharge venous blood from the right atrium to the left compartment.

Congenital atrial septal defect and its clinic

The clinic of a congenital atrial septal defect is very diverse. During the first month of life, the main, and often the only symptom is a fickle, mild cyanosis, which manifests itself with a cry, anxiety, which in a number of children goes unnoticed.

The main symptoms of defects begin to appear on, but often the diagnosis of defects is made only in 2-3 years and even later.

With small defects of the interatrial septa (up to 10-15 mm), children are physically developed normally, there are no complaints.

V early childhood in children with big defect atrial septum, there is a lag in physical development, mental development, underweight develops. They often suffer from respiratory problems. Signs congestive failure they are, as a rule, absent. At an older age, children also experience growth retardation, delay in sexual development, at the same time, they do not tolerate physical activity.

On examination, the skin is pale. Deformation chest in the form of a central heart hump, which is caused by a weakening of muscle tone and an increase in the size of the right ventricle, is noted in 5-3% of cases (with large defects and rapidly progressing pulmonary hypertension in slightly older children). Systolic tremors are usually absent. The apical impulse of average (normal) strength or enhanced, displaced to the left, always diffuse, due to the hypertrophied right ventricle.

The borders of the heart are expanded to the right and upward, mainly due to an increase in the right atrium and pulmonary trunk, but with large defects and in older children, expansion of the heart is also noted, usually due to the right ventricle, which pushes the left ventricle back. Severe symptoms expansion of cardiac boundaries are rare.

Pulse of normal tension and slightly reduced filling. Blood pressure is normal or decreased systolic and pulse blood pressure with a large shunt of blood through the defect.

When listening: the tone is often increased due to a decrease in the congestion of the left ventricle and an increased contraction of the overloaded right ventricle, the II tone is usually strengthened and split over the pulmonary artery due to an increase in blood volume and an increase in pressure in the pulmonary circulation and late closure of the pulmonary valve, especially in older children. A systolic murmur - of medium intensity and duration, not of a coarse timbre - is heard locally in the 2-3rd intercostal space to the left of the sternum, moderately carried out to the left clavicle and less often up to Botkin's 5 point. The noise is better heard in the patient's lying position, at the depth of maximum exhalation. During physical exertion, the noise in case of an interatrial septal defect increases, in contrast to physiological noise (a moderate accent of tone over the pulmonary artery in healthy children under 10 years of age), which disappears during exercise. In addition to the main systolic murmur, in older children, a short interdiastolic murmur of relative stenosis of the tricuspid valve (Coombs murmur) associated with an increase in blood circulation through the right atrioventricular opening can be heard.

In the later stages of the disease, with a significant expansion of the trunk of the pulmonary artery (in 10-15% of patients), sometimes a gentle protodiastolic murmur of relative insufficiency of the pulmonary valve appears.

The diagnosis of an isolated secondary atrial septal defect in children is based on following signs- the appearance of non-intense transient cyanosis during the first 2-3 months of life, frequent respiratory diseases in the first year of life, listening to a moderate systolic murmur in the 2nd intercostal space to the left of the sternum.

From the second half of the year or after a year - the presence of signs of overload of the right atrium, hypertrophy of the right ventricle, an intact left ventricle according to ECG, Echo-KG, catheterization of the cardiac cavities, signs of overload of the pulmonary circulation.

Differential diagnosis is carried out with functional systolic murmur (open aortic heart disease, ventricular septal defect, stenosis of the aortic orifice), mitral valve insufficiency.

Complications and prognosis of the interatrial septum in children

Among the complications of atrial septal defect in children, rheumatism and bacterial secondary pneumonia are most common. Accession of rheumatism is observed in 10% of patients, mainly ends in death or mitral defects are formed.

Arrhythmias result from a sharp dilatation of the right atrium (extrasystole, paroxysmal tachycardia, atrial fibrillation and other rhythm disturbances).

As a result of frequent respiratory diseases, pneumonia, a chronic nonspecific bronchopulmonary process is formed in a number of patients.

Pulmonary hypertension develops at the age of 30-40 years and older.

The average life expectancy for a secondary defect of the interventricular septum in children is 36-40 years, but some patients live up to 70 years, but after 50 years they become disabled. Spontaneous closure of the ventricular septal defect in children occurs at 5-6 years of age in 3-5%.

Sometimes children die in infancy as a result of severe circulatory failure or pneumonia.

Atrial septal defect in newborn babies - extremely rare disease, which is referred to as congenital heart defects (CHD).

It entails great amount consequences.

How to recognize the problem in time and how to deal with it? We will tell you in this article.

Atrial septal defect is a congenital anomaly of the heart (congenital defect). With an incomplete defect, there is opening between baffles, and at full - the partition is absent altogether. The disease is characterized by the presence of communication between the right and left atria.

The disease can be detected with ultrasound examination quite by accident, since many people are asymptomatic.

Causes of development and risk factors

Atrial septal defect is an genetic disease ... If a child has close relatives suffering from a heart defect, more attention should be paid to his health.

Also this disease may develop due to external causes ... During pregnancy, you should stop smoking and alcohol, take medication only under the supervision of your doctor. Congenital malformation can appear if the mother of the child was sick during pregnancy diabetes mellitus, phenylketonuria or rubella.

Forms

Defects are distinguished by the size and shape of the holes between the atria:

Primary.
Usually characterized by large size(from three to five centimeters), localization in the lower part of the septum and the absence of the lower edge. The underdevelopment of the primary interatrial septum and the preservation of the primary message are attributed to this form of the defect. Most often, patients have an open antrioventicular canal and splitting of the tricuspid and bicuspid valves.
Secondary.
It is characterized by an underdeveloped secondary septum. Usually this is a small lesion (from one to two centimeters), which is located in the area of the vena cava orifices or in the center of the septum.
Complete absence of a partition.
This defect is called a three-chambered heart. This is due to the fact that due to the complete absence of the septum, a single common atrium is formed, which may be associated with abnormalities of the antrioventicular valves or with asplenia.

One of the options for interatrial communication is called an open oval window, which is not attributed to this defect, since this is just an underdevelopment of the valve of the opening. When the oval window is open, hemodynamic disturbances do not occur, therefore, in this case surgery not required.

Complications and consequences

Small defects are difficult to detect- some people learn about their illness only in old age. With a large defect, life expectancy can be reduced to 35-40 years.

This problem over time leads to depletion of the restorative resources of the heart that can cause development pulmonary diseases, heart failure, and also lead to frequent fainting or even a stroke.

Symptoms

In the nursery and adolescence it is often difficult to recognize a small to medium defect, as it does not cause any obvious inconvenience. It is much easier to recognize a large defect, since rather pronounced symptoms appear with it:

shortness of breath that occurs when physical activity;
susceptibility to respiratory tract infections;
pallor or even cyanosis of the skin;
weakness, fatigue;
violation heart rate.

If the patient observes one of the above symptoms, or the parents pay attention to the child's capriciousness, tearfulness, lack of desire to play for a long time with other children, then you should contact to a pediatrician or a general practitioner... Next, the doctor will conduct initial inspection and, if necessary, will give a referral for further examination.

Learn about the danger from another article - it is important for all parents of children with CHD risk to know.

What is the difference between the defect of the interventricular septum in the fetus from atrial defect? Find out the articles.

Diagnostics

To identify the disease are used different methods... For further instructions, you should contact your pediatrician or therapist, who, based on the analysis of complaints from the patient or his parents, can refer you to a cardiologist.

First, a history of the patient's life is collected (whether his relatives have congenital heart defects, how the mother's pregnancy proceeded), and then they give referral for the following analyzes: general analysis urine, biochemical and general blood test. Based on the results obtained, you can find out how other internal organs, and whether it is connected with the work of the heart.

Also held general inspection, auscultation (listening to the heart), percussion (percussion of the heart)... Two latest methods allow you to find out if there are changes in the shape of the heart and whether the sounds characteristic of this defect are heard. After the studies have been carried out, the pediatrician or therapist decides whether there is a reason for further diagnosis.

In the event that the doctor suspects the patient has a congenital heart defect, applied over complex ways research:

X-rays of the chest organs can show changes in the shape of the heart.
Electrocardiography (ECG) makes it possible to observe abnormalities in the conduction and rhythm of the heart in a patient, as well as an increase in the right sections.
Echocardiography (echocardiography), or ultrasound. When using a two-dimensional (Doppler) method, you can see where the septal defect is located and its size. Besides, this way allows you to see the direction of the discharge of blood through the hole.
Probing (insertion of a catheter) helps to determine the pressure in the cavities of the heart and blood vessels.
Angiography, ventculography and magnetic resonance imaging (MRI) are prescribed in cases where other research methods were not indicative.

After the diagnosis, the attending doctor decides whether the patient needs surgery or whether conservative treatment is sufficient.

Treatment methods

One of the ways to treat minor defects that do not complicate the patient's life is conservative method treatment. In addition, this type of treatment is also used in cases where an operation that was not performed on time was the result of the development of diseases such as myocardial ischemia and heart failure.

Surgical intervention is recommended for patients aged 1 to 12 years... This is due to the fact that at this age the body has already adapted to the changes that have occurred in the body due to an atrial septal defect, and there is no longer any possibility of self-closing of the defect. On this moment there are two ways to close a defect.

Open operation

If the hole size is less than four centimeters then open heart surgery can be performed. During the operation, a heart-lung machine is used, most often with cardiac arrest.

Depending on the size of the defect, the method of its elimination is also determined: suturing the defect (no more than 120 millimeters) or installing a patch from its own pericardium.

The recovery period lasts about a month... At this time, it is necessary to monitor nutrition and refrain from physical activity.

Endovascular occlusion (closed)

This way surgical intervention thing is across femoral vein a catheter with an occluder (plate) is inserted, which is then directed into the right atrium. Then the occluder closes the hole, "seals" it.

This method of performing the operation has several advantages over open surgery: no need for general anesthesia, few injuries, fast recovery period - just a few days.

Forecasts and preventive measures

In order to prevent the development of an atrial septal defect in children, the mother needs register in time antenatal clinic during pregnancy.

You should exclude smoking, drinking alcohol, adhere to proper nutrition and take medications only as directed by your doctor. It is also worth telling the gynecologist who is managing your pregnancy about the presence of relatives suffering from congenital heart disease.

Despite the fact that this disease has a positive prognosis, it is necessary to take timely treatment measures so that various complications do not appear in the future.

Today, it is quite simple to identify an atrial septal defect in children, heart disease in newborns in most cases detected during ultrasound examination... If the disease was not detected immediately after birth, but you have suspicions, you should consult your doctor.

Which are characterized by the presence of abnormal communication between the two atrial chambers. Atrial septal defects in children differ in the location of the opening. Central, upper, lower, posterior, anterior defects are common. Also, a defect can be classified by its size from a small slit hole, for example, when the oval window does not close up, to the complete absence of the oval window. There is also a complete absence of the interatrial septum - the only atrium. The number of defects (from one to many) is of decisive importance for diagnosis and further treatment. Defects are unequally located in relation to the place of confluence of the superior and inferior vena cava.

How does atrial septal defect manifest in children?

With large atrial septal defects in children, there is no pressure component, however, the blood discharge, as a rule, goes from left to right, since the blood flow from the right atrium to the right ventricle encounters much less resistance during movement than the blood flow from the left atrium to the left ventricle. This is due to the anatomical features of the right atrium: thinner and more flexible wall of the atrium and ventricle; large area of the right atrioventricular opening compared to the left (10.5 and 7 cm), greater lability and capacity of the vessels of the pulmonary circulation.

In newborns, due to high pulmonary capillary resistance and low pressure in the left atrium, there may be periodic discharge of blood from the right atrium to the left compartment. In young children, the direction of blood flow can also easily change due to an increase in pressure in the right atrium (with great physical exertion, respiratory diseases, crying, sucking). In the later stages of the disease, with an increase in pressure in the right chambers of the heart, due to the development of hypertension in the pulmonary circulation, a cross discharge occurs, and then a constant discharge of venous blood from the right atrium to the left compartment.

Congenital atrial septal defect and its clinic

The main symptoms of defects begin to appear on, but often the diagnosis of defects is made only in 2-3 years and even later.

With small defects of the interatrial septa (up to 10-15 mm), children are physically developed normally, there are no complaints.

In early childhood, in children with a large atrial septal defect, there is a lag in physical development, mental development, and weight loss develops. They often suffer from respiratory problems. They usually have no signs of congestive failure. At an older age, children also experience growth retardation, delay in sexual development, at the same time, they do not tolerate physical activity.

On examination, the skin is pale. Deformation of the chest in the form of a central heart hump, which is caused by a weakening of muscle tone and an increase in the size of the right ventricle, is noted in 5-3% of cases (with large defects and rapidly progressing pulmonary hypertension in slightly older children). Systolic tremors are usually absent. The apical impulse of average (normal) strength or enhanced, displaced to the left, always diffuse, due to the hypertrophied right ventricle.

Pulse of normal tension and slightly reduced filling. Blood pressure is normal or systolic and pulse blood pressure is reduced with a large blood shunt through the defect.

In the later stages of the disease, with a significant expansion of the trunk of the pulmonary artery (in 10-15% of patients), sometimes a gentle protodiastolic murmur of relative insufficiency of the pulmonary valve appears.

The diagnosis of an isolated secondary atrial septal defect in children is based on the following signs - the appearance of non-intense transient cyanosis during the first 2-3 months of life, frequent respiratory diseases in the first year of life, listening to a moderate systolic murmur in the 2nd intercostal space to the left of the sternum.

Differential diagnosis is carried out with functional systolic murmur (open aortic heart disease, ventricular septal defect, stenosis of the aortic orifice), mitral valve insufficiency.

Complications and prognosis of the interatrial septum in children

Arrhythmias result from a sharp dilatation of the right atrium (extrasystole, paroxysmal tachycardia, atrial fibrillation and other rhythm disturbances).

As a result of frequent respiratory diseases, pneumonia, a chronic nonspecific bronchopulmonary process is formed in a number of patients.

Pulmonary hypertension develops at the age of 30-40 years and older.

Sometimes children die in infancy as a result of severe circulatory failure or pneumonia.

In which there is a hole between the right and left atrium. Through it, blood from the left parts of the heart is thrown into the right, which leads to an overload of the right parts and the pulmonary circulation. An atrial septal defect becomes the cause of disruption of the heart and lungs due to the pressure difference in the atria.

Depending on the location, a defect of the primary and secondary types is distinguished. Primary ones are located in the lower part of the septum and can be 1 - 5 cm in size. The most common secondary defects are located in upper section... They account for approximately 90% of all cases of this defect. The secondary defect may have a high location, at the confluence of the inferior vena cava, or be located at the location of the oval window. This defect can be an isolated disease or be combined with others.

If the size of the ASD is small, it is possible childhood(up to 1 year). If the atrial septal defect has big size then without surgical intervention it will not close.

Reasons for the development of ASD

Doctors do not name the exact cause of the appearance of an atrial septal defect, but note the genetic and external factors of its occurrence. The appearance of any heart defects is associated with violations of its development during the formation of the fetus in the womb. To determine the likelihood of developing a defect in an unborn child, spouses with relatives with congenital heart defects, doctors recommend to be examined.

From external factors The following risks should be noted:

Taking some medications in early pregnancy, when the main organs of the fetus begin to form. The likelihood of abnormal development of the unborn child increases if a woman takes alcoholic drinks during gestation.
One of the risk factors for atrial septal defect is rubella if a pregnant woman has had it in the first trimester.

ASD symptoms

Most often, children do not have any symptoms of this heart defect, even with a sufficiently large septal defect. ASD is usually diagnosed in adults, more often by the age of 30, when signs of the disease appear. Symptoms of the atrial septal defect depend on the patient's age, the size of the pathological opening and the presence of other heart defects.

Signs of ASD in children

Despite the asymptomatic course of the disease in children, there are some signs that indicate a possible defect of the interatrial septum:

Fatigue, weakness, refusal to play.
Frequent respiratory diseases: long persistent cough, bronchitis, pneumonia.
Lack of air, shortness of breath when running, outdoor games.

These symptoms do not necessarily indicate the presence of this disease... However, having found at least one of the above signs in a child, it should be shown to a pediatrician or cardiologist.

Signs of ASD in adults

It is not always possible to diagnose ASD in a newborn. With age, symptoms begin to manifest themselves more and more clearly due to the increased load on the heart muscle and lungs. You should go to the hospital if the following symptoms appear in adults:

Difficulty breathing and shortness of breath, even with minor physical exertion and at rest.
Fainting, dizziness.
Rapid fatigue, feeling of tiredness and weakness.
Respiratory Disease Susceptibility.
Unstable pulse, bouts of increased heartbeat.
Swelling of the legs.
Cyanosis of the skin.

The above signs indicate heart failure, which usually develops in adults with ASD without treatment.

Why is ASD dangerous?

If the atrial septal defect is left untreated, life-threatening complications can occur. This is due to stagnation of blood in the pulmonary circulation due to the overload of the right heart. With a large pathological opening, it develops, which is characterized by increased blood pressure in a small circle. In some cases, severe irreversible hypertension of the pulmonary circulation develops - Eisenmenger's syndrome.

There are several other consequences of ASD in the absence of treatment:

heart failure;
atrial fibrillation;
risk of stroke;
high mortality.

According to statistics, without treatment, approximately 50% of patients with moderate and large septal defect survive up to 40-50 years of age.

How is the diagnosis carried out?

On a routine examination by a general practitioner or cardiologist, it is almost impossible to identify an atrial septal defect, since pathological ones are most often absent. The reason for more thorough examination are the patient's complaints and some indirect signs heart defects detected by a doctor.

Several methods are used to diagnose the defect:

A chest X-ray makes it possible to identify signs of right ventricular heart failure, which is observed with an atrial septal defect. In this case, the X-ray shows that the right ventricle and right atrium are significantly enlarged, there is stagnation of blood in the lungs, pulmonary artery expanded.
An ultrasound of the heart helps determine the severity of the disease. This method makes it possible to find out the direction of movement of blood, its amount passing through the pathological opening, to assess the work of the heart, to reveal the anomalies of its development.
An ECG can help detect cardiac abnormalities that are characteristic of an atrial septal defect, such as arrhythmias and thickening of the right ventricle.
Magnetic resonance imaging is used if it was not possible to diagnose with ultrasound.

Often, secondary ASD has to be differentiated with functional systolic murmur and some diseases: Fallot's triad, ventricular septal defect.

How to treat?

There is no medical treatment for atrial septal defect. To eliminate the defect, use only surgical techniques, which consist in installing a special mesh covering the hole. Cardiac surgeons recommend treating a septal defect in childhood in order to avoid further complications. The doctors are armed with the following two methods:

Classic operation on open heart... Under general anesthesia an incision of the chest is performed, while it is necessary to connect the patient to a heart-lung machine. A synthetic "patch" is sewn into the heart through an incision, which gradually grows into living tissue and closes the defect. This operation is traumatic and fraught with complications. The patient needs a long period of time to recover.
Catheterization is a safer and less traumatic method. Compared to open surgery, catheterization is easier to tolerate, complications are less frequent, and the rehabilitation period is shorter. In this case, the mesh is applied to the defect using a thin catheter, which is inserted through the femoral vein under the control of X-ray equipment. However, complications are possible with this method: pain, bleeding, infection of the insertion site; allergy to contrast agent used during the operation; damage to a blood vessel.

After the defect is eliminated, an ultrasound scan is performed to assess the effectiveness of the operation and drug treatment is prescribed, which lasts up to 6 months. You should regularly visit a cardiologist to monitor the development of arrhythmias.

What's the prognosis?

The forecast depends on the timeliness of the operation. If the defect is eliminated in childhood, then the likelihood of complications is quite small. When the hole is closed in patients over 25 years of age, the risk of complications increases depending on how impaired the functions of the lungs and heart are.

The most common complication after surgery to close an atrial septal defect is a heart rhythm disorder. Arrhythmia develops in 50% of those operated after the age of 40. In patients with impairments, such as heart failure, even after the operation, there is no improvement in the work of the heart, and the point of the operation is to prevent the deterioration of the condition.