Is a 12mm atrial septal defect serious?

Written by Li Hai Wen
Cardiology
Updated on September 04, 2024
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Atrial septal defect (ASD) is a fairly common congenital heart disease in pediatric cardiology. For infants and young children, atrial septal defects can be categorized based on their size into three types: A large atrial septal defect typically refers to a defect larger than 10 millimeters. A medium atrial septal defect generally refers to a defect that ranges from 5 to 10 millimeters. A small atrial septal defect usually refers to a defect that is less than 5 millimeters. Therefore, for an infant or young child, an atrial septal defect measuring 12 millimeters would indeed be considered quite severe.

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Written by Li Hai Wen
Cardiology
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What does atrial septal defect mean?

Atrial septal defect is a relatively common type of congenital heart disease encountered clinically. In simple terms, the human heart has four chambers: the left atrium, right atrium, left ventricle, and right ventricle. Between the left and right atria, there is a structure called the atrial septum, which separates the two atria. If there is a hole in this septum, this condition is referred to as an atrial septal defect. Atrial septal defects are common congenital heart conditions, and when the defect is severe, it often accompanies heart failure and other complications. Under such circumstances, it is crucial to visit a cardiologist for a formal assessment to determine the necessity and approach to treatment.

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Written by Tang Li
Cardiology
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Can a ventricular septal defect heal itself?

Traditional views suggest that the best age to close atrial septal defects (ASDs) is between four and five years old, during preschool. The possibility of spontaneous closure of atrial septal defects larger than 8 millimeters in diameter is very low. If the defect is less than 4 millimeters, there is a possibility of healing. Currently, it is advocated that if an atrial septal defect still exists after the age of one year, and there is evident systolic murmur and fixed splitting of the second heart sound, or if heart catheterization and echocardiography show left-to-right shunting greater than 1.5:1, indicating a defect diameter of five to six millimeters or more, early surgery should be pursued to stop the left-to-right shunt to avoid causing pulmonary hypertension and endocarditis.

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Written by Cai Li E
Cardiology
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Atrial septal defect can cause which complications?

Small atrial septal defects generally are asymptomatic, whereas medium to large atrial septal defects may result in pulmonary hypertension and right heart failure. The impact of an atrial septal defect on hemodynamics mainly depends on the amount of shunting, which in turn is determined by the size of the defect. It also relates to the compliance of the left and right ventricles and the relative resistance of the systemic and pulmonary circulation. Continued increase in pulmonary blood flow leads to pulmonary congestion, increasing right heart volume load. Pulmonary vascular compliance decreases, evolving from functional to organic pulmonary hypertension. This in turn continuously increases right heart system pressure until it surpasses the pressure of the left heart system, causing the original left-to-right shunt to reverse to a right-to-left shunt, leading to cyanosis. Atrial septal defects are generally asymptomatic but with the progression of the condition, symptoms such as exertional dyspnea, arrhythmias, and right heart failure may occur. In the advanced stages, about 15% of patients with severe pulmonary hypertension exhibit a right-to-left shunt and cyanosis, leading to the formation of Eisenmenger syndrome.

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Written by Tang Li
Cardiology
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Can atrial septal defect be cured?

Atrial septal defect is a common congenital heart disease. When the defect is small, some patients may heal naturally. In recent years, with the development of interventional technology for congenital heart diseases, most patients with atrial septal defects can be completely cured through interventional treatment, and some through surgical treatment. However, some patients have a large atrial septal defect with significant left-to-right shunting, leading to severe pulmonary arterial hypertension and right heart failure, which generally results in a poor prognosis. Some patients also have complications such as atrial flutter and atrial fibrillation. Certain patients may experience right heart failure due to excessive load on the right ventricle, and these patients often have a poor prognosis.

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Written by Tang Li
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How does septal defect shunt?

Atrial septal defect is the most common congenital heart disease in adults, accounting for 20%-30% of all adult congenital heart conditions. The impact of an atrial septal defect on hemodynamics primarily depends on the amount of shunting. Due to higher pressure in the left atrium compared to the right atrium, a left-to-right shunt is formed. The amount of shunting depends on the size of the defect, as well as the compliance of the left and right ventricles and the relative resistance in the systemic and pulmonary circulations. Diseases that affect the compliance of the left ventricle, such as hypertension and coronary artery disease, can increase the extent of the left-to-right shunt. A continuous increase in pulmonary blood flow leads to pulmonary congestion, increasing the load on the right heart. Pulmonary vascular compliance decreases, progressing from functional pulmonary arterial hypertension to organic pulmonary arterial hypertension. As right heart system pressure continuously increases and eventually exceeds the pressure in the left heart system, the original left-to-right shunt reverses to become a right-to-left shunt, resulting in cyanosis.