Is a ventricular septal defect with pulmonary hypertension mild or severe?

Written by Xie Zhi Hong
Cardiology
Updated on May 20, 2025
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The most common complication of atrial septal defect is pulmonary hypertension, which can be classified as mild, moderate, or severe. Generally, mild pulmonary hypertension is not a major issue and is not considered very serious. However, moderate to severe pulmonary hypertension often accompanies repeated coughing, shortness of breath after exercise, or difficulty breathing. This situation is relatively serious and it is advisable to undergo surgery as soon as possible. If the condition reaches a severe stage, pulmonary hypertension could continuously increase. Furthermore, in patients with severe pulmonary hypertension, closing the atrial septum can lead to severe breathing difficulties and increased shortness of breath. Therefore, it is crucial to closely monitor patients with pulmonary hypertension.

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Written by Li Hai Wen
Cardiology
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How severe is an atrial septal defect considered to be?

Atrial septal defect (ASD) is a relatively common congenital heart disease in clinical practice. From a medical perspective, the severity of ASD depends on whether the patient is an adult or a child. For adults with ASD, generally speaking, defects larger than 20 millimeters are considered large atrial septal defects, which are more severe. If the defect size is between 10 and 20 millimeters, it is often classified as a moderate atrial septal defect. Defects smaller than 4 millimeters are considered small atrial septal defects. Generally, small and moderate atrial septal defects are not severe. For children, an atrial septal defect larger than 10 millimeters is considered a large atrial septal defect, which is more severe. Sizes between 5 and 10 millimeters are classified as moderate atrial septal defects. Defects smaller than 5 millimeters are considered small atrial septal defects, which generally are not severe.

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Written by Tang Li
Cardiology
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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.

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Written by Tong Peng
Pediatrics
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Will babies with atrial septal defects develop slowly?

Babies with atrial septal defects do not necessarily develop more slowly. An atrial septal defect is one of the congenital heart diseases. If the diameter of the defect is relatively small, it will not affect the normal blood flow of the heart, the oxygen supply to the body, or significantly impact daily activities like sleeping or exercising for the baby. The growth and development of the baby would be normal, with no abnormalities compared to their peers. However, if the diameter of the atrial septal defect is relatively large, typically exceeding 6-8 millimeters, it can cause the baby to experience a lack of oxygen during physical activities, leading to a compromised quality of life and potentially causing delayed development.

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Written by Tang Li
Cardiology
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How to treat atrial septal defect

Typical cardiac murmur ECG and X-ray findings may suggest the presence of an atrial septal defect. An echocardiogram can confirm the diagnosis, and it should be differentiated from conditions such as anomalous pulmonary venous return, pulmonary valve stenosis, and small ventricular septal defects. For the treatment of atrial septal defects, in adult patients, if echocardiographic evidence of increased right ventricular volume load is present, the defect should be closed as soon as possible. Treatment options include interventional and open-heart surgical procedures. Before the implementation of interventional surgeries, all cases of simple atrial septal defects that have caused hemodynamic changes, with signs of increased pulmonary blood flow, enlargement of the atria and ventricles, and corresponding ECG findings, should undergo surgical treatment. In older patients with severe pulmonary hypertension, surgical treatment should be approached with caution.

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Written by Di Zhi Yong
Cardiology
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Can atrial septal defect of the patent foramen ovale type heal itself?

This disease is a congenital heart disease, and it is recommended that the patient undergo a cardiac echocardiography. If symptoms such as palpitations and chest tightness occur, and distinct murmurs can be heard in the precordial area, surgical treatment is sometimes advised. After all, an atrial septal defect can lead to certain conditions, especially in children who are prone to pediatric pneumonia or bronchitis, which can affect their growth and development. Currently, surgical treatment is the main approach. If the issue is not very serious, the defect might heal on its own as the child grows, but this possibility is relatively small. In most cases, surgery is recommended.