Visit our foundation to give a gift.
View Locations Near Me
Main Campus – Hartford
Connecticut Children’s – Waterbury
Urgent Care – Farmington
Specialty Care Center – Danbury
Connecticut Children’s Surgery Center at Farmington
Specialty Care Center – Fairfield
Search All Locations
Find a doctor
Find A Doctor
Request an Appointment
Amenities and Services
Who’s Who on Care Team
Getting Ready for Surgery
What to Expect—Picture Stories
Pay a Bill
Understanding the Different Fees
Pricing Transparency and Estimates
Raytheon Technologies Family Resource Center
Family Advisory Council
Legal Advocacy: Benefits, Education, Housing
Electronic Health Records
Share Your Story
Pay a Bill
Login to MyChart
Clinical Support Services Referrals
About the Network
Join the Network
Graduate Medical Education
Continuing Medical Education
MOC/Practice Quality Improvement
Educating Practices in the Community (EPIC)
Learning & Performance
Meet our Physician Relations Team
Request Medical Records
Join our Referring Provider Advisory Board
View our Physician Callback Standards
Read & Subscribe to Medical News
Register for Email Updates
Update Your Practice Information
Refer a Patient
Find and Print Health Info
Health Information For Parents
An atrial septal defect (ASD) — sometimes called a hole in the heart — is a type of congenital heart defect in which there is an abnormal opening in the dividing wall between the upper filling chambers of the heart (the atria).
In most cases, ASDs are diagnosed and treated successfully with few or no complications.
In an atrial septal defect, there’s an opening in the wall (septum) between the atria. As a result, some oxygenated blood from the left atrium flows through the hole in the septum into the right atrium, where it mixes with oxygen-poor blood and increases the total amount of blood that flows toward the lungs.
The increased blood flow to the lungs creates a swishing sound, known as a heart murmur. The murmur, along with other specific heart sounds, often is the first tip-off to a doctor that a child has an ASD. ASDs can be located in different places on the atrial septum and can vary in size.
Children with ASDs are born with the defect. ASDs happen during fetal development of the heart. The heart develops from a large tube, dividing into sections that will eventually become its walls and chambers. If there’s a problem during this process, a hole can form in the wall that divides the left atrium from the right.
In some cases, the tendency to develop an ASD might be inherited (genetic). Genetic syndromes can cause extra or missing pieces of chromosomes that can be associated with ASD. Most ASDs, though, have no clear cause. It’s also not clear why ASDs are more common in girls than in boys.
The size of an ASD and its location determine the symptoms it causes. Most kids who have ASDs seem healthy and appear to have no symptoms. Most feel well, and grow and gain weight normally.
Children with larger, more severe ASDs, though, might have some of these signs or symptoms:
An ASD that isn’t treated in childhood can lead to health problems later, including an abnormal heart rhythm (an atrial arrhythmia) and problems in how well the heart pumps blood.
As kids with ASDs get older, they also might be at an increased risk for stroke because a blood clot could form, pass through the hole in the septum, and travel to the brain. Pulmonary hypertension (high blood pressure in the lungs) also may develop over time in older patients with larger untreated ASDs.
Because of these possible complications, doctors usually recommend closing ASDs early in childhood.
After hearing the heart murmur that suggests a hole in the atrial septum, a doctor may refer a child to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart disease in kids and teens.
The cardiologist might order one or more of these tests:
Treatment of an ASD will depend on a child’s age and the size, location, and severity of the defect.
Very small ASDs might not need any treatment. In other cases, the cardiologist may recommend follow-up visits for observation.
Usually, though, if an ASD hasn’t closed on its own by the time a child starts school, the cardiologist will recommend fixing the hole, either with cardiac catheterization or heart surgery.
Many ASDs can be treated with cardiac catheterization. In this procedure, a thin, flexible tube (a catheter) is inserted into a blood vessel in the leg that leads to the heart. The cardiologist guides the tube into the heart to make measurements of blood flow, pressure, and oxygen levels in the heart chambers. A special implant is positioned into the hole and 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 implant and covers it entirely. This nonsurgical technique leaves no chest scar, has a shorter recovery time than heart surgery, and usually needs just an overnight stay in the hospital.
There’s a small risk of blood clots forming on the closure device while new tissue heals over it, so kids who had a catheterization take a low dose of aspirin for 6 months after the procedure. Over time, the normal tissue of the heart grows over the device and the aspirin is no longer necessary.
After catheterization, a child should take it easy for a few days and might need to skip gym class or sports practice for a week or two.
Sometimes, when the ASD is very large or close to the wall of the heart, a device cannot be safely used and heart surgery is needed to close the defect.
If your child has surgery, he or she will get general anesthesia and won’t feel pain or be able move around during the surgery. The surgeon will make a cut in the chest, then stitch the hole in the atrial septum closed or sew a patch of manmade surgical material (such as Gore-Tex) over it. Eventually, the tissue of the heart heals over the patch or stitches, making the area smooth and nearly normal in appearance.
Kids usually can leave the hospital 3 to 4 days after surgery, if there are no problems. The first few days at home, your child should relax in bed or on the couch doing quiet activities such as reading, sleeping, and watching TV. Your doctor will let you know when your child can go back to school.
It takes about 6 weeks for a chest incision to heal. After that, if there are no problems and the doctor say it’s OK, your child should be fully recovered and able to return to normal activities.
Heart surgery does leave a permanent scar on the chest. It will be sore at first, so the doctor might prescribe a pain reliever, or recommend acetaminophen or ibuprofen. Your child might feel numbness, itchiness, tightness, and burning around the cut, although these shouldn’t be severe.
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 (an infection of the inner surface of the heart). When the heart tissue has healed over the closed ASD, most patients no longer need to worry about the risk of infective endocarditis.
Your doctor will discuss other possible risks and complications with you before the procedure.
After their ASD is closed and they’ve had plenty of time to heal, most kids have no further symptoms or problems.
In the weeks after surgery or cardiac catheterization, the cardiologist will check on your child’s progress. Your child might have another echocardiogram to make sure that the heart defect has closed completely.
Most kids recover from treatment quickly, and will just need regular follow-up visits with their cardiologist. You might even notice that within a few weeks, your child is eating more and is more active than before surgery.
However, some signs and symptoms might indicate a problem. If your child is having trouble breathing, call the doctor or go to the emergency department immediately. Also call the doctor if your child has any of these symptoms:
Having your child diagnosed with a heart condition can be scary. But the good news is that your pediatric cardiologist will be very familiar with ASDs and how best to manage the condition. Most kids who’ve had an ASD corrected go on to live healthy, active lives.
Your heart beats and sends oxygen throughout your entire body. Find out how it works and how heart problems can be fixed.
Getting an EKG doesn’t hurt and it gives doctors important info about how your heart is beating. Watch what happens in this video for kids.
It may seem scary to go to a hospital, but doctors and nurses are there to help people who are sick or hurt feel better. Read our article for kids to find out what happens inside a hospital.
This video shows what it’s like to have an electrocardiogram (EKG for short).
Knowing what to expect with surgery before you get to the hospital can make you less anxious about your surgical experience – and less stress helps a person recover faster.
Heart murmurs are very common, and most are no cause for concern and won’t affect a child’s health.
Heart defects happen when there’s a problem with a baby’s heart development during pregnancy. Most heart defects can be treated during infancy.
Coarctation of the aorta (COA) is a narrowing of the aorta, the major blood vessel that carries blood away from the heart to the body.
Mitral valve prolapse (MVP) is a very common heart condition, but it isn’t a critical heart problem or a sign of other serious medical conditions.
The ductus arteriosus is a blood vessel that connects two major arteries before birth and normally closes after a baby is born. If it stays open, the result is a condition called patent ductus arteriosus (PDA).
Atrial septal defect, or ASD, is a heart defect that some people are born with. Most ASDs are diagnosed and treated successfully with few or no complications.
Ventricular septal defect, or VSD, is a heart condition that a few teens can have. Find out what it is, how it happens, and what doctors do to correct it.
Ventricular septal defect (VSD) â also known as a “hole in the heart” â is a congenital heart defect. Most VSDs are diagnosed and treated successfully.
The heart and circulatory system (also called the cardiovascular system) make up the network that delivers blood to the body’s tissues.
Good preparation can help your child feel less anxious about getting surgery. Kids of all ages cope much better if they have an idea of what’s going to happen and why.
The heart and circulatory system are our body’s lifeline, delivering blood to the body’s tissues. Brush up on your ticker with this body basics article.
Knowing the basics of anesthesia may help answer your questions and ease some concerns â both yours and your child’s.
Take this quiz about the circulatory system, which sends blood throughout your body.
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
© 1995-2020 KidsHealth®. All rights reserved.
Images provided by The Nemours Foundation, iStock, Getty Images, Veer, Shutterstock, and Clipart.com.