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Forum Name: Congenital Heart Disease in Adults

Question: Newly diagnosed ASD


 maja602 - Sun Jan 04, 2009 3:02 am

Hello. I am a 24 year old female in generally good health. I went for a physical a couple weeks ago. My physician identified a grade 4/6 systolic ejection murmur heard loudest over the left sternal border.

She sent me for an echocardiogram. I had this performed on Dec 31, 2008. The radiologist came in at the end of the test and told me that I have a small ASD. He didn't say much else and told me to follow up with my family physician for the results. I have an appointment in 2 weeks with her and am anxious to find out more.

I've been doing some reading on ASDs and treatment. My question is - is it recommended that ALL ASDs are closed? Is there any reason why they would not close an ASD? Based on what I have read, even when the ASD is small, there can be symptoms later in life. Any information on what I can expect to happen next would be helpful. Also, should I ask for a referral to a cardiologist regardless of how big the ASD is?

Thanks in advance for any information you can provide.
 John Kenyon, CNA - Sun Jan 04, 2009 9:07 pm

User avatar Hi there -

Last things first: yes, you should absolutely ask for a cardiology consult. That's the only thing that makes sense. I realize managed care is making things go out of order quite a bit these days, but this is a cardiological issue and while your GP should be involved, a cardiologist should be in charge at this point.

Now then: a small ASD, at your age, obviously isn't causing any obvious symptoms. You could, conceivably, go your whole life without any problems. However, there is always a greater risk of eventual problems, whether they be shunting of blood from one side to another to the detriment of good functioning; there is a greater than average risk of small clots forming eventually, especially if the slightly greater risk of developing atrial fibrillation is eventually realized. These are all "maybes", but this is why even a small ASD is generally repaired if practical (which it usually is).

As for the repair, it can usually be accomplished by catheter guided placement of a small patch, which can be virtually an in-and-out procedure many times. This would involve inserting a catheter via a tiny incision in the groin, into a femoral vessel, feeding it up to the heart, and watching the entire thing on a monitor screen. It's simple, relatively easy, minimally invasive, and takes a few hours. There are a few cases in which the ASD is difficult to reach directly via catheter, although it's almost always best to at least have it visualized that way anyway.

There's likely no immediate problem, and I have known patients who've had these discovered well into the fifth decade with no particular problems having taken place. Still, the sooner the thing is repaired, if that is possible (and it almost always is), the less the chance of some random mishap later on. There's plenty of time to discuss this with a cardiologist and develop a plan. It's not usually a big deal at all. Once in a great while either the ASD is considered too insignificant or is simply watched over a period of time rather than repaired early, and there are also a few cases where the ASD is found to be located in an awkward place and then the need for open (but still usually minimally invasive) surgery is discussed. These are increasingly unusual.

I hope this is helpful to you. Please keep us updated, and if there are any additional questions or concerns, please follow up with us here.

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