Atrial Septal Defect

A normal heart has two atria, left and right, separated by the atrium and diaphragm. Atrial middiaphragmatic defect refers to a hole in the atrium's middiaphragm, allowing blood from the left and right atria to communicate with each other. The incidence rate is about 1/1500.

It is a very common congenital heart disease, accounting for about 5~10% of all congenital heart diseases, twice as much as women and men. There are four types of atrial middiaphragmatic defects, which have different names depending on the location of the hole. Type 1 hole is located in the lower part of the atrium middiaphragm, accounting for about 30%; type 2 is the most common, and the damage is in the middle of the atrium middiaphragm. , accounting for about 50~70%; the other two types (venous sinus type and uncapped coronary sinus type) are very rare clinically.

Symptoms of diaphragmatic defect in the atrium:

1. The severity of symptoms is determined by the size and flow of the defect. Newborns have almost no symptoms due to the hypertrophy of the right ventricle.

2. Small defects will not cause symptoms, more than 90% will close before one year old, and 20~50% will heal on their own after one year old.

3. For large defects, because the pressure in the left and right atria is not high, there will be no obvious symptoms in childhood, and they will not be discovered until adults, or even after middle age.

4. Common initial symptoms: including palpitations, headache, and physical decline. In severe cases, heart failure and pulmonary hypertension may be complicated by symptoms such as dyspnea, arrhythmia, hepatosplenomegaly, and limb edema.

How to diagnose atrial septal defect: Correct diagnosis can be made through cardiac ultrasound examination.

Medical treatment:

1. Small defects do not affect heart function and can be tracked regularly every month during infancy.

2. For large defects, as age increases, the blood flow from the left atrium to the right atrium increases, which can easily cause pulmonary blood vessel congestion, and sick children are prone to recurrent respiratory infections.

3. When the pulmonary artery pressure continues to increase for a long time, the endothelial cells are damaged, which will lead to irreversible pulmonary hypertension.

4. For patients with type II defects below 2 cm and without pulmonary hypertension, cardiac catheterization can be treated when they are 2 years old or weigh more than 10 kg. Type III defects are often combined with other cardiac malformations and require surgical treatment. The current opinion of the medical community is that if such a defect is found, even if there are no symptoms (but if the shunt flow Qp/Qs ratio exceeds 1.5), it should be repaired in childhood or school age. In recent years, due to the continuous advancement of cardiac catheterization technology, most type 2 defects can also be closed using an "atrial septal defect closure device". It is a relatively simple and safe treatment method. Weight 10 It can be performed if the patient weighs more than 2 kilograms or the sick child is over 2 years old.

Daily care instructions:

1. Diet:

a. Eat a balanced diet and feed small amounts at frequent meals.

b. Babies can be fed with breast milk or formula milk. If bottle feeding is used, a soft nipple with a slightly larger sucking hole should be used to save the baby effort. It is recommended that each meal should be fed for no more than 30 minutes.

c. Sick children who have undergone surgery can eat a normal diet after being evaluated by a doctor and their condition stabilizes, but high-salt foods are not encouraged.

2. Activities:

a. During the care process, try to meet the baby's needs and reduce the baby's crying to prevent hypoxemia from causing inability to move.

b. When there is an atrial septal defect and no right ventricular enlargement, there is no need to restrict activities. After surgical repair of larger atrial septal defects, if there is no pulmonary hypertension, arrhythmia or poor cardiac function, activities can no longer be restricted six months after repair.

3. Prevent infection:

a. Wash hands frequently, avoid contact with infected people, and reduce entry and exit into public places to prevent infection.

b. If symptoms of respiratory infection such as "fever, cough, runny nose, shortness of breath, and rapid heartbeat" occur, you should seek medical attention immediately.

c. When seeking medical treatment, you should proactively inform the doctor that you have congenital heart disease. When invasive treatments are performed, such as tooth extraction, intubation, etc., antibiotics must be used to prevent endocarditis infection.

4. Medication and follow-up: Take medication on time according to the doctor's instructions, and return for regular follow-up examinations.

5. Wound care: For children undergoing surgical treatment, the wound dressing should be changed regularly. If redness, swelling or abnormal secretions appear, seek medical attention immediately.