Hearing the words "heart disease" certainly makes any parent's heart race, especially when it concerns a newborn. Congenital heart disease is a condition present from birth and is one of the most common birth defects. One fairly common type is atrial septal defect, or ASD. This article will help you understand what ASD is, how to recognize it, and what treatment options are available.
What is Congenital Heart Disease?
Congenital Heart Disease (CHD) is a structural abnormality of the heart that develops in the womb, specifically during the development of the baby's heart during the first trimester of pregnancy. This abnormality can include a hole in the heart wall, narrowing of the blood vessels, or an abnormal position of the heart and blood vessels.
Congenital heart disease (CHD) is one of the most common congenital abnormalities worldwide. In Indonesia, it is estimated that approximately 8 out of every 1,000 babies born have congenital heart defects of varying severity.
Risk factors that can increase the likelihood of PJB include:
- The mother had certain infections during pregnancy, such as rubella
- The mother had uncontrolled diabetes during pregnancy.
- Consumption of certain medications during pregnancy without medical supervision
- Genetic factors or history of PJB in the family
- Exposure to cigarette smoke or harmful substances during pregnancy
What is an Atrial Septal Defect (ASD)?
Atrial Septal Defect (ASD) is a type of congenital heart disease (CHD) in which there is a hole in the wall (septum) that separates the right and left atriums of the heart . Normally, the right and left atriums of the heart are completely separated to prevent oxygen-rich and oxygen-poor blood from mixing.
When there's a hole in the septum, oxygen-rich blood from the left atrium can flow into the right atrium and mix with blood that's supposed to be sent to the lungs. As a result, the heart and lungs have to work harder than usual.
ASD is one of the most common types of congenital heart disease, and is more common in girls than boys.
ASD Symptoms in Infants and Children
ASD symptoms vary greatly depending on the size of the hole. Small holes may not cause any symptoms and may even close on their own as the child grows. However, larger holes can cause concerning symptoms, such as:
- Babies get tired easily when breastfeeding or doing activities
- Shortness of breath, especially during activity or crying
- Slow growth and weight gain
- Frequent recurrent respiratory tract infections (cough, cold, pneumonia)
- Heart palpitations (in older children)
- In ASD with high pulmonary pressure causing blood flow to shunt back from the right heart to the left (Eisenmenger syndrome) The skin or lips may appear bluish (cyanosis) — in such conditions, immediate treatment is required.
It's important to remember: Many babies with ASD don't show any symptoms early in life. Therefore, routine newborn heart screenings are crucial for early detection.
How Is ASD Diagnosed?
Doctors usually detect ASD through the following series of examinations:
- Auscultation: The doctor may listen for abnormal heart sounds (murmurs) using a stethoscope.
- Echocardiography (heart ultrasound): The primary test for diagnosing ASD. It can show the size, location of the hole, and how much it affects blood flow.
- ECG (Electrocardiography): Records the electrical activity of the heart to detect rhythm abnormalities or heart enlargement.
- Chest X-ray: To see if there is an enlarged heart or changes in the lungs due to ASD.
ASD Treatment: What Are the Options?
Not all ASDs require immediate intervention. Treatment depends on the size of the hole, the child's age, and the presence or absence of symptoms. The following treatment options are available:
1. Periodic Monitoring (Observation)
For small ASDs, your doctor may simply recommend regular monitoring. Many small ASDs close on their own before the child is 5 years old without requiring any medical intervention.
2. Closure with a catheter (Transcatheter Closure)
This procedure is performed without major surgery. The doctor inserts a thin tube (catheter) through a blood vessel in the thigh and then places a special device (occluder) over the hole in the heart. This procedure is generally effective, carries fewer risks, and has a shorter recovery time than open surgery.
3. Open Heart Surgery
For large ASDs or those in specific locations that prevent catheter placement, open-heart surgery may be necessary. The surgeon will close the hole using stitches or a patch made of tissue or synthetic material. This surgery has a very high success rate.
4. Supportive Treatment
In some cases, a doctor may prescribe medications to help the heart work more efficiently, control the heart rhythm, or prevent complications while waiting for the right time for definitive action.
Can PJB Be Prevented?
Not all cases of congenital heart disease (CHD) can be prevented, especially those caused by genetic factors. However, there are steps you can take during pregnancy to minimize the risk:
- Perform pregnancy check-ups (ANC) regularly and routinely
- Ensure rubella immunization before planning a pregnancy.
- Consume folic acid from planning pregnancy until the first trimester.
- Avoid smoking, alcohol, and exposure to harmful chemicals during pregnancy.
- Consult your doctor about all medications you are taking before and during pregnancy.
- Keep your blood sugar levels under control if you have diabetes.
Consult with our specialist doctor
Early detection of ASD and congenital heart disease is key to successful treatment. With the right screening technology and care from an experienced medical team, children with ASD have a very good chance of healthy and normal growth.
If you have any concerns about your baby or child's heart condition, don't hesitate to consult with our specialist doctors. We are ready to support you and your family with caring and professional service.
Article written by Dr. Ina Nadia Irawadi, Sp.JP (K) (Heart & Blood Vessel Specialist - Consultant for Congenital Heart Disease & Pediatric Cardiology, EMC Sentul Hospital).