Pediatric Heart Expert Forum
ASD
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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ASD

Hello Dr,

Can you please help me.  I am 26 year old male and I suffer from migraines.  I was recently diagnosed with asd during a bubble study.  I was told that I have severe shunting and the hole accrdoing to the surgeon is between 8mm to 12 mm.  From what I understand there is no damage to the heart.  My MRI is normal but the surgeon was most concerned that the hole may lead to a stroke.  Could you please tell me what my risk is to have a stroke because of this hole, I do not have any risk factors such as high blood pressure.  Can you also tell me is 8mm to 12mm considered a big hole and whether I should consider closing a hole?  Thank you so much.
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Dear Alex,

An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of the heart.  They are the most commonly missed congenital cardiac defect, and can be found incidentally during other evaluations, such as in your case with your migraine evaluation.  Typically, these are found during childhood, and are repaired if they are large.  They do not have to cause “damage” to the heart (that can be seen), however.  But, they do lead to the risk of arrhythmias, exercise intolerance, and pulmonary hypertension (high blood pressure across the lungs).  Your defect, in measuring 8-12 mm, is considered a large defect.  The medical literature has demonstrated that closure of large defects, even in adulthood, is beneficial to patients, migraine or not.  I cannot evaluate your specific risk for a stroke, but I also believe that it is immaterial at this point, since you have a large defect.

Closing the defect, however, can easily be done by placing a device in the defect with a catheter that plugs the hole ASSUMING that you have appropriate anatomy for it.  Open-heart surgery can be performed, but most people elect to have the transcatheter device placed.  I recommend that, if you move forward with this, you have this performed at a location that performs lots of these procedures.
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