Atrial Septal Defect

[Deborah Panethiere]

When I was five, I had surgery to repair pulmonary stenosis.  I have done well until the last two years.  I am a 44 year old teacher and mother of two.  I have progressively felt more and more tired.(Many nights I sleep for 1-2 hours after work.) During my last visit with my doctor, he heard a strange heart murmur.  He sent me to a cardiologist who did a stress echo and a transesophical echo.  These tests showed an ASD and minor leakage from the pulmonary valve.  This doctor referred me to the Mayo Clinic's Center For Adults With Congenital Heart Defects.  My insurance would not pay for this visit, so they referred me to another cardiologist in Kansas City.  He did a heart cath which showed that the ASD did dnot open unless probed, although I was sedated during this test.  I passed out immediately ont he tilt table, so he did an echo in the standing position and another transesophical echo in the standing position.  He found that the ASD was approximately 2 cm., with some shunting and moderate pulmonary insuficiency.  The right side of my heart is slightly enlarged.  The second doctor sent me to a surgeon.  I was surprised when the surgeon told me that he did not recommend the surgery because I had previous heart surgery and because I had asthma. Also, he doesn't feel it would aleviate my symptoms. Do you have any info. that might help?

[Peggy Sumner]

I am 43 and recently have found out that I have an ASD, confirmed by a TEE.  I have seen three cardiologists all who feel I should have it fixed and just as Deborah a surgeon has informed me that this may not clear up the problem.  He stated that I had symptoms and they found an ASD but this may not be my problem and even after surgery might not feel better????   I'm confused.  Deborah, what has happened to you if you are still monitoring this site, I would like to know.  Is there anyone else out there our age with ASD????????

Confused in Tennessee.

[Cleveland Clinic, MD]

Dear Deborah,

The treatment of ASD is currently a controverial topic.  ASD (atrial septal defect) is often undetected and is usually correctable once it is found.  In this condition there is a hole between the upper chambers of the heart.  Long term complications of this disorder if it is not corrected include lung and heart failure.  

Correction can be done surgically or via catheter.  The surgical approach involves open heart surgery and about a week's hospitalization.   The catheter approach is currently done only at large medical centers and uses a "clamshell" device that clamps the hole shut.  It is done through a small hole usually in the leg.

The controversy is whether small VSDs need to be closed or not.  This decision will be ultimately between you and your doctor.