Treatment

Many atrial septal defects close on their own during childhood. For those that don't close, some small atrial septal defects might not require treatment. But many persistent atrial septal defects eventually require surgery.

Medical monitoring

If you or your child has an atrial septal defect, your cardiologist might recommend monitoring it for a time to see if it closes on its own. Your doctor will decide when you or your child needs treatment, depending on your condition and whether you or your child has other congenital heart defects.

Medications

Medications won't repair the hole, but they may be used to reduce some of the signs and symptoms that can accompany an atrial septal defect. Drugs may also be used to reduce the risk of complications after surgery. Medications may include those to keep the heartbeat regular (beta blockers) or to reduce the risk of blood clots (anticoagulants).

Surgery

Many doctors recommend repairing a medium to large atrial septal defect diagnosed during childhood or adulthood to prevent future complications. However, surgery isn't recommended if you have severe pulmonary hypertension because it might make the condition worse.

For adults and children, surgery involves sewing closed or patching the abnormal opening between the atria. Doctors will evaluate your condition and determine which of two procedures to use:

• Cardiac catheterization. Doctors insert a thin, flexible tube (catheter) into a blood vessel in the groin and guide it to the heart using imaging techniques. Through the catheter, doctors place a mesh patch or plug to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.

  This type of procedure is used to repair only the secundum type of atrial septal defects. Some large secundum atrial septal defects, however, might require open-heart surgery.

• Open-heart surgery. This type of surgery is done under general anesthesia and requires the use of a heart-lung machine. Through an incision in the chest, surgeons use patches to close the hole. This procedure is the only way to repair primum, sinus venosus and coronary sinus atrial defects.

  This procedure can be done using small incisions (minimally invasive surgery) and with a robot for some types of atrial septal defects.

Follow-up care

Follow-up care depends on the type of defect, the treatment suggested and whether other defects are present. Repeated echocardiograms are done after hospital discharge, one year later and then as requested by your or your child's doctor. For simple atrial septal defects closed during childhood, only occasional follow-up care generally is needed.

Adults who've had atrial septal defect repair need to be monitored throughout life to check for complications, such as pulmonary hypertension, arrhythmias, heart failure or valve problems. Follow-up exams are typically done yearly.