Atrial septal defect (ASD) is a birth defect that causes a hole in the wall between the heart’s upper chambers (atria). 84 in every 100, 000 babies are born with this defect, yet not much attention is being given to it in Nigeria. Africa Health Report’s Gom Mirian sat down with Professor Karma Tayo Adeleke, a cardiologist and the president/CEO of Tristate Healthcare System, Lagos, who spoke extensively on the problem.
Excerpts:
Can you explain what atrial septal defects are?
Sure. Atrial septal defects, commonly known as a hole in the heart, is a congenital heart condition characterised by an abnormal opening in the atrial septum, the wall between the two upper chambers of the heart (atria). There are three main types of ASDs, including ostium secundum defect, ostium primum defect and sinus venous defect. This results in blood flowing abnormally between the chambers, which can lead to several health
complications.
Why are women linked more to ASD?
There is a common misconception that ASDs primarily affect children and young adults, causing this condition to fly under the radar in older individuals. However, ASD can occur in adults too, and it can remain undiagnosed for years. It has been proven that women are more likely to develop ASD than men. A significant number of women, particularly those above the age of 30, live with undiagnosed ASDs. Therefore, Nigerian women need to be aware of the symptoms and seek medical attention if they experience any.
Also, women who are planning to get pregnant should take extra precautions to ensure that they discuss the kind of medications they are using with a doctor to ensure they are in good health before conception. A healthy pregnancy leads to healthier babies.
What are some of the symptoms of ASD in children that mothers should look out for?
Symptoms of ASDs can vary, depending on the size of the defect. Small to moderate defects often do not cause noticeable symptoms and may go undiagnosed until adulthood. However, larger defects can lead to various symptoms, including shortness of breath, especially during physical activity, fatigue or easy tiring, recurrent lung infections, rapid or irregular heartbeat, poor feeding, slow weight gain, recurrent respiratory infections, delayed growth and development in children.
What are the causes of ASD in babies?
The exact cause of ASDs is not always clear, but they are generally believed to result from a combination of genetic and environmental factors. Genetic conditions like Down Syndrome and certain genetic heart disorders can increase the risk of developing ASD. Additionally, exposure to certain medications, toxins, or infections during pregnancy might contribute to the development of ASDs in some cases.
Can ASDs be detected during pregnancy?
Yes, atrial septal defects (ASDs) can often be detected during pregnancy. Routine prenatal ultrasound screenings can provide valuable information about the development of the baby, including the detection of structural abnormalities in the heart.
During a fetal echocardiogram, a specialised ultrasound examination focused on the baby’s heart, the healthcare provider can assess the structure and function of the fetal heart. This examination can often identify the presence of an ASD, its size impact on blood flow within the heart.
If an ASD is suspected during pregnancy, further diagnostic tests may be recommended, such as a more detailed fetal echocardiogram or a fetal MRI, to confirm the diagnosis and assess the severity of the defect. These tests can help guide appropriate management and plan for potential treatment options after birth. Early detection of an ASD during pregnancy allows for timely planning and coordination of postnatal care, including consultation with pediatric cardiologists and appropriate monitoring and treatment after the baby is born. However, it is unfortunate that most pregnant women in Nigeria only stop at the first stage of the ultrasound.
How is ASD diagnosed?
To diagnose an ASD, a cardiologist may perform several tests, including the physical examination. This involves listening to the heart with a stethoscope which reveal a heart murmur, which is often a key sign of an ASD. Echocardiogram is an ultrasound imaging technique which provides detailed images of the heart’s structures, enabling the visualisation of the defect and its size.
Electrocardiogram (ECG) is a non-invasive test that records the electrical activity of the heart and can help identify any abnormal rhythms or patterns, and finally, the chest X-ray which is an imaging technique that can show the size and shape of the heart and the blood vessels surrounding it, providing additional information about the defect.
What should pregnant women avoid during pregnancy to curb the risk of having babies born with ASD?
Yes, there are certain things that pregnant women can do to reduce their risk of having a baby with ASD. These include avoiding smoking, both on the part of the father and mother as it is connected to the risk of having a baby with ASD; avoiding alcohol during pregnancy as it can harm the baby’s development; ensuring they eat a healthy, balanced diet that comprises of fruits, vegetables, grains, and protein and attending prenatal check-ups regularly to monitor fetal development and identify any potential health issues early on.
I will emphasise nutrition as the key to preventing future illnesses that children are likely to acquire at birth, including atrial septal abnormalities.
Are there health complications arising from ASD?
If left untreated, ASD can lead to several health complications, including the enlargement of the heart, high blood pressure, heart murmurs, and in severe cases, heart failure.
What are some of the treatment options for ASD?
Treatment of ASDs depends on the size of the defect and associated symptoms. Small ASDs that cause no symptoms often do not require treatment and may close on their own as the child grows. For moderate to large defects, treatment options may include cardiac catheterisation. In this minimally invasive procedure, a catheter is inserted through a blood vessel and guided to the heart. A device or patch is then used to close the defect.
Open-heart surgery may be necessary for larger ASDs or in cases where catheter-based closure is not feasible. During the surgery, the defect is directly repaired using a patch or the patient’s tissue. Medications may be prescribed to manage symptoms like heart rhythm abnormalities or heart failure associated with large ASDs.
Is there anything else you would like to mention about ASD?
It is important to note that ASD occurs in about 2.5% of 1,000 live births, and 84 in every 100,000 people are affected with ASD globally and it can be managed with appropriate medical care. ASD can be diagnosed with tests such as chest X-rays, echocardiograms, and electrocardiograms. Early diagnosis and treatment are crucial for optimal management.
