Atrial Septal Defect (ASD) with clinical anatomy of heart

Atrial Septal Defect

Anatomy of heart

Heart located in front and left side of the chest near to the apex beat.

Superiorly,  an imaginary line passing through the jugular notch ,

In inferiorly,   a parallel line passing through the xiphoid process

bilaterally,  two imaginary vertical  to midclavicular  lines both sides.

Heart composed by cardiac muscle which is striated but involuntary and have intercalated disc.

Heart has 4 Chambers in human :

The right atrium receives non oxygenated  blood from the  superior  venacava and inferior  venacava  and pumps it to the right ventricle through the tricuspid valve.

The right ventricle get blood from the right atrium and pumps this non oxygenated  blood  to the lungs for oxygenation . The left atrium receives oxygenated blood from the lungs  (after  oxygenation )  and pumps it to the left ventricle.The left ventricle (more Powerful than another chmaber) pumps oxygenated  blood through the Arch Of Aorta in the whole body by powerful contraction.

Heart covered by a membrane that’s called pericardium.

Landmarks of Heart: Thoracic 5 to thoracic  8 vertebrata (supine), Thoracic 6  toThoracic 9 (erect)

Left atrium
Receives nutrient rich oxygenated blood from the lungs via the four pulmonary  veins.

Right atrium
Receives poor nutrient rich deoxygenated blood from the systemic circulation via the venacava.

left ventricle
Receives oxygenated blood from left atrium
Then pump to the arch of aorta.

Right Ventricle
Receives non oxygenated blood from right atrium then pump into the Pulmonary artery.

The heart is at the center of the cardiovascular  system, the heart  pumps blood through vassels  in the body to  the target target tissue. It is a  pyramidal organ made up of two muscular pumps that are

1) left heart and

 2) Right Heart
an upper part of the chamber that receive  incoming non oxygenated blood , called the atrium, and a lower part of the chamber thats pump blood out of the heart through the Aorta called the ventricle.

Circulation of blood :

Systemic circulation:

Blood pump left ventricle to arch of aorta

 Arch of aorta
Systemic aorta to whole body
After deoygenetion
Right atrim
Right ventricle

Pulmonary circulation:

 blood pass through the Right ventricle

Pulmonary aorta


Pulmonary vein

Left atrim

Left ventricle

The heart have three three muscular  layers of tissue. The inner layer is known as the endocardium and  outer layer is the epicardium. Between those two layers is known as the myocardium which is more thik than another.
The thickness of the middle layer  myocardium varies between regions of the heart.
the ventricles are altime thicker than the atria.
the left chambers are more thicker than the right Chamber , Left ventricle 3 times thicker than right ventricle    due  to pumps blood against greater resistance.

the heart needs own circulation network which is known as the coronary circulation by coronary artery  and vein.  The coronary arteries are arising from the base of the ascending aorta.

Coronary artery  gives numerous branches that supply  of the heart. There are several venous tributaries drain poor nutrient  deoxygenated blood from the heart and back it mainly to the right atrium; some vein have been shown to drain to the right ventricle.

Fetal circulation :

In intrauterine life, a physiological shunting of oxygenated blood enters the right atrium and passes the left atrium by foramen ovale  then blood  passed to the left  ventricle and pump  throughout the whole body

Some blood pass right atrium to lungs for oxygenation  via Pulmonary trunk then pass to left ventricle.
As a result blood of left ventricle mixed of oxygenated blood and de-oxygenated blood.
that’s called feotal circulation. In Normal condition the gap of foramen ovale repair Normally within three month of extrauterine life.

IMG 20200713 205811

Atrial septal defects

Atrial septal defects refer to abnormal communications between the left atrium and right atrium.   In Normal condition the gap of foramen ovale repair Normally within three month of extrauterine life.

Unluckily,  over time, the right atrium will be exposed to relatively higher pressures and its myocardium will hypertrophy and enlargement . If the right atrial pressure increase more than the left atrial pressure, the shunt will be change from ( left to right) to  (right to left). As a Result , blood with lower oxygen(more de oxygeneted blood/less oxygeneted blood )  saturation will be passed into the systemic circulation and occurs hypoxemia for low oxygen saturation.

Atrial septal defect vs ventricular septal defect  by doctors gang

genetic cause of atrial septal defects

  • DiGeorge  syndrome (microdeletion of 22q11.2),
  • Down syndrome  (trisomy 21), and
  •  Ellis-van Creveld syndrome or chondroectodermal dysplasia (mutation of 4p16 )

Types of Atrial septal defect

  1. Ostium secundum -75%(followed by patent foramen ovale)
  2. Ostium primum-15%(endocardial cushion defect)
  3. Sinus venosus-10%

Most common types of Atrial septal defect (ASD) is Ostium secundum
commonly diagnosed in childhood.
60% patients of ASD are female.
Most Commonly seen in female

Clinical feature of ASD :

  • Small defect -Asymptomatic
  • Large defect-have some symptoms
  • Wide and fixed splitting of 2nd heart sound & Soft mid-diastolic Murmur at left sternal border
  • Exercise intolerance
  • Fatigability
  • Increased perspiration
  • Failure to thrive or poor weight gain
  • Recurrent chest infection
  • Dyspnea on exertion
Know more:

Complications of ASD :

  • Pulmonary Hypertension with Eisenmenger syndrome
  • Atrial fibrilation
  • Pulmonary embolism
  • Systemic embolism
  • Infective endocarditis
  • Recurrent respiratory tract infection

Laboratory investigation :

  • Chest X-ray show cardiomegaly,  full Pulmonary conus
  • ECG change
  • ostium secundum show RBBB with Right axis daviation
  • 2.ostium primum show RBBB with left axis daviarion
  • 3.RSR pattern in V1
  • Echocardiogram show dilated right heart
  • CT or CMR maybe helpful

Treatment of ASD :

  • Counselling to the parents about ASD, treatment and Prognosis
  • Reduce volume overload and prevent congestive cardiac failure by furosemide
  • Surgical closure
  • Cardiac cathterizetion
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