Atrial septal defect complications


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Atrial septal defect is associated with complications such as atrial fibrillation, pulmonary hypertension, heart failure, and stroke.

Atrial septal defect and atrial fibrillation
50-60% of atrial septal defect patients over the age of 40 will develop atrial fibrillation. Late-onset atrial fibrillation is associated with both morbidity and mortality. Anticoagulation may lower the mortality risk.

Atrial septal defect and pulmonary hypertension
15-20% of atrial septal defect patients develop pulmonary hypertension. Although rare in children and adolescents, pulmonary arterial hypertension is observed in approximately 50% of patients over the age of 40. The development of Eisenmenger's syndrome can result in reversal of the original left-to-right shunt which may switch to become a right-to-left shunt. Right-to-left shunting can in turn lead to deoxygenation (hypoxemia and cyanosis).

Atrial septal defect and right heart failure
Atrial septal defect is associated with left-to-right shunting which in turn may be associated with right ventricular volume overload. Patients may experience right heart failure as a result of right ventricular volume overload.

Atrial septal defect and stroke
Even without surgery, as many as 5-10% of all atrial septal defect patients experience thromboembolic events such as stroke and transient ischemic attack. Paradoxical emboli in atrial septal defect patients is not correlated with defect size and can occur in all ASD patients.