Atrium septum defect
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Back to "Kardiologie"The atrium septum defect (ASD) or forecourt septum defect is a hole in the heart septum between the atria. It is with approx. 7.5% of all innate heart errors the third-most frequent innate heart false formation. A ASD arises also, except the singular forms described here, in connection with other heart errors and is then in its effect differently to be evaluated.
Forms
It arises in four variants:
Persisting Foramen oval
The simplest form of an atrium septum defect is the persisting Foramen oval. The Foramen oval is a door-like connection between the heart pre-chambers, which to the left permits in the fetalen (vorgeburtlichen) cycle the blood crossing of on the right of (lung cycle) (body cycle). Since the lung is not yet ventilated and thus also yet relevantly one does not supply with blood, the blood flows over the Foramen oval into the left pre-chamber and by the Ductus arteriosus (or also D.A. Botalli) from the lung artery into the Aorta.
The Foramen oval normally locks in the first life days or - for weeks. This happens not, speaks one of a persisting (continuous, continuous) Foramen oval (PFO). With the help of the Farbdopplerechokardiographie (ultrasonic) then a small blood river can be proven by this opening. The children are impaired and a treatment usually not necessarily.
After first references in the year 1996 meanwhile several investigations resulted in a connection between persisting Foramen oval and With 60-80 per cent of the with aura one finds this heart false formation. An artificial catch of the Foramen oval by a Schirmchen (Occluder), used by means of heart catheter technology, lets the disappear in one of two cases.
Type of sec. and around
The most frequent form is the forecourt septum defect mentioned by the Sekundumtyp, also ASD II. The hole lies in the center and depending upon size flows because of the difference of pressure in the Herzkammern a more or less large blood quantity from left to right, thus again into the lung cycle. This defect can be locked in many cases by using a sealing system with the heart catheter: a "Doppelschirmchen" or an autocentering from Nitinol (Amplatzer system) is inserted by the catheter into the hole and unfolded there. After over waxes with heart interior skin (Endokard) the hole is durably locked. A condition for it is that the hole is not too large, centrically lies and smooth edges has. If these conditions are not given, the hole must be locked by surgery.
A Endokarditisprophylaxe is not recommended with the ASD II. A pulmonale hypertonia (lung high pressure) by do not shunt is in the first life decades to be expected, since the difference of pressure is not very important in the forecourts. This heart error is sometimes also only diagnosed in juvenile or advanced adult age. It was shown that the patients get often important complaints starting from a certain shunting size with increasing age. Therefore important ASD II is today usually locked, even if the patients feel well.
To mention it would be still that nachgeburtlich unlocked a Foramen oval with relevance under the ASD II remained due to further false formations falls.
Ostium Primum type
The next frequent form is the Ostium primum defect, also ASD I mentioned. The hole lies in the lower portion of the forecourt septum, is enough until to the flap level near and is often connected with a malfunctioning of the Mitralklappe (between left forecourt and left ventricle = Herzkammer), rarer with a malfunctioning of the Trikuspidalklappe (between right forecourt and right Herzkammer). A heart catheter investigation or a Echokardiografie ("sip echo ") before the operation is only rarely necessary. This defect is locked always by surgery with a Patch from plastic or body-own fabric. After the operation if an often arising low-grade Mitralklappenfehlfunktion is determined, a far increased Endokarditisrisiko must be considered.
Sine Venosus type
A very rare form of the ASD is the sine venosus defect. It lies in the upper portion of the forecourt septum and in approx. 90% of the cases or several in right forecourt or into the upper Hohlvene falseleading into Lungenvenen is proven. Therefore here nearly always a Echokardiografie or a heart catheter before an operation is necessary. Also this defect is by surgery locked with a Patch and the Lungenvene/n is converted in such a way that the normal blood river is ensured into the left pre-chamber. As is the case for many defects within the forecourt range it comes in the long-term process more frequently to heartbeat disturbances.
Risks
Although nowadays a diagnosed ASD is usually locked, this false formation represents a fundamental risk for the concerning. Since smaller ASDs (also with normal ultrasonic investigations) remains partly unnoticed, for example dipping accidents arise with allegedly healthy divers despite adherence to all precautionary measures, since the thrombosehemmende filter function of the lung remains incomplete by the ASD.
Literature
- Dalla Volta G et al.: Prevalence OF patent foramen oval series OF large in A patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype. J Headache Pain (2005) 6 (4): 328-30. PMID 16362702
- Ferrarini G et al.:
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