Most physicians agree that no matter how small the hole, ASD should be treated during childhood if it is detected. Closing the hole in a child can prevent serious medical problems later in life. ASD is typically repaired in adults as well. Treatment of ASD depends on a number of factors, including the size of the hole, the severity of the symptoms and how the condition is affecting the heart muscle and function.

Treatment may include certain medications, such as diuretics, which flush out excess fluids and minerals from the body. Removing excess fluids can lower blood pressure and somewhat relieve the burden on the right ventricle. This treatment is usually reserved for larger ASDs. Additionally, digoxin, which reduces the exertion of the heart muscle, may be used with larger ASDs.

In some cases (e.g., primum ASDs),  open-heart surgery may be necessary to correct the defect. This is no longer the optimal treatment for less serious cases, but it remains an important option for patients with more severe forms of ASD. The surgery is usually done by age 5, before any significant damage or malformation develops as a result of the defect.

The strategy for closing a defect during surgery depends on the size of the hole. Smaller holes are closed by stitches (sutures). Larger defects are patched with a large “swatch” made of either a synthetic material or the patient’s own tissue (often from the fluid-filled sac around the heart called the pericardium).

When an ASD occurs with other defects, the surgery becomes more complicated. However, the surgery to treat an ASD alone has a relatively low risk and a high rate of success; the risk of death from surgery is less than 1 percent.

More recently, less serious cases (secundum ASDs) have been treated with a catheter closure technique. In one such procedure, a septal occluder (a type of elastic catheter made of flexible wire) is fed through an artery and guided to the heart. There, it is implanted in the septal hole. Once in place, it is expanded to lie across the defect and seal the hole. In another catheter-based procedure, a clamshell or umbrella device is opened inside the heart to block the hole.

By using a catheter instead of opening up the chest through surgery, patients face much less trauma and pain and do not undergo cardiopulmonary bypass, which carries risks of its own. They can leave the hospital sooner and scarring is greatly reduced.

Researchers are also evaluating a method to squeeze a patch into a catheter and snake it through the body up to the heart. Once in place, the physician can place the patch over the hole, sealing it. The patch eventually becomes covered with the body’s tissues. In these catheter procedures, physicians will often prescribe antibiotics to help prevent infection and complication.

Another treatment method is minimally invasive heart surgery in which three or four small incisions are made in the chest and specially designed instruments are passed into the chest to repair the ASD. For smaller ASDs, this has become the treatment of choice when surgery is indicated. During this procedure, a partial lower sternotomy is used, meaning the surgeon cuts through the lower part of the breastbone to expose the heart.

In the future, physicians may use robotic technology to further reduce the trauma and complications associated with ADS.

Once treated, ASDs are usually cured for life and there is no need for taking medication or other treatments. The repair of the defect generally has no harmful effects on normal growth and development. Patients, especially children, may need to be monitored by a cardiologist for a period of time.