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Atrial septal defects (ASDs) and ventricular septal defects (VSDs) are congenital heart conditions characterized by abnormal openings in the walls separating the heart's chambers. ASDs involve holes in the atrial septum allowing blood flow between the left and right atria, while VSDs involve openings in the ventricular septum permitting blood flow between the ventricles. These defects can range from small, asymptomatic lesions that may close spontaneously to large defects requiring surgical intervention.
Both ASDs and VSDs create abnormal left-to-right shunting due to higher pressures in the left-sided chambers. In ASDs, oxygenated blood flows from the left atrium to the right atrium, causing right heart volume overload and potential pulmonary overcirculation. VSDs allow oxygenated blood to flow from the left ventricle to the right ventricle, leading to increased pulmonary blood flow and potential left heart volume overload, with risk of pulmonary hypertension in large defects.
Small septal defects may be asymptomatic and detected incidentally through heart murmurs, while larger defects present with symptoms of congestive heart failure, poor feeding, and failure to thrive in infants. The presence of a systolic murmur, particularly in the context of developmental concerns or exercise intolerance, should prompt echocardiographic evaluation. Management decisions depend on defect size, symptoms, and evidence of heart chamber enlargement or pulmonary hypertension.