Atrial septal defect (ASD), a cardiac congenital malformation, is an abnormal communication between the two atria (the two small chambers at the top of the heart).
Ventricular septal defect (VSD) is a congenital cardiac malformation representing an abnormal communication between the two ventricles (the two larger chambers at the bottom of the heart).
Left chamber (left atrium and left ventricle) pressure is higher than right chamber (right atrium and right ventricle) pressure. Thus, an atrial septal defect permits an abnormal flow of blood from the left chambers of the heart to the right chambers of the heart (left-to-right shunt).
The volume of blood passing from the left side of the heart to the right side of the heart depends on the size of the septal defect and the pressure difference between the chambers. This leads to the increase in the volume of the right side of the heart and in the lungs, and to left ventricle overload. The flow increase in the right ventricle and in the lungs make the right ventricle work harder and consequently dilate. Subsequently, the right ventricle can no longer effectively pump the blood to the lungs, leading to pooling of the blood in the abdomen and the lower extremities (the so-called right heart failure).
The increased blood flow in the lungs leads to the occurence of structural changes leading to pulmonary hypertension and, in the end, the right chambers pressure becomes higher than the left chambers pressure, and shunt reversal occurs (reversal of the left-to-right shunt to a right-to-left shunt).
These defects are innate, and the patient may be symptom free for a long period of time (depending, as mentioned above, on the size of the shunt, the pressure difference between the left cavities). Over time, symptoms appear – such as failure to thrive in infants, exertional dyspnea, recurrent pulmonary infections, palpitations, fatigue, cyanosis of the skin (bluish coloration indicating deoxygenation of the arterial blood), leg edema.