middle portion of the septum (central heart wall), the secundum defect, they may even close on their own (spontaneous closure). However,
moderate and large holes do not close, and the extra work over the years places a strain on the right side of the heart causing an enlargement of both the receiving and pumping chambers (atria and ventricles). It is therefore, usual for treatment to be recommended in the first few years of life for larger holes, before
excessive strain has been placed on the
heart. Holes at the bottom (primum defects) and large holes in the middle (secundum defects) may require surgical patching and any abnormality of the mitral valve will usually be repaired at the same time as the atrial septal defect is closed. However, most holes with good margins (sufficient surrounding tissue) may be closed using an
atrial septal defect occlusion device which is placed in position by way of a catheter from the femoral vein, thus avoiding the need for open heart surgery (see Cardiac Catheterisation Topic Note).
Follow Up Advice
Most patients with a cardiac defect, whether repaired or not, will require antibiotic cover during any dental treatment to prevent any bacteria entering the blood stream from where they can reach the heart causing bacterial endocarditis (infection of the heart lining), which can be very serious. If there was repair of the valve, it may have a residual leak which will require monitoring in case further surgery or valve replacement is needed. However, many patients cope very well with leaky valves and do not need further surgery.
