Pathophysiology:

In atrial septal defect, left and right atrial pressures usually are equal; thus, no pressure gradient exists between the
atria. However, the increased thickness of the left ventricle as compared to the right ventricle makes the left ventricle less
compliant and, therefore, harder to fill.

Blood flow takes the path of least resistance and, thus, is shunted from the left atrium to the right atrium. The net effect is
to increase the volume work of the right ventricle. The increased volume pumped through the pulmonary vasculature may
lead to architectural changes in the pulmonary vasculature and to the development of irreversible pulmonary hypertension
- a serious but rare complication.

Atrial Septal Defect (ASD) is a congenital heart disease that allows blood to flow from the left atrium into the right
atrium, and occasionally from the right atrium to the left atrium. This defect creates what is called shunting, or
mixing of the oxygenated blood, from the left side of the heart with the deoxygenated blood of the right side. Such
defects in the atrial septum account for 12% of all congenital heart diseases and are more common in women. Aside
from incomplete closure of the foramen ovale, septal defect occurs during the development of the fetal heart in the
first two weeks after conception. Although there are some suggestions that some forms may be genetic, the cause of
most ASDs is unknown.
A septal defect is a hole in the septum, the muscle wall separating the heart's upper-right chamber (the right atrium) from
the upper-left chamber (the left atrium) and the lower-right chamber (the right ventricle) from the lower-left chamber (the
left ventricle). A septal defect is sometimes called "a hole in the heart
Atrial septal defect (ASD) means that the hole is located between the upper chambers of the heart (the right and left atria).
Since the pressure is higher on the left side of the heart, blood gets pushed through the hole from left to right. This may
cause the right atrium to become enlarged.

Blue Baby Syndrome
Cyanotic heart problems, commonly known as Blue Baby Syndrome, can occur as a
consequence of a right to left shunt. The deoxygenated (blue) blood will bypass the lungs
and circulate throughout the systemic circulation resulting in blue coloration of the skin
(right photo). Blue baby syndrome accounts for 25% of congenital heart defects.
Although atrial septal defects can occasionally cause this defect, the most common cause
of the disease is tetrology of fallot.