Atrial septal defects

Last reviewed: 1 Mar 2023
Last updated: 27 Jan 2023



History and exam

Key diagnostic factors

  • systolic ejection murmur
  • fixed splitting of the second heart sound
More key diagnostic factors

Other diagnostic factors

  • mid-diastolic murmur
  • congestive cardiac failure
  • failure to thrive
  • symptoms of atrial arrhythmias
  • cyanosis
  • finger clubbing
Other diagnostic factors

Risk factors

  • female gender
  • maternal alcohol consumption
  • positive FHx
More risk factors

Diagnostic investigations

1st investigations to order

  • echocardiogram
  • ECG
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • chest CT/MRI
  • cardiac catheterization
More investigations to consider

Treatment algorithm


left-to-right shunt

right-to-left shunt



Sachin Khambadkone, MD, DCH, DNB

Consultant in Paediatric and Adolescent Cardiology

Interventional Cardiologist

Honorary Senior Lecturer

Paediatric and Adolescent Cardiology

Great Ormond Street Hospital and Institute of Child Health




SK declares that he has no competing interests.


Dr Sachin Khambadkone would like to gratefully acknowledge Dr Brandon Lane Phillips, Dr Frank Cetta, and Dr David J. Driscoll, previous contributors of this monograph. BLP, FC, and DJD declare that they have no competing interests.

Peer reviewers

Alexander Opotowsky, MD, MPH

Senior Fellow

Adult Congenital Heart Disease and Pulmonary Hypertension

Department of Cardiology

Children's Hospital Boston

Department of Medicine

Division of Cardiology

Brigham and Women's Hospital




AO declares that he has no competing interests.

Gianluca Rigatelli, MD, FACP, FACC, FESC, FSCAI


Section of Transcatheter Treatment of Congenital Heart Disease in the Adult

Rovigo General Hospital




GR declares that he has no competing interests.

  • Atrial septal defects images
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  • Guidelines

    • Advances in managing transition to adulthood for adolescents with congenital heart disease
    • ACC/AHA 2008 guidelines for the management of adults with congenital heart disease
    More Guidelines
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