Investigations

This is an ECG from a 5-month-old infant with a large atrial septal defect. Note the right axis deviation, the right ventricular hypertrophy and the rSR pattern. These are the three "classical" ECG findings in someone with an ASD, although in reality you rarely see all three, if any.

This is a chest x-ray from a young girl with an atrial septal defect. The plain film of the chest shows a heart with a slightly increased transverse diameter. Both lateral borders of the heart are convex due to enlargement of the right atrium, right ventricle and right ventricular outflow tract. The arrow is pointing at the enlarged right ventricular outflow tract and pulmonary artery which is obliterating the normal concavity of the left atrial appendage. At cardiac catheterisation the pulmonary to systemic blood flow ratio was greater than 2:1 and the defect was subsequently closed surgically.

This chest x-ray is from an older child with a large atrial septal defect. It shows a normal size heart with lack of prominence of the aortic knuckle. There is pulmonary plethora consistent with a left to right shunt. It is more likely to be an ASD given the lack of obvious ventricular enlargement.

These two echos demonstrate a large atrial septum defect. In the 2-D images a large hole can be seen in the atrial septum. When the colour Doppler is switched on you can see red flow across the defect. This means that the flow of blood is towards the probe which is at the bottom of the image, in other words from the left atrium to the right atrium, a left to right shunt.