This is a "hole" in the wall that separates the top two chambers of the heart. Every child is born with an opening between the upper heart chambers. It's a normal fetal opening that allows blood to detour away from the lungs before birth. After birth, the opening is no longer needed & usually closes or becomes very small within several weeks or months. Sometimes the opening is larger than normal & doesn't close after birth. In most children the cause isn't known. Some children can have other heart defects along with ASD. This causes blood to flow from the right to left atria & vice versa! Which means you can also get backwards blood flow which is very bad for the heart! Your heart has to work much harder just to pump the same blood out when someone has an ASD compared to a normal healthy heart!