What is an Atrial Septal Defect (ASD)?
Some children are born with a hole in the wall between the upper two chambers of the heart, called the atria. This hole is called an atrial septal defect. Although this defect usually does not cause any symptoms or problems in a young child, over a lifetime there can be harmful effects on the heart and lungs. Although most ASDs can now be closed with a closure device deployed by a catheter (a long thin tube) threaded from an opening in a blood vessel in the groin, occasionally open heart surgery is still used to close this hole. Children more likely to need surgery have a:
- Larger hole than the device can close
- Not enough tissue to hold the device in place
- Other heart problems that must also be addressed at the time of surgery.
Preparing for the Procedure
Prior to cardiac surgery, this heart defect will be diagnosed with an EKG, a chest X-ray and an echocardiogram. Before surgery, blood tests are conducted to be sure that there is no infection, no problem with clotting and a normal range of electrolytes are in the blood. A blood test to determine the blood type and compatibility is performed so that blood is available for the surgery if necessary.
Beginning for the Procedure
The child is placed under general anesthesia, and special monitoring intravenous lines are put in. The chest is entered through the sternum (breastbone). This procedure is often feasible through only a partial opening in the sternum using a minimally invasive approach.
The heart/lung machine is then connected to the heart to temporarily take over the work of the heart and the lungs while the repair is done. The right atrium is opened and the hole is visualized. It is closed either by direct sutures or by using a patch. The patch can be synthetic material, or most often, a piece of pericardium (part of the sac surrounding the heart).
The heart is then allowed to fill and take over its normal function. The chest incision is closed after placing a drainage tube. The child is allowed to awaken from anesthesia after the procedure and is taken off the breathing machine.
After the Procedure
The child will need a day or two to recover from anesthesia, the use of the heart-lung bypass machine and from the surgery. The goals during this time are for the child to return to normal activities -- to drink, to eat, to get up and walk around and to control any pain from surgery.