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 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. Cardiac surgery to close this hole is usually performed before the child starts going to school.
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 and no problem with clotting and that a normal range of electrolytes are in the blood. A blood test to determine the blood type and compatibility will be performed so that blood will be available for the surgery.
During the procedure
The child will be placed under general anesthesia, and special monitoring intravenous lines will be 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 being done. The right atrium is then opened and the hole is visualized. It is closed either by direct sutures or by using a patch of 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 usually allowed to awaken from anesthesia within a couple of hours and is taken off the breathing machine. In adolescents, a minimally invasive port access (Heartport) approach may be used.
After the procedure
The child will need a day or two to recover from general anesthesia, from the use of the heart-lung bypass machine and from the surgery. The main goals during this time will be 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.
Click here for recovery guidelines after discharge for congenital heart defect repair at the Inova Heart Center.