An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of your heart (atria). The condition is present at birth (congenital).
Small defects might be found by chance and never cause a problem. Some small atrial septal defects close during infancy or early childhood.
The hole increases the amount of blood that flows through the lungs. A large, long-standing atrial septal defect can damage your heart and lungs. Surgery or device closure might be necessary to repair atrial septal defects to prevent complications.
If the ASD is small enough, it can be closed with a special device. The procedure is done in the heart catheterization lab.
During heart catheterization, the doctor carefully puts a long, thin tube called a catheter into a vein or artery in your child’s neck or groin. The groin is the area at the top of the leg. Then, the catheter is threaded through the vein or artery to your child’s heart.
The doctor who does the procedure is a cardiologist, which means a doctor who works on the heart and blood vessels. This may not be your child’s regular cardiologist.
Many babies who are born with atrial septal defects (ASDs) have no signs or symptoms. When signs and symptoms do occur, heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat.
Often, a heart murmur is the only sign of an ASD. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Doctors can listen to heart murmurs and tell whether they’re harmless or signs of heart problems.
Over time, if a large ASD isn’t repaired, the extra blood flow to the right side of the heart can damage the heart and lungs and cause heart failure. This doesn’t occur until adulthood. Signs and symptoms of heart failure include:
A large atrial septal defect can cause extra blood to overfill the lungs and overwork the right side of the heart. If not treated, the right side of the heart eventually enlarges and weakens. The blood pressure in your lungs can also increase, leading to pulmonary hypertension.
There are several types of atrial septal defects, including:
It’s not known why atrial septal defects occur, but some congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. If you have a heart defect, or you have a child with a heart defect, a genetic counselor can estimate the odds that future children will have one.
Some conditions that you have during pregnancy can increase your risk of having a baby with a heart defect, including:
A small atrial septal defect might never cause any problems. Small atrial septal defects often close during infancy.
Larger defects can cause serious problems, including:
Less common serious complications may include:
Hearing a heart murmur during a checkup might cause your or your child’s doctor to suspect an atrial septal defect or other heart defect. For a suspected heart defect, your doctor might request one or more of the following tests:
This test also checks heart valves and looks for signs of heart defects. Doctors can also use this test to evaluate your condition and determine your treatment plan.
However, this test usually isn’t needed to diagnose an atrial septal defect. Doctors might also use catheterization techniques to repair heart defects.
The surgeon provides specific instructions to the patient prior to the ASD closure procedure, discussing risks such as bleeding, infection, or adverse reaction to anesthesia.
Patients also meet with the anesthesiologist prior to the surgery to review their medical history. Patients should not eat after midnight the night before the surgery.
On the day of surgery, the patient arrives at the hospital, registers, and changes into a hospital gown. A nurse reviews the patient’s charts to make sure there are no problems.
The anesthesiologist then starts an IV, and the patient is taken to the operating room, where the surgeon verifies the patient’s name and procedure before any medication is given. Surgery will begin once the patient is under anesthesia.
For pediatric patients: It’s important that children are free from infection – including dental infections – for up to six weeks prior to surgery. Please be sure that your child’s immunization records are made available to your surgeon or the nurse.
Before the surgery begins, a cardiologist starts a transesophageal echocardiogram (TEE) so the surgeon can look at the heart structure during surgery.
The surgeon then makes an incision in the breastbone to reach the heart, and the patient is placed on a cardiopulmonary bypass machine – which pumps blood to the body, bypassing the heart and lungs except for the coronary arteries – while the heart is stopped temporarily. An incision is then made in the heart’s right atrium to access the defect.
The patch – either the patient’s own pericardial tissue or a synthetic graft – is then stitched onto the hole in the septum to close it.
The heart is closed with sutures, and the cardiopulmonary bypass machine is removed. Pacing wires are placed temporarily on the heart to prevent heart rhythm abnormalities after the operation. Chest tubes are placed to collect residual blood or fluid in the chest after the surgery, and the skin is closed with stitches or staples.
After surgery, patients are taken to the intensive care unit and monitored. Pain is likely, and pain medication is given as appropriate. Patients also are on a respirator and have a breathing tube for the first few hours after surgery.
The length of the hospital stay depends on how quickly a patient recovers and can perform some physical activity.
The cost of ASD closure surgery ranges from $3500 – $5500 in India.
When it comes to surgery related to the heart, the safety and the comfort of the patients is top most on the agenda and the Indian hospitals are the perfect role model in that regard.
The larger opening in the septa can cause serious complications and therefore, it must be closed surgically by an experienced cardiac surgeon. For a smaller ASD defect, cardiac catheterization is typically suggested as the primary treatment. But for a larger ASD defect, heart surgery is considered as the best possible option. Minimally invasive ASD heart surgery in India has a high success rate and is carried out by extensively trained and experienced doctors.