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Atrial Septal Defect Repair in Children—Open Heart Surgery
An atrial septal defect is a hole in the wall between the 2 upper chambers (right and left atriums) of the heart. Open heart surgery can repair the hole, either by closing the hole with stitches or by placing a patch over it.
|Patch Repair for Atrial Septal Defect|
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Reasons for Procedure
If a child is born with a hole between the upper chambers of the heart, the blood can flow backward into the right side of the heart and into the lungs. This triggers the heart to work harder. Over time, this can lead to damage to blood vessels in the lungs and congestive heart failure . This procedure is done to fix the hole.
Most children who have this surgery will have good outcomes.
Complications are rare, but no procedure is free of risk. Possible complications may include:
- Damage to the heart or lungs
- Reaction to the anesthesia, such as lightheadedness and wheezing
- Infection, including endocarditis, an infection of the inner lining of the heart muscle
- Heart attack
- Blood clot formation
- Arrhythmia—abnormal heart rhythm
Before your child's procedure, talk to the doctor about ways to manage factors that may increase your child's risk of complications such as chronic disease such as diabetes or obesity. Low birth weight or a recent infection may increase the risk of complications.
What to Expect
Prior to Procedure
A physical exam will be done. Other tests may include:
- Blood and urine tests
- Echocardiogram —a test that uses sound waves to visualize heart functioning
- Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
- Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
- Cardiac catheterization —the insertion of a tube-like instrument into the heart through an artery
The doctor will tell you if your child needs to stop taking medicines. Ask the doctor when your child should stop eating or drinking before the surgery.
General anesthesia will be used. It will block pain and keep your child asleep through the surgery.
Description of the Procedure
An incision will be made in the skin and breastbone. The chest cavity will be opened. Next, the heart will be connected to a heart-lung machine. This machine will take over the functions of the heart and lungs. The heart will be stopped to do surgery.
The pericardial sac around the heart will be opened. A small part of this sac may be removed and used to patch the hole. A cut will be made in the right atrium. A small hole will be closed with sutures. A larger hole will be covered with a patch that is made of the sac or other material. Once the defect is repaired, the incision will be cloesd. The heart will then be restarted. Once it is working fine, the heart-lung machine will not be needed. The chest cavity will be closed. Sutures will be used to close the skin.
Immediately After Procedure
Your child will be monitored in the intensive care unit (ICU) with the help of the following devices:
- Heart monitor
- Breathing tube until your child can breathe unaided
- Chest tubes to drain fluids that have collected in the chest
- A line into an artery in the arm or leg to measure blood pressure
- A tube through the nose and into the stomach to drain fluids and gas that collect in the stomach
- Bladder catheter
How Long Will It Take?
How Much Will It Hurt?
Pain or soreness during recovery will be managed with pain medication.
Average Hospital Stay
The usual length of stay is 5-7 days. If there are complications, your child may need to stay longer.
At the Hospital
The hospital staff may:
- Do tests, such as ECG and blood tests.
- Give pain medication.
- Gradually transition your child to a normal diet.
During your stay, the hospital staff will take steps to reduce your child's chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your child's incisions covered
There are also steps you can take to reduce your child's chances of infection such as:
- Washing your hands and your child's hands often and reminding visitors and healthcare providers to do the same
- Reminding your child's healthcare providers to wear gloves or masks
- Not allowing others to touch your child's incisions
When your child returns home, do the following:
- Encourage your child to rest, especially during the first few days. He will slowly return to normal activities. Have your child avoid rough play.
- Follow all of the doctor’s instructions.
In about 6 months, the heart tissue will grow over the sutures or patch.
Call Your Doctor If Any of the Following Occurs
After your child leaves the hospital, call your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Increased sweating
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Incision opens
- Nausea and/or vomiting
- Increased pain
- Pain, burning, urgency or frequency of urination, blood in the urine, or not urinating
- Cough, shortness of breath, or chest pain
- Rattling in the chest
- Not wanting to eat or drink
- Noisy breathing
Call for Medical Help Right Away If Any of the Following Occurs
Call for medical help or go to the emergency room right away if any of the following occurs in your child:
- Fast breathing or trouble breathing
- Blue or gray skin color
- Not waking up or not interacting
In case of an emergency, call for emergency medical services right away.
American Heart Association
National Heart, Lung, and Blood Institute
Heart and Stroke Foundation
Atrial septal defect (ASD). Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/atrialseptaldefect.html. Accessed June 29, 2015.
Atrial septal defect. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site477/mainpageS477P0.html. Accessed June 29, 2015.
Open-heart surgery. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/open.htm. Updated June 2015. Accessed June 29, 2015.
Atrial septal defect. Cove Point Foundation website. Available at: http://www.pted.org/?id=atrialseptal4. Updated May 16, 2011. Accessed June 29, 2015.
Atrial septal defect. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/heart/asd.html. Accessed May 2013. Accessed June 29, 2015.
- Reviewer: Michael J. Fucci, DO
- Review Date: 06/2015
- Update Date: 01/27/2014