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Atrial Septal Defect Repair in Children—Open Heart Surgery

Definition

An atrial septal defect is a hole in the wall between the two 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
Arterial Defect Patch
Copyright © Nucleus Medical Media, Inc.

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.

Possible Complications

Complications are rare, but no procedure is free of risk. Possible complications may include:
  • Bleeding
  • Damage to the heart or lungs
  • Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
  • Infection, including endocarditis (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

The doctor will examine your child. The doctor may order tests, like:
  • 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.

Anesthesia

General anesthesia will be used. It will block pain and keep your child asleep through the surgery.

Description of the Procedure

First, the doctor will cut through 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 doctor will stop the heart to do surgery.
The pericardial sac around the heart will be opened. The doctor may remove a small part of this sac and use it 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 doctor will close the incision. The heart will then be restarted. Once it is working fine, the heart-lung machine will not be needed. The doctor will close the chest cavity. 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 on his own)
  • 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?

2-4 hours

How Much Will It Hurt?

Pain or soreness during recovery will be managed with pain medicine.

Average Hospital Stay

The usual length of stay is 5-7 days. If there are complications, your child may need to stay longer.

Post-procedure Care

At the Hospital
The hospital staff may:
  • Do tests (eg, ECG, blood tests).
  • Give pain medicine.
  • 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
At Home
When your child returns home, do the following:
  • If directed by the doctor, give antibiotics. This will help to prevent endocarditis. Also, give pain medicine as needed.
  • Keep the incision area clean and dry. Avoid applying lotion or powder to this area.
  • Have your child return to his normal diet.
  • Ask the doctor about when it is safe to shower, bathe, or soak in water. Usually, you will want to avoid giving your child a bath or allowing him to shower for 10 days after surgery.
  • Encourage your child to rest, especially during the first few days. He will slowly return to normal activities. Have your child avoid rough play.
  • Dress your child in loose, comfortable clothing.
  • If your infant had surgery, hold him by supporting his back and buttocks. Do not pull your baby up by the arms or under the arms.
  • Follow all of the doctor’s instructions.
In about six 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
  • Problems with urinating (eg, 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
  • Fatigue
  • Rash
  • 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 medical help right away.

RESOURCES

American Heart Association http://www.americanheart.org/

National Library of Medicine http://www.nlm.nih.gov/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

Heart and Stroke Foundation http://ww2.heartandstroke.ca/splash/

References

Baylor College of Medicine. Atrial septal defect. Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc%5Fname=atrial+septum+defect+repaircontent%5Fid=274. Updated April 2010. Accessed April 21, 2010.

Cardiothoracic Surgery. Atrial septal defect (ASD). Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/atrialseptaldefect.html. Accessed April 21, 2010.

Children’s Hospital Boston. Atrial septal defect. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site477/mainpageS477P0.html. Accessed April 21, 2010.

Cincinnati Children’s Hospital. Open-heart surgery. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/open.htm. Updated July 2009. Accessed April 21, 2010.

Cornell University. Taking care of your child after heart surgery. Cornell University website. Available at: http://www-users.med.cornell.edu/~spon/picu/parents/peddcwd.htm. Updated November 2001. Accessed April 21, 2010.

Cove Point Foundation. Atrial septal defect. Cove Point Foundation website. Available at: http://www.pted.org/?id=atrialseptal4. Updated April 2009. Accessed April 21, 2010.

Durham L, Mendelsohn A. Atrial septal defects: surgical and transcatheter management. Congenital Heart Information Network website. Available at: http://tchin.org/resource%5Froom/c%5Fart%5F14.htm. Updated May 2003. Accessed April 21, 2010.

Kids Health. Atrial septal defect. Kids Health website. Available at: http://kidshealth.org/parent/medical/heart/asd.html#. Accessed April 21, 2010.

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