Atrial Septal Defect Closure (ASD)

An atrial septal defect (ASD) is a congenital heart defect where there is a hole in the atrial septum, the wall which separates the right and left atria. A small opening is usually always present at birth, but seals shortly thereafter. If the opening persists, it is called ASD. Females are twice as often affected than males. There are three major types of ASDs.

• Secundum. This defect is in the middle of the atrial septum and is the most common form of ASD. At least half of these ASDs close on their own; however, it is less likely if the defect is large.
• Primum. This defect is in the lower part of the atrial septum. It often occurs along with problems in the heart valves that connect the upper and lower heart chambers. These aren’t very common and do not close on their own.
• Sinus Venosus. This defect is in the upper part of the atrial septum, near where the large vein brings oxygen-poor blood from the upper body to the right atrium. These types of ASDs are rare and do not close on their own.

A doctor may first suspect an atrial septal defect or other heart defect during a regular checkup if he or she hears a heart murmur while listening to the heart using a stethoscope.

Symptoms can develop in childhood or later in life depending on the size of the defect. Some may experience:

• Shortness of breath
• Fatigue
• Heart palpitations
• Decrease in exercise capacity

If your doctor finds that you have a large ASD, they will need to perform surgical closure to avoid potentially dangerous conditions, such as congestive heart failure or stroke.  

BEFORE THE PROCEDURE

The heart surgeon performing your procedure will provide specific instructions and discuss risks such as bleeding, infection, or adverse reaction to anesthesia. Patients will also view their medical history with the doctor prior to the surgery. You are directed not to eat after midnight the night before the surgery.

When you arrive at the hospital, you will change into a hospital gown and a nurse will review your charts to ensure that there are no problems. Before the surgery begins, an echocardiogram will be started so that the surgeon can look at the heart structure during surgery. An anesthesiologist will then start an IV and the surgery will begin once the patient is under anesthesia.

DURING THE PROCEDURE

The surgeon will make an incision in the breastbone to reach the heart, and the patient is placed on a cardiopulmonary bypass machine (a heart-lung machine). This machine is used for support and pumps blood into the body, bypassing the heart and lungs, but not the coronary arteries. This is necessary 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 the ASD. 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. Finally, the skin is closed with stitches or staples.

AFTER THE PROCEDURE

After the surgery, patients are taken to the intensive care unit and monitored. Pain is likely and medication is given as appropriate. Patients also are on a respirator and have a breathing tube for the first few hours after surgery. Every patient is different, and the stay at the hospital depends on how quickly a patient recovers.