Atrial Septal Defect Repair in Children—Open Heart Surgery
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
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 (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)
Some factors that may increase the risk of complications include:
- Pre-existing conditions (eg, poor kidney functioning)
- Low birth weight
- Recent infection
Discuss these risks with the doctor before the surgery.
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.
]]>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?
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.
At the Hospital
The hospital staff may:
- Do tests (eg, ECG, blood tests).
- Give pain medicine.
- Gradually transition your child to a normal diet.
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.
- Do not give your child a bath or allow 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
- Not wanting to eat or drink
- Noisy breathing
American Heart Association
National Library of Medicine
Heart and Stroke Foundation
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Cardiothoracic Surgery. Atrial septal defect (ASD). Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/atrialseptaldefect.html . Accessed April 21, 2010.
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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.
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Health Library editorial staff and contributors. Heart valve replacement. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated November 2009. 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.
Rosenblum L. Septal defects. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated September 2009. Accessed April 21, 2010.
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Last reviewed May 2010 by ]]>David N. Smith, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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