ASD (Atrial Septal Defect) is a common type of congenital heart disease commonly called a hole in the heart which includes an abnormal opening in the wall between the upper chambers of the heart (right and left atria).
These may often close on its own by school age. Patients with smaller defects can lead a healthy life without even knowing it and those with medium-size defects may not face any problem until their middle age.
Signs and Symptoms of ASD
Patients with Atrial Septal Defect usually have a heart murmur. However, depending on the size of the atrial septal defect, the patient may experience symptoms like:
- Poor appetite
- Heart palpitations
- A decrease in exercise capacity
Treatment for Atrial Septal Defect closure
It depends on the location, size and severity of the defect. Very small defects might not need any treatment, except follow-up visits for observation. Medium-to-large-sized ASDs may need surgical correction or closure by the device. Different types of procedures can be performed for ASD closure.
Open surgery for ASD:
- The procedure is done under general anesthesia.
- Surgical closure of an Atrial Septal Defect includes closing the defect with a patch under direct visualization.
- A heart-lung machine is used.
- ASD is corrected through an opening in the right atrium.
- Smaller ASDs can be closed using a suture. However, for larger ASDs a patch is used to close the hole.
Minimally Invasive Surgery for ASD repair
- The procedure is performed under general anesthesia.
- Surgeons perform the surgery by making only a small 4-6 cm incision in the chest.
- The heart-lung machine is used so that the heart can be stopped for the sewing of the patch.
- A soft retractor is inserted which opens the space between the ribs that enables the insertion of specialized instruments.
- An endoscope is used to get a high-resolution image of the ASD and heart.
- With this technique for ASD closure, patients recover more quickly and the minimal scar will be barely visible after the patient recovers.
After Surgical Repair
- The patient needs to be in the hospital for 3- 4 days after the surgery.
- The patient may feel soreness, itchiness, numbness and tightness around the incision area.
- After the surgical repair of ASD, the main concern is the healing of the chest incision.
- The patient should spend the first few days at home doing quiet activities such as sleeping, reading and watching TV.
- Chest incision takes about six weeks to heal and able to return to normal activities.
- Patient must tell the doctor about his/her medical history.
- Clinical examination of the patient is done.
- The patient is advised to go for general tests to check for the fitness of surgery.
- The patient is counselled regarding the procedure.
- Usually performed in a cardiac catheterization lab.
- It includes closing the defect using a catheter inserted through the blood vessels.
- The catheter is placed in the right femoral vein and guided into the right atrium.
- When the catheter is in the right place, one disc opens up as the device moves out of the catheter. The tube portion plugs the hole and the other disc opens up on the opposite side of the hole.
- An X-ray called fluoroscopy is used to visualize the catheter.
- Once the device is placed at the right place, the catheter is pulled out.
- Usually, the patient stays in the hospital overnight for monitoring.
- The patient may be discharged the next day after evaluation and he/she is kept on oral antibiotics.
- The doctor recommends subacute bacterial endocarditis prophylaxis for six months or until complete closure is obtained.
- There's a risk of blood clots forming on the closure device while new tissue heals over it. However, medications are given to prevent blood clots.
- The patient should attend the follow-up appointments after the closure.
Prognosis of ASD closure
The long-term prognosis of Atrial Septal Defect closure is good and usually no additional surgery or catheterization is needed. However, regular monitoring with tests like ECG, echocardiography, stress test etc. are essential.
Diagnosis and Tests for ASD
- Physical examination: Physical examination of the patient is done by keeping in mind that patients with ASD usually have a heart murmur on auscultation.
- Chest X-ray: To identify the ASD, X-ray of the chest of the person is done. If he/she has ASD, then the heart may be enlarged.
- Echocardiogram: Echocardiogram shows an echo which is the pattern of blood flow through the atrial septal opening. It determines the opening's size.
- Electrocardiogram (ECG ): It includes the testing of the electrical activity of the heart; shows arrhythmias.