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
Copyright © Nucleus Medical Media, Inc.
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:
BleedingDamage to the heart or lungsReaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
(infection of the inner lining of the heart muscle)
Heart attackBlood clot formationArrhythmia
(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.
The doctor will examine your child. The doctor may order tests, like:
Blood and urine testsEchocardiogram
—a test that uses sound waves to visualize heart functioning
(ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
—a test that uses radiation to take a picture of structures inside the chest
—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.
will be used. It will block pain and keep your child asleep through the surgery.
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.
Your child will be monitored in the intensive care unit (ICU) with the help of the following devices:
Heart monitorBreathing tube (until your child can breathe on his own)Chest tubes—to drain fluids that have collected in the chestA line into an artery in the arm or leg—to measure blood pressureA tube through the nose and into the stomach—to drain fluids and gas that collect in the stomachBladder catheter
Pain or soreness during recovery will be managed with pain medicine.
The usual length of stay is 5-7 days. If there are complications, your child may need to stay longer.
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 handsWearing gloves or masksKeeping 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 sameReminding your child's healthcare providers to wear gloves or masksNot allowing others to touch your child's incisions
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.
After your child leaves the hospital, call your doctor if any of the following occurs:
Signs of infection, including fever and chillsIncreased sweatingRedness, swelling, increasing pain, excessive bleeding, or any discharge from the incision siteIncision opensNausea and/or vomitingIncreased painProblems with urinating (eg, pain, burning, urgency or frequency of urination, blood in the urine) or not urinatingCough, shortness of breath, or chest painRattling in the chestFatigueRashNot wanting to eat or drinkNoisy breathing
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 breathingBlue or gray skin colorNot waking up or not interacting
In case of an emergency, call for medical help right away.
Baylor College of Medicine. Atrial septal defect. Baylor College of Medicine website. Available at:
http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=atrial+septum+defect+repaircontent_id=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_room/c_art_14.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.
Last reviewed June 2013 by Michael J. Fucci, DO
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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