atrial septal defect
is a hole in the wall between the 2 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, such as lightheadedness and wheezing
endocarditis, an infection of the inner lining of the heart muscleHeart 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.
A physical exam will be done. Other tests may include: 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 medications.
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.
An incision will be made in 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 heart will be stopped to do surgery.
The pericardial sac around the heart will be opened. A small part of this sac may be removed and used 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 incision will be closed. The heart will then be restarted. Once it is working fine, the heart-lung machine will not be needed. The chest cavity will be closed. 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 unaidedChest 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 medication.
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, such as ECG and blood tests.Give pain medication.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:
Limit activities until your child's doctor says it is okay to resume them. Follow all of the doctor’s instructions.
In about 6 months, the heart tissue will grow over the sutures or patch.
Contact your child's doctor if your child's recovery is not progressing as expected or your child develops complications such as: Signs of infection, including fever and chillsIncreased sweatingRedness, swelling, increasing pain, excessive bleeding, or any discharge from the incision siteIncision opensNausea and/or vomitingIncreased painPain, 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 occur in your child:
Fast breathing or trouble breathingBlue or gray skin colorNot waking up or not interacting
In case of an emergency, call for emergency medical services right away.
Atrial septal defect (ASD). Cardiothoracic Surgery website. Available at:
http://www.cts.usc.edu/atrialseptaldefect.html. Accessed June 6, 2016.
Atrial septal defect. Children’s Hospital Boston website. Available at:
http://www.childrenshospital.org/az/Site477/mainpageS477P0.html. Accessed June 6, 2016.
Open-heart surgery. Cincinnati Children’s Hospital website. Available at:
http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/open.htm. Updated June 2015. Accessed June 6, 2016.
Atrial septal defect. Cove Point Foundation website. Available at:
http://www.pted.org/?id=atrialseptal4. Updated May 16, 2011. Accessed June 6, 2016.
Atrial septal defect. Kids Health—Nemours Foundation website. Available at:
http://kidshealth.org/parent/medical/heart/asd.html. Accessed May 2013. Accessed June 6, 2016.
Last reviewed June 2016 by Karri Kassir, 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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