Atrial Septal Defect Surgery-Causes Risks and Procedure

Heart is a muscular organ that pumps blood in your body. It is the center of your circulatory system. This system consists of network of blood vessels, such as arteries, veins and capillaries. These blood vessels carry blood to and from all areas of your body. Heart has two sides separated by an inner wall called septum. The septum prevents mixing of blood between the two sides of the heart. However some babies are born with holes in the upper or lower septum. A hole in the septum between the heart’s upper chambers is called an atrial septal defect(ASD) and between the lower chambers is called as ventricular septal defect (VSD).The surgery performed to correct atrial septal defect is known as Atrial septal defect surgery.

Holes in the heart are simple congenital heart defects. Congenital heart defects are problem with the heart’s structure that is present at birth. These defects change the normal flow of blood through the heart.

Over the past few decades the diagnosis and treatment of ASD and VSDs have greatly improved. Children who have simple congenital heart defects can survive to adulthood and live normal, active and productive lives because their heart defects close on their own or have been repaired.

However, an ASD may not produce noticeable signs or symptoms especially if the defect is small

Causes:
  • Mother’s of the children are born with atrial septal defects (ASDs), ventricular septal defects (VSDs) or other types of heart defects often think that they did something wrong during pregnancy to cause problems.However,most of the time doctors don’t know why congenital defects develop
  • Heredity also plays an important role in some heart defects. If a parent had a congenital defect the chances of defect in the child grow higher, very rarely more than one child in the family is born with a heart defect.
  • Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. Half of all the babies with Down syndrome have congenital heart defects
  • Smoking during pregnancy also has been linked to several congenital heart defects including septal defects.
  • Scientists continue to still search the causes of congenital heart defects. ASDs account for about 10-15% of all congenital cardiac abnormalities.
Types of ASD

  • Ostium secundum defect- 70% of ASDs.
  • Ostium primum defect- 20% of ASDs.
  • Sinus venosus defect-10% of ASDs.
  • Coronary sinus septal defect-1% ASDs.


Complications due to ASD

  • Right heart failure as ASD causes the right side of the heart to work harder.
  • Arrhythmias or extra flow of blood into the right atrium though ASD. Symptoms include palpitations or rapid heartbeat.
  • Stroke- Usually lungs filter out small blood clots that can form on the right side of the heat. Sometimes blood clot can pass from right atrium to the left atrium through ASD and be pumped out to the body. This type of clot can travel to an artery in the brain, block airflow and cause stroke.
  • Pulmonary hypertension which is an increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen. Overtime, PH can damage the arteries and small blood vessels in the lungs. They become thick and stiff making it harder for blood to flow through them.

Surgery/Transplants Procedure

Atrial septal defect repair requires an open heart surgery.

Atrial septal defect surgery in India is performed in the cardiac catherisation lab. In most of the cases Local or general anesthesia is given by a qualified anesthetist.

  • The patient is given medicine so that he or she will sleep through the surgery and will not feel any pain
  • During the surgery Atrial septal defect surgeon makes an incision in the chest to reach the ASD. Surgeon then repairs the defect with a special patch that covers the hole.
  • Patient is placed on the heart lung bypass machine so that the heart can be opened to do the surgery
  • The outlook for children after ASD is excellent. On an average, children spend 3-4 days in the hospital before going to home. Complications such as bleeding and infection from ASD surgery are very rare.
  • While in hospital the patient will be given medicines as needed to reduce pain or anxiety.
  • While discharge all the post operative guidelines will be given


How it works:

  • After ASD heart surgery for congenital defects the patient goes to an intensive care unit for continued cardiac monitoring. Continued ventilator support is required by the patient.
  • Chest tubes allow blood to be drained from inside the chest as the surgical site heals
  • Pain medications will be continued and the patient may remain under general anesthetic
  • Within 24 hours the chest tubes and ventilation may be discontinued
  • Any cardiac drugs used to help the heart perform better will be adjusted as per the patient's condition
  • For temporary procedures additional follow-up with the physician will be required to judge timing for complete repair, In the meantime the patient should continue to grow and thrive normally
  • Complete repair requires follow up with the physician initially to judge the adequacy of repair, but thereafter will be infrequent with good prognosis
  • The child should be made aware of any procedure to be communicated for future medical care in adulthood

Risks
There are risks and complications with Atrial septal defect treatment. They include

  • Higher lifetime risk from exposure to radiation
  • Abnormal rhythm that continues for a long time.This may need an electric shock to correct.
  • Major bruising or swelling(Hematoma)
  • Bleeding around catheter site
  • High or low blood pressure.
  • Sore throat from anesthetic tube or echo probe
  • Rare risks include- Stroke or TIA(transient ischemic attack)which may cause long term disability
  • Device infection which will need open heart surgery and antibiotics
  • Puncture of the heart with a collection of blood around the heart. This will require surgery to repair.
  • Clots in the leg with pain and swelling. Rarely this clot may break off and go into the lungs

Cost

Atrial septal defect surgery cost varies from hospital to hospital and depends on the surgeon. The surgery is costly though ranging in lakhs.There are hospitals in India that provide best atrial septal defect surgery at affordable costs and effective treatment with well qualified surgeons. More and more people are coming to India for surgery as it is cheaper and with the qualified surgeons and they are getting the treatment at a cheaper price but same quality

Recovery
  • Patients will be transferred to the cardiac Intensive Care Unit where they will spend next 24 hours.
  • After awakening from anesthesia a feeling of disorientation is common.
  • Pain relievers are given to prevent the feeling of pain at the site of incision
  • Breathing will be through a tube called endotracheal tube(ET) inserted into the mouth and going to the trachea, The ET is attached to a ventilator which will breathe for the patient
  • When the patient is more alert, they will be able to breathe on their own. At this time the ET will be removed and pure oxygen will be provided through a facemask and eventually nasal prongs.
  • The patient will spend the remainder of the time in regular hospital unit, where their heart will be monitored continuously.
  • The patient is encouraged to walk along the hallways while connected to the monitoring machines.
  • The patient’s stay in hospital is usually 4-5 days long enough time to ensure that the defect is closed completely and that the tissue swelling is decreased.
  • The usual time required for the full recovery is six to eight weeks.
  • Patients are usually prescribed an anticoagulation medication to prevent possible blood clotting.
  • The time required to regain full energy strength is usually 3-6 months.

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