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 close the hole. The hole may be stitched shut, patched over, or plugged with a device.
Copyright © Nucleus Medical Media, Inc.
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 is done to fix the hole.
Most children who have this surgery will have good results.
Problems are rare, but no procedure is free of risk. Some problems may be:
- Damage to the heart or lungs
- Reaction to anesthesia
- Infection, including endocarditis, an infection of the inner lining of the heart muscle
- Heart attack
- Blood clots
- Arrhythmia —heart rhythem problems
Before surgery, talk to the doctor about ways to manage things that may raise your child's risk of problems such as chronic diseases like diabetes or obesity. Low birth weight or a recent infection may raise the risk of problems.
What to Expect
Prior to Procedure
Your child may have:
- Blood and urine tests
- Echocardiogram —a test that uses sound waves to view the heart
- Electrocardiogram (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 —placing a tube into the heart through an artery
The doctor will tell you if your child needs to stop taking medicine. 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
A cut will be made in the skin and breastbone. The chest will be opened. Next, the heart will be connected to a heart-lung machine. This machine will take over the work 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 or plug. The patch is made of tissue from the heart sac or other material. Once the defect is repaired, the cut will be closed. The heart will then be restarted. Once it is working fine, the heart-lung machine will not be needed. The chest will be closed. Sutures will be used to close the skin.
Immediately After Procedure
Your child will be watched in the intensive care unit (ICU) with the help of:
- A heart monitor
- A breathing tube until your child can breathe without help
- Chest tubes to drain fluids that have built up 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 during recovery will be managed with pain medicine.
Average Hospital Stay
The usual length of stay is 5 to 7 days. If there are problems, your child may need to stay longer.
At the Hospital
The staff may:
- Do tests, such as EKG and blood tests.
- Give pain medicine.
- Gradually help your child eat a normal diet.
During the stay, staff will take steps to lower your child's chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your child's cuts covered
There are also steps you can take to lower your child's chances of infection such as:
- Washing your hands and your child's hands often and reminding visitors and staff to do the same
- Reminding your child's healthcare staff to wear gloves or masks
- Not letting others touch your child's cuts
When your child returns home:
- 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.
Call Your Doctor If Any of the Following Occur
Call your child's doctor if your child is not progressing or your child has problems such as:
- Signs of infection, such as fever and chills
- Increased sweating
- Redness, swelling, increasing pain, excessive bleeding, or any leaking from the incision site
- Incision opens
- Nausea and vomiting
- Increased pain
- Pain, burning, urgency or frequency of urination, blood in the urine, or not urinating
- Cough, problems breathing, or chest pain
- Rattling in the chest
- Not wanting to eat or drink
- Noisy breathing
Call for Medical Help Right Away If Any of the Following Occur
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 breathing
- Blue or gray skin color
- Not waking up or not interacting
In case of an emergency, call for emergency medical services right away.
American Heart Association
National Heart, Lung, and Blood Institute
Heart and Stroke Foundation
Atrial septal defect. Cove Point Foundation website. Available at: http://www.pted.org/?id=atrialseptal4. Updated January 24, 2017. Accessed June 26, 2018.
Atrial septal defect. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/heart/asd.html. Accessed September 2016. Accessed June 26, 2018.
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 26, 2018.
Last reviewed May 2018 by Karri Kassir, MD Last Updated: 1/27/2014