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Atrial Septal Defect Repair in Children—Transcatheter Procedure

Definition

An atrial septal defect is a hole in the wall between the two upper chambers (right and left atriums) of the heart. A transcatheter procedure is a minimally-invasive way to fix the hole. During this procedure, a device is implanted to seal the hole. As your child gets better, the device will trigger the heart tissue to grow. It will slowly grow over the hole.

Reasons for Procedure    TOP

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.

Blood Flow Through the Heart

Blood Flow Through the Heart
Copyright © Nucleus Medical Media, Inc.

Most children will have good results.

Possible Complications    TOP

Problems are rare, but no procedure is free of risk. Here are some problems:

  • Bleeding at the point of the catheter insertion
  • Damage to arteries
  • Allergic reaction to x-ray dye
  • Blood clots
  • Infection, including endocarditis, an infection of the inner lining of the heart muscle
  • Reaction to the anesthesia
  • Arrhythmia —heart beat problems

Talk to the doctor about ways to manage things that may raise your child's risk of problems such as chronic disease such as diabetes or obesity. Low birth weight or a recent infection may raise the risk of problems.

What to Expect    TOP

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

You will be told whether your child needs to stop taking certain medicine. Ask when your child should stop eating or drinking before the surgery.

Anesthesia

General anesthesia will be used. It will block any pain and keep your child asleep through the surgery.

Description of the Procedure    TOP

Your child will get IV fluid and medicines through a vein in the arm. A tube will be inserted either in the arm or groin. Next, electrodes will be placed on the chest. They will send information to the EKG machine, allowing the heart to be monitored.

A catheter will be placed in the blood vessel and advanced so the end is in the heart. Dye will be injected to allow the doctor to view x-ray images of the heart. An echocardiogram may also be used. Before the hole can be covered, the doctor will need to find out the size of the hole. A tube with a balloon attached to it will be sent to the upper chambers of the heart. The balloon will inflate and measure the hole.

When the size of the defect is known, another tube will be sent to the heart. This tube will have a device attached. There are many types of devices. Some are able to open so that the hole is covered on both sides. Others open like an umbrella to cover the defect. After the device is placed, the tube will be removed. Lastly, a bandage will be placed over the site.

Immediately After Procedure    TOP

Your child will be watched closely in the intensive care unit (ICU). The staff will:

  • Place pressure on the insertion site and apply a pressure bandage
  • Have your child lie flat

How Long Will It Take?    TOP

1 to 2 hours

How Much Will It Hurt?    TOP

Your child will have pain. Your child will be given pain medicine.

Average Hospital Stay    TOP

The usual length of stay is 2 to 4 days. In some cases, your child may be able to go home as soon as the next day. The doctor may choose to keep your child longer if there are problems.

Post-procedure Care    TOP

At the Hospital

When your child is recovering at the hospital, the staff may:

  • Do tests, such as an EKG, chest x-ray, and blood tests.
  • Have your child lie still and flat for several hours. This is to prevent bleeding.
  • Place a pressure bandage to reduce bleeding.
  • Encourage your child to drink plenty of fluids to flush the dye from his body.
  • Give pain medicine to ease discomfort.

During your stay, the 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

At Home

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.

Call Your Child’s Doctor If Any of the Following Occur    TOP

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
  • Nausea and vomiting
  • Lightheadedness
  • Increased pain
  • Lack of energy
  • Rash
  • Lack of hunger or poor feeding
  • Not drinking enough fluids
  • Not urinating

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 your child has:

  • Fast breathing or trouble breathing
  • Blue or gray skin color
  • Not waking up or not interacting
  • Chest pain
  • Heart palpitations
  • Lack of strength or fainting
  • Signs of a stroke, such as drooping facial muscles, changes in vision or speech, and difficulty walking

In case of an emergency, call for emergency medical services right away.

RESOURCES:

American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Heart and Stroke Foundation
http://www.heartandstroke.com

References:

Atrial septal defect. Cove Point Foundation website. Available at:
...(Click grey area to select URL)
Updated January 24, 2017. Accessed June 26, 2018.
Atrial septal defect. Kids Health—Nemours Foundation website. Available at:
...(Click grey area to select URL)
Accessed September 2016. Accessed June 26, 2018.
Open-heart surgery. Cincinnati Children’s Hospital website. Available at:
...(Click grey area to select URL)
Updated June 2015. Accessed June 26, 2018.
Last reviewed June 2018 by Karri Kassir, MD
Last Updated: 1/27/2014

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