Atrial Septal Defect Repair in Children—Open Heart Surgery
Definition
An 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 close the hole. The hole may be stitched shut, patched over, or plugged with a device. In about 6 months, the heart tissue will grow over the sutures or patch.
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Reasons for Procedure
An atrial septal defect can cause blood to 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 surgery is done to fix the hole.
Possible Complications
Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:
- Excess bleeding
- Problems from anesthesia, such as wheezing or sore throat
- Allergic reaction to x-ray contrast material
- Infection, including endocarditis, an infection of the inner lining of the heart muscle
- Blood clots
- Damage to arteries
- Heart rhythm problems
Things that may raise the risk of problems are:
- Recent infection
- Low birth weight
- Chronic diseases, such as diabetes or obesity
What to Expect
Prior to Procedure
The surgical team may meet with you to talk about:
- Anesthesia options
- Any allergies your child may have
- Current medicines, herbs, and supplements that your child takes and whether your child needs to stop taking them before surgery
- Fasting before surgery, such as avoiding food or drink after midnight the night before
- Tests that will need to be done before surgery, such as images of the heart
Anesthesia
General anesthesia will be used. Your child will be asleep.
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. A bandage will be placed over the area.
Immediately After Procedure
After the operation, your child will be taken to the intensive care unit (ICU) for observation.
How Long Will It Take?
2 to 4 hours
Will It Hurt?
Pain and swelling are common in the first 1 to 2 weeks. Medicine and home care can manage pain.
Average Hospital Stay
The usual length of stay is 5 to 7 days. If your child has any problems, he or she may need to stay longer.
Post-procedure Care
At the Hospital
Right after the procedure, the staff may:
- Give your child pain medicines
- Have your child lie still and flat for several hours. This is to prevent bleeding.
During your child's stay, the staff will take steps to lower the chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your child's incisions 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 staff to wear gloves or masks
- Not letting others touch your child's incisions
At Home
It will take about 6 weeks to fully heal. Physical activity will need to be limited during recovery. Your child may need to delay return to school.
Call Your Doctor If Any of the Following Occur
Call the doctor if your child is not getting better or has:
- Signs of infection, such as fever and chills
- Increased sweating
- Redness, swelling, increasing pain, excessive bleeding, or any leaking from the incision
- Incisions that open
- Nausea and vomiting
- Lightheadedness
- Pain that cannot be controlled with medicine
- 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 problems breathing
- Blue or gray skin color
- Problems waking up and interacting
- Chest pain
- Fast heartbeat
- Lack of strength or fainting
- Signs of a stroke, such as drooping facial muscles, changes in vision or speech, and problems walking
If you think your child is having an emergency, call for medical help right away.
RESOURCES:
American Heart Association
http://www.heart.org
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov
CANADIAN RESOURCES:
Health Canada
https://www.canada.ca
Heart and Stroke Foundation
http://www.heartandstroke.com
REFERENCES:
Atrial septal defect. Cove Point Foundation website. Available at: http://www.pted.org/?id=atrialseptal4. Accessed November 3, 2020.
Atrial septal defect. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/parent/medical/heart/asd.html. Accessed November 3, 2020.
Atrial septal defects. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/atrial-septal-defects. Accessed November 3, 2020.
Geva T, Martins JD, et al. Atrial septal defects. Lancet. 2014 May 31;383(9932):1921-1932.
Open-heart surgery. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/open.htm. Accessed November 3, 2020.
Last reviewed September 2020 by EBSCO Medical Review Board Kari Kassir, MD Last Updated: 5/7/2021