Question 1

1) What are the complications of Atrial Septal Defect Surgery?

Accepted Answer

The risks associated with an atrial septal defect surgery include:

Infection
Bleeding
Blood clot formation
Allergy to anesthetic agents
Heart attack
Heart failure
Pulmonary hypertension (increase in the pressure of blood in the lungs)
Eisenmenger syndrome (permanent damage to the lung caused by pulmonary hypertension)
Kidney failure
Lung failure
Arrhythmia (irregular heart rhythm)
Damage to the artery from the catheter
Stroke
Death

Question 2

2) What is an Atrial Septal Defect?

Accepted Answer

The presence of a hole in the septum or wall between the two upper chambers of the heart, that is, the right and left atria, is known as an atrial septal defect.

Question 3

3) What are the different types of Atrial Septal Defects?

Accepted Answer

The different types of atrial septal defects include:
Secundum: This defect occurs in the middle of the septum between the atria, and is the most common type of atrial septal defect.
Primum: This defect occurs in the lower portion of the atrial septum.
Coronary sinus: In this type of defect a part of the wall between the left atrium and the coronary sinus (a part of the venous system of the heart) is missing.
Sinus venosus: This type of defect occurs in the upper part of the atrial system.

Question 4

4) What are the causes of Atrial Septal Defects?

Accepted Answer

Atrial Septal defects are usually congenital, that is, present at birth. However, the exact cause of atrial septal defects is unknown.
Genetic and environmental factors may play a role in causing atrial septal defects.

Question 5

5) What are the risk factors of Atrial Septal Defects ?

Accepted Answer

Certain factors may increase the risk of developing atrial septal defects, which include:

Smoking during pregnancy
Alcohol consumption during pregnancy
Drug abuse during pregnancy
Exposure to some chemicals during pregnancy
Diabetes during pregnancy
Lupus (an autoimmune disorder in which the body’s disease-fighting system attacks its own tissues and organs) during pregnancy
Family history of septal heart defects
Rubella infection (a viral infection causing a distinctive red rash) during the first few months of pregnancy
Down syndrome (a genetic disorder causing delayed growth and development)

Question 6

6) What are the symptoms of Atrial Septal Defects?

Accepted Answer

In the early stages, atrial septal defects may show no symptoms. In the later stages, atrial septal defects may show the following symptoms:

Shortness of breath
Heart palpitations (extra heartbeats or skipped heartbeats)
Swelling of the legs or feet
Swelling of the abdomen
Fatigue
Stroke (a condition in which the blood supply to the brain is stopped)
Heart murmur (a whooshing sound heard through a stethoscope)

Question 7

7) How to diagnose Atrial Septal Defects?

Accepted Answer

Atrial Septal defects can be diagnosed using the following tests:

Physical examination: The doctor will examine your symptoms. Your medical history and family history are noted. The doctor may hear a heart murmur using a stethoscope, which may indicate a heart defect.
Chest x-ray: It helps the doctor to evaluate the condition of the heart and lungs.
Imaging tests: CT scans and MRI scans may be used to obtain clear pictures of the heart.
Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart.
Echocardiogram: High-frequency sound waves are used to obtain the images of the heart in motion.
Cardiac catheterization: A catheter (thin, flexible tube) is inserted into a blood vessel in the arm or groin region and guided to the heart. This test helps in diagnosing congenital heart defects, checking the function of the heart valves, checking how well the heart is pumping blood and measuring the blood pressure in the lungs.

Question 8

8) How to prepare for Atrial Septal Defect Surgery?

Accepted Answer

The following preparation may be required for an atrial septal defect surgery:

The doctor should be told about any medical conditions that may be present.
If you have a pacemaker device or any other implanted cardiac device, inform the doctor about the same.
If are on any medications, herbs, or supplements currently, tell the doctor about the same.
In case of any known allergic reactions to anesthetic agents, latex, tape, medications, or iodine, tell your doctor about the same.
You may be advised to stop taking blood-thinning medications like aspirin and warfarin a few days before the procedure.
Avoid eating or drinking anything after midnight, the day before the surgery.
Stop smoking at least fifteen days before the procedure.

Question 9

9) What is the treatment for Atrial Septal Defects?

Accepted Answer

Small atrial septal defects usually cause no problem and may close on their own. Septal defects that do not close may require treatment, which can include:
1. Medications:

Although medications cannot treat atrial septal defects, they can help in relieving the symptoms associated with an atrial septal defect.
Medicines can also be used for reducing the risk of developing complications after surgery.
Beta-blockers can be prescribed to keep the heartbeat regular.
Anticoagulants help in reducing the risk of blood clot development.

2. Surgery:
A medium to large septal defect can be repaired by surgery to prevent further complications.
The different types of surgical procedures that can be performed include:

a) Cardiac catheterization:

The procedure is done by injecting local anesthesia (numbs the area of insertion) in the area of catheter insertion.
A flexible, thin tube known as a catheter is inserted into a blood vessel in the groin region and guided to the heart using imaging tests.
A mesh patch or plug is placed through the catheter to close the hole.
The heart tissue eventually grows around the mesh to permanently seal the hole.
This type of procedure is performed to repair the secundum type of atrial septal defects, although the large secundum atrial septal defects may require open-heart surgery.

b) Open-heart surgery:

The procedure is generally done under general anesthesia, that is, the patient is put to sleep during the procedure.
An incision is made by the surgeon in the chest region.
The surgeon uses patches made of synthetic material or pericardium (lining of the heart) to close the hole.
Smaller defects can be closed using sutures (stitches).
A heart-lung bypass machine takes over the function of the heart, which is pumping of blood to the rest of the body, during the procedure while the heart stops working.
The bypass machine is removed once the procedure is complete.
This procedure is done to repair primum, coronary sinus, and sinus venosus atrial defects.

c) Minimally invasive surgery:

The procedure is performed under general anesthesia.
A small, three-incision is made in the side of the chest.
Special instruments are used by the surgeon to repair the septal defect through the small incision.
The surgeon will make an incision in the groin area to provide access to the heart-lung bypass machine.
This procedure causes less pain and has a quicker recovery than open surgery.
It causes less trauma to the surrounding organs and tissues and a smaller incision is made by the surgeon as compared to open surgery. The surgical tools are threaded around the tissues and muscles, instead of displacing them or cutting through them, as in open surgery.

d) Robot-assisted surgery:

The procedure is performed by using robotic arms, which are controlled by the surgeon through a computer.
Several tiny porthole incisions are made between the ribs.
A thin, lighted instrument known as a thoracoscope and special surgical tools are inserted through these incisions to perform the procedure.
This procedure involves less pain and a quicker recovery compared to open surgery.

Question 10

10) What are the post-operative steps after Atrial Septal Defect Surgery?

Accepted Answer

The patient is usually discharged on the next day of a cardiac catheterization surgery.
The patient can go to work one week after the cardiac catheterization surgery.
After open-heart surgery, the patient stays in the hospital for three to seven days.
It is normal to experience some soreness after the procedure. The doctor may recommend pain-relieving medications for the same.
The doctor prescribes antibiotics to be taken for six months after the atrial septal defect surgery to prevent endocarditis (heart infection).
Complete recovery of the patient may take many weeks.

Contact your doctor right away if you notice any of the following after the surgery:

Bleeding
Cyanosis (bluish color of the skin, tongue, lips, and nailbeds)
Breathing difficulties
Confusion
Pain in the chest
Fever
Inability to have a bowel movement
Inability to urinate
Leg pain, redness, or swelling
Decrease in activity seen in children
Decrease in appetite
Pus drainage or swelling in the incision area
Echocardiograms are recommended after discharge from the hospital as and when recommended by the doctor.
In cases of small, simple atrial defects that get closed on their own during childhood, an occasional follow-up appointment with the doctor is recommended.

In the case of adults who undergo surgery for atrial septal defect repair, life-long monitoring is required.

Question 11

11) How to prevent Atrial Septal Defects?

Accepted Answer

Atrial septal defects can be prevented in the following ways:

Get all your vaccinations before you plan for a pregnancy
Talk to a genetic counselor before you plan a pregnancy if you have a family history of heart defects
Get prenatal care before you plan your pregnancy
Keep your blood sugar levels under control during pregnancy
Eat a healthy diet
Maintain a healthy weight
Monitor health problems that may occur during pregnancy
Exercise regularly
Avoid alcohol, tobacco, and drug consumption during pregnancy

Question 12

12) What is the cost of Atrial Septal Defect Surgery in India?

Accepted Answer

The cost of an atrial septal defect surgery varies depending on the type of surgery performed, the severity of the condition, and the overall health of the patient.
The cost is different in different hospitals and amongst different doctors. Generally, atrial septal defect surgery cost in India ranges from INR 3,00,000 to INR 5,00,000.

Atrial Septal Defect Surgery

Symptoms

Diagnosis

Atrial Septal Defects can be diagnosed in the following ways:

Treatment

Risks

After Procedure