What is Atrial Septal Defect Surgery ?

Dr Foram Bhuta

Dr Foram Bhuta

BDS (Bachelor of Dental Surgery), 10 years of experience

February 26, 2022 Heart Diseases 375 Views

English हिन्दी Bengali

What is the meaning of Atrial Septal Defect Surgery?

A surgical procedure performed to repair an atrial septal defect is known as an atrial septal defect surgery. An atrial septal defect is a condition in which there is a hole in the septum or wall present between the two chambers of the heart, known as atria. An atrial septal defect is usually congenital, that is, present at birth. A small hole may be found by chance, and usually never causes a problem. They may even close on their own without treatment in early childhood.

A long-lasting and large hole may however cause damage to the heart and lungs and may require device closure or surgery to repair the atrial septal defects.

In this article, we will be discussing in detail about atrial septal defect surgery.

  • How does the heart normally work?
  • What are the types of Atrial Septal Defects?
  • What are the causes of Atrial Septal Defect?
  • What are the risk factors of Atrial Septal Defect?
  • What are the symptoms of Atrial Septal Defect?
  • How to diagnose Atrial Septal Defect?
  • How to prepare for Atrial Septal Defect Surgery?
  • What is the procedure of Atrial Septal Defect Surgery?
  • How to care after Atrial Septal Defect Surgery?
  • What are the complications of Atrial Septal Defect Surgery?
  • How to prevent Atrial Septal Defect?
  • What is the cost of Atrial Septal Defect Surgery in India?

How does the heart normally work?

  • The heart has four chambers, called the right and left atria (upper chambers), and the right and left ventricles (lower chambers).
  • The blood flows from the right side of the heart to the lungs.
  • The blood picks up oxygen from the lungs and returns this oxygenated blood to the left side of the heart.
  • The left side of the heart will then pump this blood to the different parts of the body through the aorta (the main artery of the heart).

What are the types of Atrial Septal Defects?

The different types of atrial septal defects include:

  • Secundum: The most common type of atrial septal defect is known as secundum. It occurs in the middle of the septum between the right and left atria.
  • Primum: This defect normally occurs in the lower part of the atrial septum.
  • Sinus venosus: This defect normally occurs in the upper part of the atrial septum.
  • Coronary sinus: This defect occurs between the wall of the coronary sinus (a part of the vein system of the heart) and the left atrium. ( Know more about- What are the causes of Cardiomyopathy? )

What are the causes of Atrial Septal Defect?

  • An atrial septal defect is a congenital condition, that is, it is present at birth.
  • This may occur due to errors in the early heart development, however, the exact cause of the atrial septal defect is not known. ( Know more about- What is Pediatric Cardiac Surgery? )
  • Environmental factors and genetics may play a role in causing the atrial septal defect.

What are the risk factors of Atrial Septal Defect?

Certain factors increase the risk of developing atrial septal defect in babies and may include:

  • Down syndrome (a genetic disorder that causes intellectual and developmental delays)
  • Family history of heart defects
  • German measles or rubella infection (a contagious viral infection causing a distinctive red rash) in the first few months of pregnancy
  • Drug abuse during pregnancy
  • Alcohol or tobacco consumption during pregnancy
  • Exposure to certain chemicals during pregnancy
  • Diabetes during pregnancy
  • Lupus (an autoimmune disorder, in which the disease-fighting system of the body attacks its own tissues) during pregnancy

What are the symptoms of Atrial Septal Defect?

The symptoms of atrial septal defect are:

  • Fatigue
  • Shortness of breath
  • Swelling of feet, legs, or abdomen (stomach)
  • Heart palpitations (a skipped heartbeat or extra heartbeat) ( Know more about- What are Cerebro-vascular diseases? )
  • Stroke (blood supply to the brain is interrupted)
  • Heart murmur (whooshing sound heard by the doctor through a stethoscope) 

How to diagnose Atrial Septal Defect?

  • Physical examination: The doctor may use a stethoscope to hear a heart murmur, which could indicate a heart defect. The symptoms, medical history, and family history of the patient are also noted.
  • Echocardiogram: Sound waves are used to produce the image of the heart in motion. It helps the doctor in visualizing the heart chambers and heart valves.
  • Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart and helps in the identification of heart rhythm problems. ( Know more about- What is Echocardiography? )
  • Chest x-ray: This test helps the doctor to check the condition of the heart and lungs.
  • CT scan: This test helps in obtaining clear images of the heart and diagnosis of congenital heart defects.
  • MRI scan: A magnetic field and radio waves are used to obtain clear images of the heart and other organs.
  • Cardiac catheterization: A catheter (thin, flexible tube) is inserted into a blood vessel at the arm or groin region and guided to the heart. This helps the doctor to check how well the heart is pumping, the valve function of the heart, measure the blood pressure in the lungs, and diagnose congenital heart defects. ( Know more about- What is Cardiac Catheterization? )

How to prepare for Atrial Septal Defect Surgery?

  • Your doctor should be told about the symptoms and medical history of the patient.
  • If the patient is taking any medications, herbs, or supplements, inform your doctor about the same.
  • If the patient is allergic or sensitive to any medicines, anesthetic agents, latex, iodine, or tape, tell your doctor about the same.
  • Inform the doctor if the patient has any history of bleeding disorders.
  • If the patient has a pacemaker or any other implanted cardiac device, inform your doctor about the same.
  • The patient will be instructed to stop taking blood-thinners like warfarin and aspirin a few days before the surgery.
  • The patient should avoid eating or drinking anything 8 hours before the procedure.
  • If the patient needs to take any medications before the procedure, they should be taken with small sips of water.
  • The patient should stop smoking at least two weeks before the procedure.

What is the procedure of Atrial Septal Defect Surgery?

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:

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.

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:

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.

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. ( Know more about- What is Heart Bypass Surgery? )

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.

Robot-assisted surgery:

  • The procedure is performed by using robotic arms, which are controlled by the surgeon through a computer. ( Know more about- What is Robotic Surgery? )
  • 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.

How to care after Atrial Septal Defect Surgery?

  • In case of cardiac catheterization, the patient is normally discharged on the next day of the surgery.
  • The patient can resume work one week after the cardiac catheterization procedure.
  • The patient may require a three to seven-day stay in the hospital following open-heart surgery.
  • It is normal to have some pain after the procedure, and the doctor may prescribe pain-relieving medications for the same.
  • The doctor may recommend antibiotics to be taken for six months after the surgery to prevent endocarditis (infection of the heart).
  • Complete recovery may take several weeks.
  • Call your doctor immediately if you notice any of the following after the surgery:
  • Breathing problems
  • Bleeding
  • Cyanosis (bluish color of the skin, lips, tongue, or nail beds)
  • Confusion or decreased alertness
  • Chest pain ( Know more about- What are the Home remedies for Chest Pain ? )
  • Fever
  • Inability to have a bowel movement
  • Inability to urinate
  • Leg pain, swelling, or redness
  • Extreme pain
  • Decreased activity in children
  • Poor appetite
  • Pus drainage, swelling, or redness of the incisions
  • Repeated echocardiograms are recommended after hospital discharge, one year after treatment, and as and when recommended by the doctor.
  • In cases of simple atrial defects that are closed during childhood, occasional follow-up appointments with the doctor are recommended.
  • In the case of adults who have had atrial septal defect surgery, monitoring is required throughout life to check for any complications.

What are the complications of Atrial Septal Defect Surgery?

The risks associated with an atrial septal defect surgery are:

  • Infection
  • Bleeding
  • Blood clot formation
  • Allergic reactions to anesthetic agents
  • Heart attack
  • Pulmonary hypertension (increased pressure of blood in the lung arteries)
  • Lung failure
  • Kidney failure

( Know more aboutWhat is Acute Kidney Failure? )

  • Heart arrhythmias (irregular heart rhythm)
  • Damage to the artery from the catheter
  • Stroke
  • Death

( Know more about- What are the Arrhythmias of heart ? )

How to prevent Atrial Septal Defect?

An atrial septal defect can be prevented by:

  • 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
  • Monitor health problems that may occur during pregnancy
  • Eat a healthy diet
  • Maintain a healthy weight
  • Exercise regularly
  • Avoid alcohol, tobacco, and drug consumption during pregnancy

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

The total cost of atrial septal defect surgery in India can range from around INR 3,00,000 to INR 5,00,000. However, many prominent hospital doctors in India specialize in atrial septal defect surgery. But the cost varies across different hospitals. 

If you are coming from abroad, apart from the cost of atrial septal defect surgery, there will be an additional cost of living in a hotel and the cost of local travel. After the procedure, the patient is kept for seven days in the hospital and seven days in the hotel for recovery. So, the total cost of atrial septal defect surgery in India comes to a total of INR 3,90,000 to INR 6,50,000. 

We hope that we could answer all your questions regarding atrial septal defect surgery through this article.

If you need more information about atrial septal defect surgery, you can contact a Cardio-Vascular and Thoracic Surgeon.

We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan. 

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