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Atrial Septal Defect Surgery
A surgical procedure done to repair an atrial septal defect is called atrial septal defect surgery.
An atrial septal defect is the presence of a hole in the septum (wall) between the right and left atria (the upper two chambers of the heart). The condition is congenital, that is, it is present at birth.
The heart is made up of four chambers, called the right and left atria (upper chambers), and right and left ventricles (lower chambers). The right side of the heart provides blood to the lungs. The blood will pick up oxygen in the lungs, and return the blood to the left side of the heart. The left side of the heart will then pump out blood through the aorta (the main artery of the heart) to the rest of the body.
In case of an atrial septal defect, the hole leads to an extra amount of blood flowing through the lungs and overworking of the right side of the heart. If left untreated, the right side of the heart enlarges and weakens. The pressure of blood in the lungs also increases, known as pulmonary hypertension.
The symptoms of atrial septal defect are:
- Fatigue
- Shortness of breath
- Stroke (caused by an interrupted blood supply to the brain)
- Swelling of the legs and feet
- Swelling of the stomach
- Heart palpitations (skipped beats or extra beats)
- Heart murmur (a whooshing sound heard by the doctor through a stethoscope)
Atrial Septal Defects can be diagnosed in the following ways:
- Physical examination: The doctor may check for various symptoms of a septal defect. A heart murmur may indicate a heart defect.
- Echocardiogram: Sound waves are used to check the heart chambers, measure the pumping strength of the chambers, check the valves of the heart, and also look for signs of heart defects.
- Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and identification of heart rhythm problems.
- Chest x-ray: The condition of the heart and lungs can be evaluated using a chest x-ray.
- CT scan and MRI scan: These are imaging tests done to obtain a clear image of the heart and detect any heart abnormalities.
- Cardiac catheterization: A catheter (thin, flexible tube) is inserted into a blood vessel in the groin or arm region and guided to the heart. It helps the doctor to diagnose any congenital heart defects, check the function of the heart valves, check how well the heart is pumping blood, and measure the pressure of blood in the lungs.
For many patients, the atrial septal defect may close on its own during childhood. For septal defects that do not close, treatment may be required.
A few medicines may be recommended to reduce the risk of complications after the procedure. These medications may include anticoagulants (to reduce the risk of blood clots) and beta-blockers (to keep the heartbeat regular).
A medium to large atrial septal defect can be corrected using any one of the following surgical methods:
Cardiac catheterization:
- A thin flexible tube, known as a catheter, is inserted by the doctor into the groin or arm region.
- This catheter is guided to the heart by using imaging techniques.
- The doctor places a plug or mesh patch to close the hole.
- The heart tissue starts growing around the mesh to seal the hole permanently.
- This procedure is performed to repair secundum type of atrial septal defect.
- Larger secundum atrial septal defects may however require open-heart surgery.
Open-heart surgery:
- This type of surgery is performed under general anesthesia, that is, the patient is put to sleep during the surgery.
- The surgeon makes an incision or cut in the chest region.
- The surgeon will use patches to close the hole in the septum.
- This procedure is used to treat primum, coronary sinus, and sinus venosus atrial defects.
Other types of surgeries:
- Atrial septal defects can also be treated by a minimally-invasive surgery, in which the procedure can be performed by making a few small incisions, instead of a large incision.
- The procedure can also be performed as a robot-assisted surgical procedure, where the procedure is performed by robotic arms which are controlled by the surgeon using a monitor.
The complications associated with an atrial septal defect surgery are:
- Bleeding
- Infection
- Blood clot formation
- Allergy to anesthetic agents
- Heart attack
- Pulmonary hypertension
- Eisenmenger syndrome (permanent lung damage caused due to pulmonary hypertension)
- Kidney failure
- Lung failure
- Irregular heart rhythm
- Damage to the artery from the catheter
- Stroke
- Death
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.
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Atrial Septal Defect Surgery
A surgical procedure done to repair an atrial septal defect is called atrial septal defect surgery.
An atrial septal defect is the presence of a hole in the septum (wall) between the right and left atria (the upper two chambers of the heart). The condition is congenital, that is, it is present at birth.
The heart is made up of four chambers, called the right and left atria (upper chambers), and right and left ventricles (lower chambers). The right side of the heart provides blood to the lungs. The blood will pick up oxygen in the lungs, and return the blood to the left side of the heart. The left side of the heart will then pump out blood through the aorta (the main artery of the heart) to the rest of the body.
In case of an atrial septal defect, the hole leads to an extra amount of blood flowing through the lungs and overworking of the right side of the heart. If left untreated, the right side of the heart enlarges and weakens. The pressure of blood in the lungs also increases, known as pulmonary hypertension.
Types:
The different types of atrial septal defects include:
- Secumdum: It is the most common kind of atrial septal defect. It occurs in the middle of the atrial wall or septum.
- Primum: This type of atrial septal defect occurs in the lower part of the atrial wall or septum.
- Sinus venosus: This type of defect is usually seen in the upper part of the atrial septum.
- Coronary sinus: In this type of defect, a portion of the wall between the coronary sinus (a part of the vein system of the heart) and the left atrium is absent.
Causes:
An atrial septal defect is a congenital condition.
It may occur due to early errors in the development of the heart. However, the exact cause of the same is unknown.
Genetics and environmental factors may be responsible for the development of an atrial septal defect.
Risk factors:
Some factors may increase the risk of developing an atrial septal defect. These factors include:
- Down syndrome (a genetic disorder that leads to delay in growth and development)
- Family history of heart defects
- German measles or rubella infection (a viral infection that leads to a red rash) in the first couple of months of pregnancy
- Smoking during pregnancy
- Drug abuse during pregnancy
- Alcohol consumption during pregnancy
- Exposure to chemicals during pregnancy
- Diabetes (high blood sugar) during pregnancy
- Lupus (an autoimmune disorder, in which the immune system of the body attacks its own tissues) during pregnancy
Symptoms
The symptoms of atrial septal defect are:
- Fatigue
- Shortness of breath
- Stroke (caused by an interrupted blood supply to the brain)
- Swelling of the legs and feet
- Swelling of the stomach
- Heart palpitations (skipped beats or extra beats)
- Heart murmur (a whooshing sound heard by the doctor through a stethoscope)
Diagnosis
Atrial Septal Defects can be diagnosed in the following ways:
- Physical examination: The doctor may check for various symptoms of a septal defect. A heart murmur may indicate a heart defect.
- Echocardiogram: Sound waves are used to check the heart chambers, measure the pumping strength of the chambers, check the valves of the heart, and also look for signs of heart defects.
- Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart and identification of heart rhythm problems.
- Chest x-ray: The condition of the heart and lungs can be evaluated using a chest x-ray.
- CT scan and MRI scan: These are imaging tests done to obtain a clear image of the heart and detect any heart abnormalities.
- Cardiac catheterization: A catheter (thin, flexible tube) is inserted into a blood vessel in the groin or arm region and guided to the heart. It helps the doctor to diagnose any congenital heart defects, check the function of the heart valves, check how well the heart is pumping blood, and measure the pressure of blood in the lungs.
Treatment
For many patients, the atrial septal defect may close on its own during childhood. For septal defects that do not close, treatment may be required.
A few medicines may be recommended to reduce the risk of complications after the procedure. These medications may include anticoagulants (to reduce the risk of blood clots) and beta-blockers (to keep the heartbeat regular).
A medium to large atrial septal defect can be corrected using any one of the following surgical methods:
Cardiac catheterization:
- A thin flexible tube, known as a catheter, is inserted by the doctor into the groin or arm region.
- This catheter is guided to the heart by using imaging techniques.
- The doctor places a plug or mesh patch to close the hole.
- The heart tissue starts growing around the mesh to seal the hole permanently.
- This procedure is performed to repair secundum type of atrial septal defect.
- Larger secundum atrial septal defects may however require open-heart surgery.
Open-heart surgery:
- This type of surgery is performed under general anesthesia, that is, the patient is put to sleep during the surgery.
- The surgeon makes an incision or cut in the chest region.
- The surgeon will use patches to close the hole in the septum.
- This procedure is used to treat primum, coronary sinus, and sinus venosus atrial defects.
Other types of surgeries:
- Atrial septal defects can also be treated by a minimally-invasive surgery, in which the procedure can be performed by making a few small incisions, instead of a large incision.
- The procedure can also be performed as a robot-assisted surgical procedure, where the procedure is performed by robotic arms which are controlled by the surgeon using a monitor.
Risks
The complications associated with an atrial septal defect surgery are:
- Bleeding
- Infection
- Blood clot formation
- Allergy to anesthetic agents
- Heart attack
- Pulmonary hypertension
- Eisenmenger syndrome (permanent lung damage caused due to pulmonary hypertension)
- Kidney failure
- Lung failure
- Irregular heart rhythm
- Damage to the artery from the catheter
- Stroke
- Death
After Procedure
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.
FAQ Section
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
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.
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.
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.
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)
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)
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.
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.
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.
- 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.
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
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.