Children's Heart Institute
Atrial Septal Defect Surgery
Atrial septal defects (ASD) are among the most common defects encountered in children. The heart has two sides: the left side which pumps to the body and the right side which pumps to the lungs. Each side has a main pumping chamber (ventricle) and a thin-walled chamber (atrium) in which blood collects before filling the ventricle between beats. A thin wall, called the atrial septum, separates the left atrium from the right atrium. At various times when the baby is in the womb, there are holes in the atrial septum, but by the time a baby is born these holes should be nearly or completely closed. A hole which remains after birth is called an atrial septal defect.
In a heart with an ASD, instead of blood pumping normally from the left atrium to the left ventricle, some of the blood will pass from the left atrium to the right atrium, through the hole. Because of the extra blood in the right atrium, the right ventricle is forced to work harder in order to pump the extra blood.
With a large ASD, the right ventricle may pump two to four times as much blood as the left side. The right ventricle does this remarkably well, and few children will show any adverse effect from this before their teenage years. Eventually the extra work that the right ventricle has to perform takes its toll. Approximately half of people with a significant atrial septal defect will die early (usually in their thirties, forties, or fifties) from heart failure. Others may lead a normal life span but may be less active than they would otherwise be.
It is recommended that atrial septal defects of significant size be closed. Since ASDs rarely become problematic until young adulthood, doctors usually recommend closure when the child is large enough to make the closure easy but young enough such that the psychological trauma is minimized. Most atrial septal defects are closed between the ages of two and five.
Closure is very often performed through minimally invasive means in the cardiac catheterization suite. Specially trained cardiologists insert a device into one of the large veins in the groin. A closure device is delivered in collapsed form through the veins to the site of the hole in the heart. It can then be expanded and placed into position to close the hole. In order to be closed with minimally invasive techniques, the holes must have a sufficient rim of tissue around them to seat the device. Otherwise, the holes must be closed surgically.
Surgery is usually done through a vertical incision in the middle of the chest. Repair does require open heart surgery; that is, the patient is put on the heart-lung machine. Tubes are placed which drain blood away before it gets to the heart and the machine oxygenates the blood and then pumps it back into the body. Closure of the hole involves sewing a small patch into place. A small incision is made in the right atrium to gain access to the atrial septal defect; the incision in the right atrium poses no damage to the heart. The child is then withdrawn from the heart lung machine, and chest is closed and the operation is completed.
Recovery after an atrial septal defect repair usually requires 2-4 days in the hospital. Children who are of school age usually stay home 2-4 weeks after surgery. Children recover quickly and usually do not have any long-term effects from the surgery.
Pediatric Cardiology ClinicUniversity of Texas Health Science Center Professional Building
6410 Fannin, Suite 500
Houston, TX 77030
Phone: (832) 325-6516
Pediatric Cardiovascular Surgery ClinicUniversity of Texas Health Science Center Professional Building6410 Fannin, Suite 950Houston, TX 77030
Phone: (713) 500-7339
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