Atrial Septal Defect (ASD) Repair

Holes in the heart are a type of congenital heart disease. Ventricular septal defect (VSD) and atrial septal defect (ASD) are the two most common congenital defects that may affect an individual. These occur due to structural malformation in the walls of the heart when these are developing at the fetal stage. ASD and VSD can be repaired and closed as soon as they are identified or right after birth. ASD is the hole in the septa that divides the two atrium and VSD refers to the hole in the ventricular walls. The holes allow the reverse flow of blood, thus, facilitating the mixing of pure and impure blood.

• To understand the holes in heart we must briefly understand the working of the heart. The heart works like a pump beating on an average of 100,000 times in a day. It has two sides which are divided by a wall called septum. The right side of the valve pumps blood to the lungs and picks up oxygen. The oxygen-rich blood then returns to the left side of the heart from the lungs and then the left side pumps it to the rest of the body.
• These two sides are divided into 4 chambers having four valves connecting them to various blood vessels. For carrying blood from the body to the heart, veins are responsible while arteries carry the blood away from the heart to be circulated to the body. The atria are two upper chambers that collect blood while ventricles are the two lower chambers pumping the blood to the lungs and other parts of the body.
• The valves act like doors allowing a flow of blood through the next chamber to arteries and then they close to keep the blood from again returning back to the previous chamber from where it came. In a systolic contraction, the ventricles pump blood from the heart and in a diastolic contraction, the ventricles relax to receive blood pumped by the atria. The aortic and pulmonary valves close at the beginning of the diastole to prevent the chances of backflow. Thus, the presence of a hole in the septa may lead to mixing of the blood and interfere with the normal flow of blood circulation in the body.
• An ASD is naturally present when the baby is still a fetus. But the hole closes on its own by the time of birth. However, in some cases, it may persist even after birth. An ASD can be of different types, including sinus venosus atrial septal defect, mixed atrial septal defect, ostium secundum atrial septal defect. A VSD, on the other hand, is usually detected in a baby or in an adult when a doctor observes a heart murmur. Certain tests such as an echocardiogram or electrocardiogram are performed to confirm its presence.

Typically, medications are administered to see whether ASD or VSD closes on its own. In case the defect does not close on its own and the individual continues to experience atrial septal defect symptoms such as breathing difficulties, heart murmurs, shortness of breath, and respiratory infections, then a surgery is recommended. The surgical procedure for atrial septal defect repair and ventricular septal defect treatment are almost the same, except the fact that different parts of the heart are targeted during the surgery.

Two different types of approaches can be used for ASD and VSD repair or closure, depending on the experience of the surgeon, the overall health of the patient, and certain other factors. The first is open-heart surgery and the second one is cardiac catheterization. Irrespective of the approach used, the patient is administered a general anesthetic so that he or she does not feel any pain and is asleep during the procedure.
Open heart surgery:
The main surgical approach used to repair or close ASD or VSD is open-heart surgery. It is conducted by making an incision in the chest and using surgical instruments to open the chest to gain access to the heart. The heart is then put on bypass, which involves connecting it to a machine that pumps blood to the body during the surgery. For the same reason, it is also known as the heart-lung bypass machine. The surgeon then repairs the hole by closing it with sutures or by placing a biological patch on it that mixes with the muscle. Once the hole is repaired, the chest is then closed and the incision site is closed with sutures.
Cardiac catheterization:
It is a minimally invasive procedure conducted using a catheter, which is inserted into the blood vessel of the groin. The catheter is then guided up to the heart and mesh material is placed over the hole through the catheter to close the defect. Once the repair is made, the catheter is removed.

Within a period of 6 months, normal tissues start growing in and around the mesh. Only a needle puncture is made in this procedure and hence this is less invasive as a procedure. This procedure is usually successful until and unless the hole is too large and only an open surgery can solve the problem.

Recovery from ASD/VSD Surgical procedure
The patient will be transferred to the intensive care unit (ICU) for a day or so for continuous monitoring. Antibiotics will be administered to the patient to prevent infections such as endocarditis. Regular checkups will follow for a while to ensure that the hole gets closed properly. To prevent the formation of blood clots, the patient may be given aspirin. Apart from all these, for the first few months, activities will be kept limited till that patient is fit enough to handle physical exertion.