Atrial Septal Defect (ASD) is a common type of congenital heart disease sometimes called a hole in the heart in which there is an abnormal opening in the wall between the upper chambers (left and right atria) of the heart.
These often will close on their own by school age. Patient with medium size defects may not have any problems until their middle age and patients with smaller defects can lead a full healthy life without even knowing it. ASD is very easily repaired with minimally-invasive techniques or surgical procedures.
Signs and Symptoms of ASD
Patients with ASD usually have a Heart murmur. Depending on the size of the atrial septal defect patient may experience symptoms like:
- Poor appetite
- Heart palpitations
- A decrease in exercise capacity
Diagnosis and Tests for ASD
- Physical examination: On auscultation patients with ASD usually have a heart murmur
- Chest X-ray: The heart may be enlarged
- Echocardiogram: An echo can show the pattern of blood flow through the atrial septal opening and determine the opening’s size
- Electrocardiogram (ECG ): Testing for electrical activity of the heart, shows arrhythmias
Treatment for Atrial Septal Defect closure
Depends on the size, location and severity of the defect. Very small ASDs might not need any treatment, except follow-up visits for observation. Medium-to-large-sized ASDs may need closure by device or surgical correction. Different types of the procedures can be performed for ASD closure :
Open surgery for ASD:
- Surgery performed to correct the defect, surgical closure of an ASD involves closing the defect with a patch under direct visualization.
- The procedure is done under general anesthesia.
- Patients are supported by a heart-lung machine.
- ASD is approached through an opening in the right atrium.
- Smaller ASDs can simply be closed using a suture. For larger ASDs, a patch is usually used to close the hole.
Minimally Invasive Surgery for ASD repair
- The procedure performed under general anaesthesia.
- Surgeons perform the operation by making only a small 4-6 cm incision on the chest instead of the large midline-incision.
- The heart-lung machine is used allowing the heart to be stopped for the sewing of the patch.
- A soft retractor is inserted, which gently opens the space between the ribs, enabling insertion of specialized minimally invasive instruments.
- An endoscope is inserted that provides a high-resolution image of the heart and the ASD.
- Using this technique patients recover more quickly, and the minimal scar will be barely visible after the patient recovers.
After Surgical Repair
- Patient hospitalized for 3 to 4 days after surgery.
- The incision area may feel sore numbness, itchiness, tightness around the incision area.
- After surgical ASD repair, the main medical concern is the healing of the chest incision.
- The first few days at home, should relax doing quiet activities such as reading, sleeping, and watching TV.
- It takes about 6 weeks for a chest incision to heal and able to return to normal activities.
- Medical history noted and clinical examination of the child performed.
- Adviced general tests to check for fitness of surgery.
- Counselled regarding the procedure.
- Usually performed in cardiac catherization lab.
- Closing thedefect using catheter inserted through blood vesse.l
- The catheter is placed in the right femoral vein and guided into the right atrium.
- When it is in the right place, one disc opens up as the device is moved out of the catheter. The tube portion plugs the hole and the other disc opens up on the opposite side of the hole.
- To visualize the catheter a type of X-ray called fluoroscopy is used.
- Once the device is in place, the catheter is pulled out.
- Usually overnight hospitalization for monitoring to make certain no complications.
- Patient discharged next day after evaluation and kept on oral antibiotic.
- Subacute bacterial endocarditis prophylaxis is recommended for six months or until complete closure is obtained.
- A cardiologist may advise some physical activity restrictions for a short time.
- There's a small risk of blood clots forming on the closure device while new tissue heals over it, Medications given to prevent blood clots .
- Follow-up appointments after the closure, making sure that the ASD is properly closed.
Complications of ASD Closure
- Infection and
- Displacement of the blocking device from where it was placed
- Transient Arrhythmia
- Allergic reaction to the device
- Clot formation
Prognosis of ASD closure
The long-term prognosis of ASD closure is good and usually, no additional surgery or catheterization are needed, however regular monitoring with tests like echocardiography, ECG, stress test etc is essential.
Factors Affecting Cost Of Atrial septal defect closure
The cost to the patient depends on a variety of factors like:
- The hospital, the patient chooses
- Type of room and number of days hospitalised
- Fee for the team of doctors and OT charges
- Cost of medications
- Standard test and diagnostic procedures.
- Cost of the procedure opted surgical or transcatheter approach
- Cost of the follow – up care required after the procedure