Question about Atrial Septal Defect

atlkidrn · Jan 4, 2002

This may be too late to help you, but I'll reply in case it helps anybody else!

Atrial septal defect (ASD) is a heart problem that occurs while the heart is developing in the first 8 weeks of pregnancy. The wall between the two atria does not form completely, leaving an opening between the 2 chambers. After birth, blood will pass from the left atrium to the right atrium through the ASD and eventually overload the right side of the heart and the lungs.

One way to repair an ASD is with open heart surgery. A patch is surgically placed over the opening in the atrial septum, closing the hole. This operation is not usually needed until a child is in the preschool years (3 to 5 years old). The incision is most often made through the sternum, although some parents opt for a submammary incision for their daughters (sort of like a breast reduction incision). Children usually recover quickly from the operation, staying in the hospital for only 3 or 4 days. Most children spend at least part of the first post-op day in an ICU setting, but at some hospitals (including mine, Children's Healthcare of Atlanta) many are moved out by the evening. By the time they are discharged, many are able to play for part of the day, and only require mild pain medications like Ibuprofen.

A new option for some children with ASD is the use of a device called a "septal occluder," which is placed in the cardiac cath lab and does not require open heart surgery. A device that seals the ASD opening is inserted into the ASD through a catheter placed in the right atrium via the femoral vein. While this is a great advance in the treatment of ASD's, since closure with a septal occluder only requires an overnight stay and no surgical incision, there are limitations to its use. The child must be old enough to have veins large enough for the septal occluder to pass through, and the ASD must be a certain size - not too big and not too small - for the device to be used successfully. Not all heart centers are using the device yet, as it is still in clinical trials in some areas of the country. Also, a pediatric cardiologist is the best person to ask about whether the septal occluder would work for a certain child.

In either case, children with ASD's usually have to take anitbiotics to prevent a heart infection associated with dental work (bacterial endocarditis) for up to a year after the procedure, then most live very normal lives. Those who had the septal occluder inserted may need to take aspirin or coumadin for a presecribed lenght of time, also.

Heart defects can be hereditary, but most result from unknown causes, so a child who had an ASD repair as a child has only a slightly increased risk of having an offspring with a heart problem. Congenital heart disease is the most common "birth defect" in the US, occurring in about 1% of all births.

I'd be happy to answer any other questions!

kabarnes · Apr 7, 2002

atlkidrn had a great explanation for, and while I don't really know too much on the subject, I came across a website http://www.childrenheartinstitute.org that does a great job of explaining congenital heart defects in laymans terms. Hope this helps.