Atrial Septal Defect (ASD)

What is Atrial Septal Defect?

Atrial Septal Defect (ASD), more commonly known as 'Hole in the Heart' is a Congenital Heart Disease present at birth. Atrial Septal Defect is a hole in the wall (septum) that separates the upper chambers (atria) of the heart into right and left atrium. This hole (defect) can be between 0.5 - 2 cm in diameter. Some of the oxygenated blood flows from the left atrium to the right atrium which contains blood that is poor in oxygen. This mixing increases the volume of blood in the right atrium that will be carried to the lungs for oxygenation, thus increasing the burden on the lungs to perform it's function. Atrial Septal Defect is a common Congenital Heart Disease that can sometimes be asymptomatic in children. Atrial Septal Defect is the second most common Congenital Heart Disease (about 6 - 8% of all Congenital Heart Disease) and is more common in girls.

Where can I get surgical repair for Atrial Septal Defect?

Country	Cost with MedSolution
India	$4,540 (inquire)

Cost of procedure performed in the US: $48,000.

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

What are the types of Atrial Septal Defect?

Depending on the location of hole in the atrial wall, Atrial Septal Defect can be of 3 types:

• Ostium Secundum Atrial Septal Defect - In this type of Congenital Heart Disease, the Atrial Septal Defect is present in the center of the septum.
• Ostium Primum Atrial Septal Defect - This type of defect is present in the lower portion of the atrial septum.
• Sinus Venosus Atrial Septal Defect - This type of Atrial Septal Defect is present in the upper portion of the septum.

Why is surgery for the closure of Atrial Septal Defect necessary?

Small Atrial Septal Defects usually close on their own as your child grows up and do not require any medical or surgical intervention as there are no symptoms. However, children who have a large Atrial Septal Defect need surgical intervention so that they can lead normal and healthy lives after the surgery. If the option of timely surgery for the closure of Atrial Septal Defect is not considered for some reason, then unfortunately your child might have to deal with some of the following consequences:

• Slow Growth and Development - Your child might have slow mental and physical growth and development as the body's increased demand for oxygenated blood is not met.
• Reduced Activity level - Your child's activity level will have to be monitored as symptoms like dizziness and breathlessness with increased activity may be a problem. However, after the surgery for the closure of Atrial Septal Defect, this is not a problem any more.
• Enlargement of the right side of Heart - Due to shunting of blood from the left to the right side of the atrium, the right side of heart may enlarge over time due to increased workload.
• Pulmonary hypertension - Due to increased flow and pressure of blood in the lungs and pulmonary blood vessels, the pulmonary arteries may get diseased resulting in pulmonary hypertension.
• Tricuspid valve regurgitation - The tricuspid valve, which is the valve between the right atrium and the right ventricle stretches and does not close properly, allowing some of the blood to leak back from the ventricle to the atrium instead of allowing it to move forward.
• Irregular heart beats - Also called arrhythmias, this is a very serious problem associated with untreated Atrial Septal Defect.
• Risk of Stroke - In people with Atrial Septal Defect, a blood clot or air bubble may develop that may travel to the brain and cause stroke.

What does the surgical repair for Atrial Septal Defect involve?

Atrial Septal Defect is most commonly closed by Open Heart Surgery. Due to worsening of symptoms with age, children suffering from Atrial Septal Defect should be operated upon between 3 - 6 years of age. The term Open Heart Surgery is used for surgical procedures performed on the heart where the heart is stopped and is connected to a heart-lung machine which oxygenates the blood and circulates it throughout the body. The surgeon makes an incision in the middle of the chest through the breast bone (sternotomy) to expose the heart. The heart is stopped and it's function is completely taken over by the heart-lung machine. The Atrial Septal Defect is either stitched (if small) or patched with a special mesh to close the hole. Once the procedure is complete, the heart is re-started and the chest incision is sutured. The Open Heart Surgery to correct Atrial Septal Defect is considered a major surgery and is performed under general anesthesia.

What to expect during the recovery period following surgery for Atrial Septal Defect?

Immediately following the Open Heart Surgery for Atrial Septal Defect, your child will spend a few hours in the ICU under observation for immediate post-operative complications. Your child will spend 4 - 5 days in the hospital until the surgical staff is satisfied with outcome of the surgery to repair Atrial Septal Defect. The recovery is generally complete in about 3 months. Your child will be prescribed pain and anti-coagulant medication to reduce the risk of clot formation. Follow the nurses instructions carefully on how to care for your child e.g. bathing, activity level, direct injuries to the chest while playing, medications to be given at home and when your child can return to school.

What is the outcome of surgery for Atrial Septal Defect?

In 99% of cases, there are successful results with no complications following surgical closure of Atrial Septal Defect as children have a remarkable ability to heal and recover quickly. There is usually no residual leakage. After the Open Heart Surgery for Atrial Septal Defect, there might be some pain and discomfort which soon subsides. Your child will be able to participate in all the normal activities pretty soon leaving all the pain and discomfort behind.

B . R . A . N . D . of surgical repair of Atrial Septal Defect

Benefits of surgical repair of Atrial Septal Defect

• The surgical repair of Atrial Septal Defect gives your child the life that he/she deserves! Following the surgery, you will observe a significant level of difference in your child's growth and development, activity level, appetite and general well being. Your child will be able to participate in and enjoy all the activities without any restrictions. There are unmistakably good long-term results for children as well as adults who undergo surgical repair of Atrial Septal Defect or surgical repair for other Congenital Heart Diseases.

Risks of surgical repair of Atrial Septal Defect

• Excessive bleeding
• Infection
• Allergic reaction to anesthesia
• Stroke
• Heart attack
• Bacterial endocarditis (Bacterial infection of the heart valve).

Alternatives to surgical repair of Atrial Septal Defect

• Medications - Diuretics, Digoxin and antibiotics may be used as palliative measures to stabilize people with Atrial Septal Defect.
• Septal Occluder - This procedure is similar to Cardiac Catheterization used to implant a Stent in the coronary artery. In this procedure, an umbrella shaped mesh is inserted to occlude or block the Atrial Septal Defect. This mesh is inserted via a blood vessel in the groin and is threaded through it with the help of a thin tube called catheter.

Now or Never

• Surgical closure of Atrial Septal Defect has very few chances of complications. Once the defect has closed spontaneously or has been repaired, most children do not need additional treatment or medications and can live normal, healthy lives.

Decision to have surgical repair of Atrial Septal Defect

• Atrial Septal Defect can have several damaging effects over time including enlargement of the right atrium and the right ventricle, damage to the arteries and blood vessels in the lungs, congestive heart failure, and irregular heartbeats or irregular heart rhythm (arrhythmia). Atrial Septal Defect that does not close spontaneously (on it's own) can often be closed through Open Heart Surgery or a Cardiac Catheterization (Trans-cath closure). These procedures are popularly used world wide. Closure of Atrial Septal Defect by these techniques is usually successful with excellent long-term results.