Atrial septal defects (ASD) are the most commonly recognized congenital cardiac anomalies. This defect is in the upper chambers (atrium) of the heart. The wall separating the right and left chambers is partially or entirely missing.

There are four basic types of ASD’s.

  • Ostium Secundum Defect - the most common but least serious.
  • Ostium Primum Defect - also known as an endocardial cushion defect because it shares the same tissue as nearby valves, i.e., mitral and tricuspid.
  • Sinus Venosus Defect - refers to the posterior aspect of the septum close to the superior vena cava, and near the pulmonary veins. This is commonly referred to as a partially anomalous pulmonary venous defect.
  • Coronary Sinus Septal Defect - also known as an unroofed coronary sinus and is the least common of the ASD’s.

Surgical Procedure

The most common approach to closing this defect is by a transcatheter approach. This technique is done by placing a catheter into the vein and guiding it into the heart to deliver a device (plug). In some cases, there is no adequate rim of tissue to place the device; in those instances, the child if referred for surgical consideration. The surgical approach can vary from a standard midline incision to a small anterior thoracotomy approach and robotically-assisted. The most common surgical technique to closing the defect is with a patch of material, either biologic or synthetic. Operative and cross-clamp times are very short and frequently, the child is extubated on the table.

Postoperative Expectations

This procedure has a low complication rate in patients with uncomplicated atrial septal defects. Children are usually transferred to the ICU without an endotracheal tube. Invasive monitoring and limited surgical drains are present. Few patients require anything more than volume support and pain control.

Expected Length of Stay

The usual hospital stay is 3-5 days.