An atrial septal defect (ASD) is a hole between the heart's two upper chambers, called the atria. It is a type of congenital heart condition, which means it’s a condition a baby is born with.
The size of an ASD can vary from small to large. An ASD allows blood to flow from the left to the right atrium, which causes more blood to flow through the lungs than normal. Over time, an ASD can stress the heart and lungs and cause the child to develop other heart problems as they age.
There are 4 basic types of classifications:
An atrial septal defect's symptoms depend largely on the amount of blood flow traveling from the left side of the heart to the right side, referred to as a left-to-right shunt. The amount of shunting is related to the size of the defect and the pulmonary vasculature resistance. When too much blood goes to the lungs, they can get overworked, often seen a few weeks after birth when pulmonary resistance falls. Children may require medication to help the body remove "extra" fluid on the lungs associated with this over circulation. Additionally, if this connection is not fixed, the lungs can become permanently injured, and the child can develop pulmonary hypertension, which may prevent any future repair.
Your child's symptoms may include:
During a baby’s development, there are several openings between the atria. Normally these openings close before birth or shortly after birth. When an opening does not close, it becomes an ASD. Experts do not know what causes some children to develop an ASD.
Your child’s treatment will depend on how large the ASD is and where it is located. Some children with small ASDs may not need any treatment. Instead, your child’s doctor may track their condition over time. Your care team at Arkansas Children’s is experienced in treating atrial septal defects and will work with you to develop the best treatment plan for your child’s specific condition and symptoms.
Recovery time is dependent on the technique used to repair the atrial septal defect.
Interventional repair in the Cath Lab will routinely require an overnight stay on the Cardiovascular Intermediate Service (Step-Down). The breathing tube (endotracheal tube) inserted for surgery is removed before leaving the Cath Lab. Minimally invasive intravenous lines are placed before the procedure for delivery of medication and hydration. These peripheral intravenous (PIV) catheters are left in place and removed as soon as enough fluids can be taken by mouth. The site where the catheter was placed, usually the groin, will have a pressure bandage applied and require lying flat for approximately 6 hours. Routine monitoring will generally include cardiac rhythm on telemetry, pulse oximetry probe to monitor oxygen saturation, and non-invasive blood pressure measurements. Anticipate discharge home the next day after a few routine exams (electrocardiogram, chest x-ray and echocardiogram).
After a surgical atrial septal defect repair, monitoring in the post-operative period will include invasive lines, such as an arterial line and central venous line, to monitor blood pressure and deliver medications. Medications may be needed to control hemodynamics, provide sedation and maintain hydration during recovery. Perfusion is monitored by pulse oximetry and NIRS (near-infrared spectroscopy) probes. The breathing tube (endotracheal tube) is generally able to be removed before leaving the operating room. A chest tube will be present to remove air, blood and/or fluid from around the heart or lungs. This tube will be removed in the ICU as soon as possible, typically the following day.
The average length of hospital stay is around 3-5 days.