Atrial Septal Defects (ASD)

Introduction:

Atrial septal defects represent a communication between the left and right atria (a hole between the upper champers of the heart). Simple atrial septal defects were among the first congenital cardiac anomalies to be corrected by surgical treatment.

Types of ASD

i) secundum atrial septal defect id by far the most common, representing 80% of all ASD.

ii) primum atrial septal defect are part of the spectrum of the AV canals and are frequently associated with a split in the leaflet of the valve, or so called cleft mitral valve.

Symptoms

When an atrial septal defect is present blood can flow (shunt) across one hole in the from one left atrium to the right atrium. The majority of patients have few symptoms, however fatigue and shorteness of breath are the most common complaints. Because most have no symptoms, atrial septal defects most often are discovered on pre-school entrance examination when the physician hears a murmur and investigates it.

Diagnosis

Echo cardiogram

Cardiac catheterization is indicated in cases of an inclusive echocardiography examination or associated anomalies which require further evaluation.

Surgical treatment

Indications for surgical repair of an atrial septal defect are right ventricular overload (due to flow from the left atrium into the right atrium).

The surgical treatment option for an ASD closure include direct suture repair, which is reserved for small atrial septal defects, and one more common patch repair. The material utilized for patch closure of ASD’s may be the patients own pericardium, commercially available bovine pericardium or synthetic material.

The surgical approach to the atrial septal defect is somewhat dependent upon its location. In general three surgical approaches may be undertaken.

1. Median sternotomy (middle strenal splitting incision).

2. right thoracotomy (going between the ribs on the right side).

3. Submmarry (under the breast tissue on the right front of the chest).

All type of ASD may be approached adequately through a median sternotomy or right thoractomy.

The term minimally invasive surgery for repair of atrial septal defects usually refers to repair of the defect using the same technique as open heart surgical repair, but performing the operation through a much smaller incision. Most children can successfully undergo this type of repair through a small incision in the sterium (breast bone).

Post operative care

In general, this post operative course in the hospital is shorter (2-3 days) due to less incision pain and discomfort.

The results of surgical repair of atrial septal defect are excellence.

Transcatheter management

To date, the primary method of therapy for closure of the atrial septel defect (ASD) has been surgical repair. Interventional cardiologist explored the possibility of transcatheter closure of the atrial septal defect. This technique involves implementation of one or several devices using heart catheterization method in the cardiac catheterization laboratory, without the need for cardio pulmonary bypass, and without the need to stop the heart.

The approximate selection of patient for this technology is rather strict obvious evidence of enlargement of the right heart by chest x-ray, cardiac ultrasound.

The usual procedure is very similar to standard heart catheterization. Briefly, flexible long tubes (or catheters) are inserted into the veins and arteries in the groin. We use the knowledge that in all human beings, these vessels are directly attached to the heart, and the standard access technique used in all patients.

There are multiple devices presently being tested under FDA guidelines.

The major advantages of this technique are its relative non-invasive approach. Patients are usually hospitalized overnight, and many return to work or school within 1-2 days. We have has patient who have been able to resume vigorous exercise within 1 week.

Each mode of ASD closure has its own associated risks and benefits and a comprehensive treatment plan should include input from the primary care provider, the pediatric cardiologist and the pediatric cardiovascular surgeon.