Minimally Invasive Cardiac Surgery - Atrial Septal Defect Closure

Atrial septal defect, or ASD, is a birth defect wherein there is a hole in the muscular wall that is between the two upper chambers of the heart. When a fetus is in its development stages, there already exists an opening between the upper chambers of the heart which gives way to blood so that it may flow into the lungs. Under normal circumstances, this opening closes by the time a child is born, but sometimes it does not, and in that case, the child will be born with an atrial septal defect (ASD).

The exact causes behind the development of atrial septal defects are yet unclear but the medical community, by and large, does attribute the condition to genetic and environmental factors that may have eventually led to the development of the birth defect wall called the atrial septum. The hole in the atrial septum will lead to leakage of oxygen-rich blood from the left side of the heart to the right side; which will exert more pressure and cause extra stress on the right side of the heart, since more blood than required is flowing through the right ventricle into the lungs.

If the ASD is small enough, it can be closed with a closure device called an atrial septal defect closure device, made of metal and mesh. The device resembles a short tube with different-sized discs on either end. The procedure for inserting the device is usually done in a heart catheterization lab.

Diagnosis of ASD

Bigger atrial septal defects can be diagnosed before or right after a child is born while the smaller atrial septal defects may escape notice only to be diagnosed later on in life.

In case an atrial septal defect is present, a doctor or nurse may hear a whooshing sound (a heart murmur) when listening to the heart with a stethoscope.

Your doctor, based on clinical findings and symptoms, may advise some tests to diagnose an atrial septal defect conclusively. 

An Echocardiogram is the most commonly used test for diagnosing an atrial septal defect. Sound waves create images of the heart in motion and the echocardiogram will reveal how well blood is moving through the heart and its valves. 

An X-ray may be used for assessing the condition of the heart and lungs while an 

ECG (electrocardiogram), a quick and painless test that can help identify irregular heartbeats, is called arrhythmias. 

An MRI scan will use magnetic fields and radio waves to render highly detailed images of the heart if the echocardiography could not come up with a definitive diagnosis.

A CT scan can also be used to diagnose an atrial septal defect and related congenital heart defects if echocardiography fails to conclusively diagnose an atrial septal defect.

Treatment

The treatment of atrial septal defect will depend on the size of the hole and if you or your child has any other heart defects.

Did you know that atrial septal defects close on their own as well during childhood? And even for some that don't close, they could be tiny atrial septal defects that won’t require any treatment either. Some of the best atrial septal defect closure doctors in India also recommend monitoring an ASD through regular health checkups to see if it closes on by itself. 

Only after ensuring the ASD isn’t closing on its own will our health care providers recommend treatment for your child. There are quite a few persistent atrial septal defects that will eventually need atrial septal defect closure surgery; which is not recommended if a child has severe pulmonary hypertension.

Medications

Medications won't do much for curing an atrial septal defect, but they can help manage symptoms. For controlling heartbeat beta-blockers are given and for reducing the risk of blood clotting, anticoagulants can be prescribed. 

Surgery and other procedures 

Most cardiologists will recommend surgery to repair medium to large atrial septal defects to prevent future complications.

For both children and adults, atrial septal defect repair surgery will be done to close the hole in the heart. This can be carried out using two methods: 

Catheter-based repair involves inserting a catheter into a blood vessel in the groin, which is then carefully guided to the heart with the assistance of imaging techniques. A mesh patch or plug is then passed through the catheter to close the hole, after which heart tissue will naturally grow around the seal, permanently closing the hole. This procedure is used solely for secundum type of atrial septal defects but some large Secundum atrial septal defects may only be treatable with open-heart surgery.

Open-heart surgery involves making an incision through the chest to access the heart directly, and patches are used later to close the hole. This surgery is the only way primum, sinus venosus, and coronary sinus atrial defects can be cured. 

Atrial septal defect repair can be done through minimally invasive surgery and with robot-assisted heart surgery (incision is about 4 inches)

Also, Read: What is Keyhole Heart Surgery? Benefits, Types & Recovery