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Atrial Septal Defect Repair in Children—Transcatheter Procedure by Rebecca J. Stahl, MA

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Child’s Doctor If Any of the Following Occurs

Definition

An atrial septal defect is a hole in the wall between the two upper chambers (right and left atriums) of the heart. A transcatheter procedure is a minimally-invasive way to repair the hole. During this procedure, a device is implanted to seal the hole. As your child recovers, the device will trigger the heart tissue to grow. The tissue will slowly grow over the hole.

Reasons for Procedure

If a child is born with a hole between the upper chambers of the heart, the blood can flow backward into the right side of the heart and into the lungs. This triggers the heart to work harder. Over time, this can lead to damage to blood vessels in the lungs and congestive heart failure . The procedure is done to fix the hole.

Blood Flow Through the Heart

Most children who have this procedure will have good outcomes.

Possible Complications

Complications are rare, but no procedure is free of risk. Possible complications may include:

Bleeding at the point of the catheter insertion
Damage to arteries
Allergic reaction to x-ray dye
Blood clot formation
Infection, including endocarditis (infection of the inner lining of the heart muscle)
Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
Blood clot formation
Arrhythmia (abnormal heart beat)

Some factors that may increase the risk of complications include:

Pre-existing conditions (eg, bleeding disorder, kidney problems)
Recent infection

Discuss these risks with the doctor before the surgery.

What to Expect

Prior to Procedure

The doctor will do a physical exam of your child. Tests may include:

Blood and urine tests
Echocardiogram —a test that uses sound waves to visualize functioning of the heart
Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
Chest x-ray —a test that uses radiation to take a picture of structures inside the chest

The doctor will tell you if you child needs to stop taking certain medicine. Ask the doctor when your child should stop eating or drinking before the surgery.

Anesthesia

General anesthesia will be used. It will block any pain and keep your child asleep through the surgery. It is given through an IV in the hand or arm.

Description of the Procedure

Your child will receive IV fluid and medicines through a vein in his arm. The catheter (small tube) will be inserted either in the arm or groin. Next, electrodes will be placed on the chest. These electrodes will send information to the EKG machine, allowing the doctor to monitor the heart.

A catheter will be inserted in the blood vessel and advanced so the end is in the heart. Dye will be injected to allow the doctor to view x-ray images of the heart. An echocardiogram may also be used. Before the hole can be covered, the doctor will need to find out the size of the hole. A catheter with a balloon attached to it will be sent to the upper chambers of the heart. The balloon will inflate and measure the hole.

Once the doctor knows the size of the defect, another catheter will be sent to the heart. This catheter will have a device attached. There are different types of devices available. Some are able to open so that the hole is covered on both sides. Other devices open like an umbrella to cover the defect. Once the device is placed, the doctor will remove the catheter. Lastly, a bandage will be placed over the insertion site.

Immediately After Procedure

Your child will be closely monitored in the intensive care unit (ICU). The hospital staff will:

Place pressure on the insertion site and apply a pressure bandage
Have your child lie flat

How Long Will It Take?

1-2 hours

How Much Will It Hurt?

Your child will have pain and soreness. The doctor will give pain medicine.

Average Hospital Stay

The usual length of stay is 2-4 days. In some cases, your child may be able to go home as soon as the next day. The doctor may choose to keep your child longer if there are complications.

Post-procedure Care

At the Hospital

When your child is recovering at the hospital, the hospital staff may:

Do tests (eg, EKG, chest x-ray, blood tests).
Have your child lie still and flat for several hours. This is to prevent bleeding.
Place a pressure bandage to reduce bleeding.
Encourage your child to drink plenty of fluids to flush the dye from his body.
Give pain medicine to ease discomfort.

At Home

When your child returns home, do the following:

If directed by the doctor, give antibiotics. This will help to prevent infections in the heart.
Give pain medicine as needed. You can also apply an ice pack to the insertion site to ease discomfort.
Your child may be at risk for blood clots. If directed by the doctor, give medicine to prevent blood clots.
Have your child return to his normal diet. He may need to drink plenty of fluids to flush the dye from his system.
Encourage your child to rest. Have him avoid strenuous activities. He will slowly return to his normal routine.
Follow all of the doctor’s instructions.

Call Your Child’s Doctor If Any of the Following Occurs

After your child leaves the hospital, call the doctor if any of the following occurs:

Signs of infection, including fever and chills
Increased sweating
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the catheter insertion site
Nausea and/or vomiting
Dizziness, lightheadedness
Increased pain
Fatigue
Rash
Loss of appetite or poor feeding
Not drinking enough fluids
Not urinating

Call for Medical Help Right Away If Any of the Following Occurs

Call for medical help or go to the emergency room right away if any of the following occurs in your child:

Fast breathing or trouble breathing
Blue or gray skin color
Not waking up or not interacting
Chest pain
Heart palpitations
Weakness or fainting
Signs of a stroke (eg, drooping facial muscles, changes in vision or speech, difficulty walking)

In case of an emergency, call for medical help right away.

RESOURCES:

American Heart Association http://www.americanheart.org/
National Library of Medicine http://www.nlm.nih.gov/

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca/index_e.html/
Heart and Stroke Foundation http://ww2.heartandstroke.ca/splash/

References:

Baylor College of Medicine. Atrial septal defect. Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=atrial+septum+defect+repaircontent_id=274 . Updated April 2010. Accessed April 21, 2010.
Cardiothoracic Surgery. Atrial septal defect (ASD). Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/atrialseptaldefect.html . Accessed April 21, 2010.
Children’s Hospital Boston. Atrial septal defect. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site477/mainpageS477P0.html . Accessed April 21, 2010.
Cincinnati Children’s Hospital. Open-heart surgery. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/heart-encyclopedia/treat/surg/open.htm . Updated July 2009. Accessed April 21, 2010.
Cornell University. Taking care of your child after heart surgery. Cornell University website. Available at: http://www-users.med.cornell.edu/~spon/picu/parents/peddcwd.htm . Updated November 2001. Accessed April 21, 2010.
Cove Point Foundation. Atrial septal defect. Cove Point Foundation website. Available at: http://www.pted.org/?id=atrialseptal4 . Updated April 2009. Accessed April 21, 2010.
Durham L, Mendelsohn A. Atrial septal defects: surgical and transcatheter management. Congenital Heart Information Network website. Available at: http://tchin.org/resource_room/c_art_14.htm . Updated May 2003. Accessed April 21, 2010.
Health Library editorial staff and contributors. Cardiac catheterization. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated February 2010. Accessed April 21, 2010.
Health Library editorial staff and contributors. Heart valve replacement. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2009. Accessed April 21, 2010.
Kids Health. Atrial septal defect. Kids Health website. Available at: http://kidshealth.org/parent/medical/heart/asd.html# . Accessed April 21, 2010.
Rosenblum L. Septal defects. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 2009. Accessed April 21, 2010.
University of Maryland Medical Center. Atrial septal defect—treatment. University of Maryland Medical Center website. Available at: http://www.umm.edu/ency/article/000157trt.htm . Updated May 2008 Accessed April 21, 2010.

Last reviewed June 2012 by David N. Smith, MD

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