Septal Defect Repairs – Atrial and VentricularBy
Sarah Lewis, PharmD
What is an atrial or ventricular septal defect repair?
An atrial or ventricular septal defect repair closes a hole in the heart’s septum. A septum, or wall, separates the two top chambers, or atria, and the two bottom chambers, or ventricles. Your doctor will sew the hole closed or patch the hole with your own tissue or a synthetic patch.
Septal defects are congenital defects that are often diagnosed at birth or shortly after birth. Symptoms of septal defects may not appear in some people until childhood or even adulthood. Symptoms include shortness of breath, fatigue, weakness, and a heart murmur. Left untreated, a septal defect can lead to an enlarged heart, heart failure, and high blood pressure in the lungs (pulmonary hypertension).
Small septal defects may close without treatment or may not pose a health risk. Larger holes that cause symptoms or put you at risk of complications require treatment. A septal defect repair can relieve symptoms and prevent complications and irreversible heart and lung damage.
An atrial or ventricular septal defect repair is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having an atrial or ventricular septal defect repair.
Why is an atrial or ventricular septal defect repair performed?
Your doctor may recommend an atrial or ventricular septal defect repair to treat a hole in your heart’s septum. Your doctor will only consider an atrial or ventricular septal defect repair for certain types of defects. Ask your doctor about all of your treatment options and consider getting a second opinion.
Regardless of whether you have symptoms or not, your doctor may recommend an atrial or ventricular septal defect repair based on the following:
Size and location of the septal defect
Degree that it affects normal blood flow
Degree of pulmonary hypertension
Who performs an atrial or ventricular septal defect repair?
A cardiac surgeon or an interventional cardiologist performs an atrial or ventricular septal defect repair. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons. Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging.
If your child needs an atrial or ventricular septal defect repair, a pediatric cardiac surgeon or pediatric interventional cardiologist will perform the procedure.
How is an atrial or ventricular septal defect repair performed?
Your atrial or ventricular septal defect repair will be performed in a hospital. Your doctor will sew the hole closed or patch the hole with your own tissue or a synthetic patch. Closing the hole in your heart can involve open-heart surgery, minimally invasive techniques, or a cardiac catheter-based procedure.
If you are a candidate for a catheter-based procedure, your cardiologist will insert a catheter and guide wire through an incision in your groin. The doctor feeds the catheter into the heart chamber with the hole. Your doctor will plug the hole with a device that remains in place. With time, your body will grow tissue over the device.
Surgical approaches to an atrial or ventricular septal defect repair
If you require surgery, your doctor will perform your atrial or ventricular septal defect repair using one of the following approaches:
Minimally invasive surgery is also known as a mini-thoracotomy. It involves making a small, three-inch incision in the side of your chest. Your surgeon uses special instruments to repair your septal defect through this small incision. A heart-lung bypass machine is necessary for this surgery. Your surgeon provides access to the heart-lung machine through another incision in your groin. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your doctor will make a small incision instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Robot-assisted endoscopic surgery involves several tiny porthole incisions between your ribs. Your cardiac surgeon uses a robot and inserts special instruments and a thoracoscope through these incisions. A thoracoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your doctor while performing the surgery. Like minimally invasive surgery, endoscopic surgery involves a faster recovery and less pain than open surgery.
Open-heart surgery involves making a large incision in the front of your chest and breastbone. Open surgery allows your doctor to directly see and access the surgical area. A heart-lung bypass machine is necessary for this surgery. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
In some cases, doctors combine surgery and catheter-based techniques in a hybrid procedure. In addition, your doctor may decide after beginning a minimally invasive technique that you require an open surgery to safely and most effectively complete your surgery.
Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different atrial or ventricular septal defect repair procedures and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia
Your surgeon will perform your atrial or ventricular septal defect repair using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
What to expect the day of your atrial or ventricular septal defect repair
Your doctor may admit you to the hospital the day before your surgery, depending on your condition and procedure. The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of an atrial or ventricular septal defect repair?
As with all surgeries, atrial and ventricular septal defect repairs involve risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of an atrial or ventricular septal defect repair
Complications of atrial and ventricular septal defect repairs include:
Damage to an artery from the catheter
Heart arrhythmias or problems with heart rhythm
Kidney or lung failure
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes cardiac rehabilitation.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my atrial or ventricular septal defect repair?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for an atrial or ventricular septal defect repair by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), echocardiogram, blood tests, and other tests as needed.
Following dietary guidelines as directed
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need an atrial or ventricular septal defect repair? Are there any other options for treating my condition?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
Will I need cardiac rehabilitation? Where do I go for it?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my atrial or ventricular septal defect repair?
Knowing what to expect can help make your road to recovery after an atrial or ventricular septal defect repair as smooth as possible.
How long will it take to recover?
You will stay briefly in the recovery room after surgery until your vital signs are stable. You will likely move to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and highly skilled nursing care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. However, the care team usually removes it within 24 hours. You may have a sore throat from the breathing tube. This is usually temporary, but tell your care team if you are uncomfortable.
With a catheter-based procedure, you will likely stay in the hospital overnight and go home the following day. Most people return to their normal activities in about a week following a catheter-based repair.
With a mini-thoracotomy or robot-assisted procedure, you will likely recover faster and move out of the ICU sooner than with traditional open-heart surgery. Hospital stays after surgical septal defect repair range from three to seven days.
Recovery after surgery is a gradual process. Recovery time varies depending on your general health, your age, the procedure, and other factors. Your doctor may refer you to a cardiac rehabilitation program to help you recover. Full recovery takes several weeks. Your surgeon will tell you when it is safe to return to your normal activities.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after an atrial or ventricular septal defect repair. Call your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bluish color of the skin, nail beds, lips, or tongue (cyanosis)
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Listlessness or decreased activity in infants and children
Pain that is not controlled by your pain medication
Poor appetite, or decreased feeding for infants
Unexpected drainage, pus, redness or swelling of your incisions
How might an atrial or ventricular septal defect repair affect my everyday life?
An atrial or ventricular septal defect repair may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. Successful heart septum repair usually results in prompt improvement of symptoms. For example, septal defect repair should relieve shortness of breath and reduce your risk of complications.
You will need to take prophylactic antibiotics for dental appointments and surgeries for six months after surgery. This helps prevent a heart infection (endocarditis). Most people are free of symptoms and are no longer at risk of infections after the heart tissue has fully healed.
Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced
or reprinted without permission from Healthgrades Operating Company, Inc. Use
of this information is governed by the Healthgrades User Agreement.
- About Atrial Septal Defects. Nemours Foundation. http://kidshealth.org/parent/medical/heart/asd.html#.
- Atrial Septal Defect (ASD). American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Atrial-S....
- Minimally-Invasive Atrial Septal Defect Closure. Johns Hopkins. http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/treatments/minimally_i....
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf.
- Robotically Assisted Heart Surgery: Atrial Septal Defect (ASD): New Approaches to Minimally Invasive Heart Surgery. Cleveland Clinic. http://my.clevelandclinic.org/heart/services/surgery/roboticallyassistedhasd.aspx.
- Ventricular Septal Defect (VSD). American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Ventricu....
- Ventricular Septal Defect (VSD). Mayo Clinic. http://www.mayoclinic.com/health/ventricular-septal-defect/DS00614/DSECTION=treatments-and-drugs.
- Ventricular Septal Defects. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/congenital/septal.aspx.
- Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview. Circulation. 2006 Oct 10;114(15):1645-53. http://circ.ahajournals.org/content/114/15/1645.full.