Atrial Septal Defect or ASD for short is sometimes referred to as a hole in the heart. It's a type of congenital heart disease, which means a person is born with it. People with ASD have an abnormal opening in the dividing wall between the upper filling chambers of the heart, or the atria. In most cases, ASDs are diagnosed and treated successfully with few or no complications. More than 3,000 babies are born with ASD each year in the United States. ASD occurs twice as often in girls as in boys.
What is Atrial Septal Defect?
An Atrial Septal Defect (ASD) is an opening in the wall that separates the upper chambers of the heart. It is one of the most common congenital heart defects, which are structural problems that develop before a baby is born or at birth. When an Atrial Septal Defect is present, some oxygen-rich blood that should have been pumped to the body flows from one side of the heart to the other. This blood is then pumped to the lungs. This creates extra work for one side of the heart. If an Atrial Septal Defect is large, heart failure may occur, although this is not common in children. This defect also may be found in older children and adults.
Types of Atrial Septal Defect:
Atrial Septal Defects (ASD) fall into three categories, within each type of defect, the severity may vary. It may be small or large, and may require surgery or close without surgical intervention. Only a cardiologist or cardiothoracic surgeon can determine the severity of the heart problem.
Secundum ASD (ASD 2 or ASD II): The most common type of ASD, where the defect is located toward the middle of the atrial septum.
Primum ASD (ASD 1 or ASD I): The second most common type of ASD, where the defect is located in the endocardial cushion area of the septum. This type of ASD is often accompanied by other problems, including endocardial cushion ventricular septal defect, which means that the defect includes the lower portion of the heart as well as the upper portion.
Sinus Venosus ASD (Sinus Venus): This type of ASD occurs in the upper portion of the septum, in close proximity to where the vena cava brings blood to the heart from the body.
Causes of Atrial Septal Defect:
Atrial Septal Defect has no clear cause, but some factors make the heart problem more likely. Some studies show conflicting information. For example, one study shows that smoking by the mother during pregnancy can result in a risk for Atrial Septal Defect while another shows no increase in risk. The various contributing factors to Atrial Septal Defects are follows:
Maternal alcohol use
Maternal or paternal exposure to solvents
Paternal cocaine use
Paternal heavy smoking
Maternal diabetes and phenylketonuria
Maternal urinary tract infection
Symptoms of Atrial Septal Defect:
Many ASDs are minor and causes few symptoms, if any. In many cases, a heart murmur may be the only sign that a defect is present. In other cases, symptoms may be severe. This is greatly dependent upon the size of the defect. Many of these problems do not show up until the defect has been present for many years, often unnoticed until adulthood. Children are less likely to show symptoms.
Right-side heart failure
Stroke: Turbulent blood is more likely to clot which can travel to the brain and cause a stroke
Weakness or easily fatigued
Diagnosis for Atrial Septal Defect:
Atrial Septal Defects (ASD) can be identified by various methods. Abnormal changes in the sound of the heart beats can be heard when a doctor listens to the heart with a stethoscope. In addition, a chest x ray, an electrocardiogram (ECG, an electrical printout of the heartbeats), and an echocardiogram (a test that uses sound waves to form a detailed image of the heart) can also be used to identify this condition. An Atrial Septal defect can also be diagnosed by using a test called cardiac catheterization. This test involves inserting a very thin tube (catheter) into the heart's chambers to measure the amount of oxygen present in the blood within the heart. If the heart has an opening between the atria, oxygen-rich blood from the left atrium enters the right atrium. Through cardiac catheterization, doctors can detect the higher-than-normal amount of oxygen in the heart's right atrium, right ventricle, and the large blood vessels that carry blood to the lungs, where the blood would normally subsequently get its oxygen.
Preparing for ASD Heart Surgery:
Preparing a child for ASD Heart Surgery emotionally is one of the most important things parents can do when their child is facing a surgical procedure. Surgery, without proper explanations and preparation, can traumatize children. Preparing a child for surgery is not difficult, but it is essential to understand that many children will adopt their parent’s attitude about healthcare and surgery. If the parent is frightened or hysterical, the child is much more likely to be frightened or hysterical. It is also important that your body language matches your words. If a parent is saying, “It’s going to be OK," but their body language says, “I’m terrified”, the child will usually adopt the attitude of fear. This may be easier said than done, as most parents do feel fear when their child needs surgery, but being aware of the issue can be helpful. The worst thing a parent can do before surgery is to not prepare the child at all, so surgery is a surprise and they are completely unaware of what is happening to them. And thus have to face situation which is difficult to handle.
Common Procedures of ASD Heart Surgery:
The following are the common types of procedures performed for the ASD Heart Surgery:
Arterial Switch: The Arterial Switch Operation is an elegant operation that is also simple in concept. This Surgery is carried out through an opening in the middle of the chest. The heart will have to be stopped temporarily during the operation. So the surgeon will first hook up the patient to the heart-lung machine. The aorta and pulmonary artery are disconnected from their abnormal attachments. Their positions are then "switched". The aorta is stitched back to the left ventricle and the pulmonary artery to the right ventricle. A VSD is closed, if present. The coronary arteries are also freed, and connected back to the aorta using very delicate hair-thin sutures. When you consider that the size of these coronary arteries in a new-born is hardly a millimeter, you can imagine the technical skill and expertise that the surgeon must possess to carry out this connection without mishap. The advantages of Arterial Switch Operation includes to restores normal structure to the heart. After the operation, the anatomy of the heart is just as in normal people. The heart is almost as good as new. The left ventricle is what pumps blood to the rest of the body. In the atrial switch operation, it is the right ventricle that does this job. Nature designed the right ventricle for less severe work - pumping blood to the lungs alone. When it is made responsible for the blood flow to the rest of the body, it may not be able to cope with the increased demands.
Damus Kaye Stansel Procedure: Transposition of the great vessels can also be corrected by the Damus Kaye Stansel procedure, in which the pulmonary artery is cut in two and connected to the ascending aorta and right ventricle. Damus-Kaye-Stansel procedure involves division of the MPA and connection to the ascending Aorta. So that the patient’s LV (connected to the PA because of transposition) could eject into the systemic circulation. The procedure of Damus Kaye Stansel as originally described was not applied for the patient with a single ventricle and also did not involve enlargement of the aortic arch. Today the procedure is most commonly used to describe a procedure in which systemic outflow obstruction within a single ventricle. This procedure is conceptually the same as the Norwood procedure and since the aortic arch is frequently hypo plastic in the patient with a single ventricle and systemic outflow tract obstruction the procedures are not uncommonly essentially the same. The main advantage of the Damus-Kaye-Stansel procedure is that it avoids coronary relocation; also, the spatial relationship of the great arteries and the coronary anatomy do not affect its feasibility. One drawback is the need for a conduit in infancy.
Venous Switch: For transposition of the great vessels, venous switch creates a tunnel inside the atria to redirect oxygen-rich blood to the right ventricle and aorta and venous blood to the left ventricle and pulmonary artery. This procedure differs from the arterial switch and Damus Kaye Stansel procedures in that blood flow is redirected through the heart. In this procedure, a baffle is created within the atria that redirect the deoxygenated caval blood to the mitral valve and the oxygenated pulmonary venous blood to the tricuspid valve. The anatomic left ventricle continues to act as the pulmonary pump and the anatomic right ventricle acts as the systemic pump. This surgery carry, complicated 'origami-style' cutting and folding of the native atrial tissue is required to achieve the venous baffle. Owing to its complexity, this procedure was initially not widely embraced.
Fontan Procedure: This procedure is a palliative surgical method used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic pulmonary ventricle. The Fontan procedure has more recently been used in pediatric situations where an infant only has a single effective ventricle, either due to heart valve defects or an abnormality of the pumping ability of the heart or has complex congenital heart disease where a bi-ventricular repair is impossible or inadvisable. Children with hypo plastic left heart syndrome have a single effective ventricle supplying blood to the lungs and the body. They are delicately balanced between inadequate blood supply to the lungs and oversupply to the lungs. In addition, the single ventricle is doing nearly twice the expected amount of work (because it has to pump blood for both lungs and body). As a result, these children can have trouble gaining weight, and are also vulnerable to decompositions in the face of otherwise minor illnesses (even a common cold). Sometimes medications (e.g. diuretics) can help them through this stage.
Pulmonary Artery Banding: A pulmonary artery band reduces blood flow and pressure treating cardiac failure (if present) and protecting the pulmonary vasculature. This palliative operation is useful when there is a high pulmonary artery pressure and/or blood flow which will induce pulmonary (eventually irreversibly) vascular disease. It is undertaken in complex disease e.g. univentricular heart when palliation is necessary or in multiple VSD’s when surgery is better deferred to childhood. The operation is usually performed through the sternum although via a lateral thoracotomy approach. The narrowing is made by wrapping a piece of surgical tape around the artery and drawing it tight. It can be difficult to get the degree of narrowing right at the first attempt and occasionally the patient will require reoperation. When the child is suitable for more definitive surgery the band is excised and the artery re-anastomosed. Recently an adjustable PA band called FloWatch has been developed by Enodart. The device encircles the pulmonary artery and has a small motor allowing the circumference to be adjusted postoperatively remotely by radio-control in a similar manner to pacemaker adjustments.The main benefits of this procedure include the ease of construction of the side to side anastomosis.
Ross Procedure: The Ross procedure (or pulmonary autograft) is a cardiac surgery operation where a diseased aortic valve is replaced with the person's own pulmonary valve. A pulmonary homograft (valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. Pulmonary autograft replacement of the aortic valve is the operation of choice in infants and children, but its use in adults remains controversial. The Ross Operation is associated with an increased incidence of autograft insufficiency and of late failure when it is utilized in patients with primary aortic valve insufficiency or dilatation of the aortic annulus and/or ascending aorta, and this abnormal dilatation is not addressed at the original operation. Techniques for annular reduction have been developed as well as techniques for enlargement of the aortic annulus or an extended root replacement for those patients requiring an aorta-ventriculoplasty for subvalvar aortic obstruction. These follow the standard use of the root and inclusion techniques. The benefits of Ross procedure include freedom from thromboembolism without the need for anticoagulation, the valve grows as the patient grows (i.e. children), favorable hemodynamic and finally, no foreign material present in the valve.
Shunt Procedure: Shunt surgery is a relatively short and uncomplicated procedure that varies slightly depending upon two factors. The neurosurgeon’s preference on where to place the upper shunt catheter and secondly the decided location of the lower shunt catheter to permit draining of the excess cerebrospinal fluid (CSF). Unfortunately, no shunt lasts forever. On average, shunts last about 10 years, although they can last for a much longer or much shorter amount of time. A shunt may need to be replaced because of an infection or blockage, or because the shunt valve stops working properly. During the shunt procedure, you are given general anesthesia. A small amount of hair on your head may be shaved and some antiseptic solution will be scrubbed on your head and parts of your belly to help prevent infection. Small incisions are then made on the head and in the abdomen to allow the neurosurgeon to pass the shunt's tubing through the fatty tissue just under the skin. A small hole is made in the skull, opening the membranes between the skull and brain to allow the upper catheter to be passed through the brain and into the ventricle. The lower catheter (or abdominal / peritoneal catheter) is passed into the belly through a small opening in the lining of the abdomen where the excess CSF will eventually be absorbed. The incisions are then closed and sterile bandages are applied.
Life after ASD Heart Surgery: After ASD Heart Surgery for congenital defects, the patient goes to an intensive care unit for continued cardiac monitoring. The patient may also require continued ventilator support. Chest tubes allow blood to be drained from inside the chest as the surgical site heals. Pain medications will be continued, and the patient may remain under general anesthetic. Within 24 hours, the chest tubes and ventilation may be discontinued. Any cardiac drugs used to help the heart perform better will be adjusted appropriate with the patient's condition. For temporary procedures, additional follow-up with the physician will be required to judge timing for complete repair. In the meantime, the patient should continue to grow and thrive normally. Complete repair requires follow-up with the physician initially to judge the adequacy of repair, but thereafter will be infrequent with good prognosis. The child should be made aware of any procedure to be communicated for future medical care in adulthood.
Recovery after ASD Heart Surgery:
Immediately following the ASD Heart Surgery, your child will spend a few hours in the ICU under observation for immediate post-operative complications. Your child will spend 4 - 5 days in the hospital until the surgical staff is satisfied with outcome of the surgery to repair Atrial Septal Defect. The recovery is generally complete in about 3 months. Your child will be prescribed pain and anti-coagulant medication to reduce the risk of clot formation. Follow the nurses’ instructions carefully on how to care for your child e.g. bathing, activity level, direct injuries to the chest while playing, medications to be given at home and when your child can return to school.
Advance ASD Heart Surgery:
Robotic ASD Heart Repair: In this procedure, surgeons remotely maneuver robotic arms from a seat in front of a console away from the patient. Instead of opening the chest and cutting the skin and muscle to view the area, surgeons make four holes (8 to 15 millimeters each) through which robotic arms are inserted. The robotic arms include one with a camera-like device to transmit the image to the console. The other arms are fitted with operating instruments. Surgeons use this procedure to successfully repair the hearts of patients with atrial septal defect (ASD) conditions in which people are born with an opening between the heart’s two upper chambers. This opening allows some blood from the left atrium to return to the right atrium, instead of flowing through the left ventricle, out the aorta and to the body. It’s repaired either by plugging the hole with a patch or suturing the hole closed. The advantages of these procedures include: Increased range of motion with the robotic arms, ability to filter out human hand tremor and translate the doctor’s larger hand movements into smaller ones, reduced trauma to the body, shorter hospital stay and faster recovery, however, the complications are rare with this procedure.
ASD Heart Surgery in India: India is fast becoming the world's first choice destination for healthcare services especially ASD Heart Surgery. With rapidly expanding infrastructure, clinical expertise and international standard implementation, it is servicing the healthcare needs, at reasonable costs to the international patients from around the world.
The ASD Heart Surgery in India is dealt by highly experienced and trained cardiologists. The specialist doctors work in tandem to develop the best treatment plan for each patient. Their understanding to the heart disease is unique to each patient, so they tailor treatment plans according to your health needs.
Indian Cardiac centres deliver high-quality care that help the patients' live active lives. These are world class hospitals with state of art medical instruments. These hospitals or cardiac centers offer specialized treatment and surgery to patients. The following are the Indian cities which cater best services pertaining to ASD Heart Surgery in India:
Cost of ASD Heart Surgery in India: Cost plays a major role in bringing foreign medical tourists to India. In fact, the availability of clinical expertise, reasonable surgery costs through internationally trained and educated medical professionals is a major factor in the growth of foreign patients coming for ASD Heart Surgery in India. The following cost comparison will give you a fair idea of the cost difference which exists in India and US:
USA (in USD)
India (in USD)
Damus Kaye Stansel Procedure
Some of the common countries from which patients travel to India for surgery are:
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