Septal Defect Repair
Septal Defect Repair
What is it?
A septal defect is referred to as a “hole in the heart”. Septal defects are diagnosed when blood is able to flow between the heart's left and right chambers due to an opening in the wall that separates the two sides (the septum). Types of septal defects are:
- Atrial septal defect (ASD) - the defect is between the heart's two upper chambers (the atria) which allows blood to flow back in
- Ventricular septal defect (VSD) – the defect is between the heart's two lower chambers (the ventricles) and allows blood to flow back into the right ventricle versus the aorta
- Eisenmenger’s complex – ventricular septal defect coupled with high blood pressure in the lungs
- Atrioventricular canal defect – the opening is between the upper and lower chambers of the heart allowing blood to flow back to the lungs instead of the rest of the body
Treatment depends upon the severity of the defect. If treatment is required, surgical repair of the opening is typically successful in restoring normal circulation. Open heart surgery may be required.
How does it work?
A cardiologist will determine if the defect should be closed. Repairing a defect restores the blood circulation to normal. The long-term outlook is good. If the defect is successfully closed, preventive treatment is needed only during a six-month healing period to prevent endocarditis.
Reasons for Septal Defect Repair
Treatment depends upon the severity of the defect. If treatment is required, surgical repair of the opening is typically successful in restoring normal circulation.
Closing an atrial septal defect can prevent serious problems later in life. The defect may be left unrepaired if there is pulmonary hypertension (high blood pressure in the lungs).
Closing small ventricular septal defects may not be needed. They often close on their own in childhood or adolescence. But if the opening is large, even in patients with few symptoms, closing the hole in the first two years of life is recommended to prevent serious problems later. Usually the defect is closed with a patch. Over time the normal heart lining tissue covers the patch, so it becomes a permanent part of the heart. Some defects can be sewn closed without a patch.
Atrioventricular canal defect is treated surgically. Surgery is done in infancy to close the atrial and ventricular septal defects and reconstruct two atrioventricular valves from the common, single valve. Some patients may have had a temporary procedure to limit blood flow to the lungs (pulmonary artery banding) before a complete repair. The reparative operation produces more normal circulation, but the reconstructed valves often work in a mildly abnormal way.
What to expect
The surgery can take anywhere from two to four hours or more. A hospital stay is required. One to two weeks is the usual hospital stay with the first one to three days being in the Intensive Care Unit (ICU).
Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. After being admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.
A mild tranquilizer, to relax the patient, will be given before entering the operating room. Small metal disks (electrodes) will be attached to the chest. These electrodes are connected to an electrocardiogram machine, which will monitor the heart's rhythm and electrical activity. The patient will then receive a local anesthetic to numb the area where a plastic tube (line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in the vein. The IV line will be used to give the anesthesia during the operation to make the patient sleep during the operation.
After the patient is completely asleep, a tube (ventilator) will be inserted down the windpipe and connected to a machine (respirator), which will take over breathing. Another tube will be inserted through the nose and down the throat, into the stomach. This tube will stop liquid and air from collecting in the stomach, so you the patient will not feel sick and bloated after surgery. A thin tube (catheter) will be inserted into the bladder to collect any urine produced during the operation.
A heart-lung machine is used for most valve operations. Before being hooked up to this machine, a blood-thinning medicine (anticoagulant) will be given to prevent your blood from clotting. Once the heart-lunch machine is hooked up, the heart is stopped and cooled.
Next, a cut is made into the heart and a cloth patch is sewn over the defect, or the defect edges are pulled and sewn together. Once the surgeon has finished the repair, the heart is then started again, and the patient disconnected from the heart-lung machine.
After surgery, the remaining hospital stay is for testing and monitoring the patient’s condition.