Atrial Septal Defect Surgical Repair

WHAT YOU SHOULD KNOW:

• Atrial septal defect surgery is done to close a hole in a wall inside the heart. This is also called an ASD repair. ASD is a common heart defect that babies are born with. The heart has 4 chambers or rooms called the atria and the ventricles. With an ASD, there is a hole in the septum (wall) between the 2 upper chambers, the right and left atria. An ASD causes blood to flow through the heart in a different way. Your heart and lungs must work harder because of this.
  
  
• Tests will be done to learn more about your heart and the ASD. Many people have open heart surgery done to close their ASD. Small ASDs may be sewn closed with stitches (thread). ASDs may also be closed with a patch of your own heart tissue or special cloth-like material. Sometimes more than one surgery is needed. If you do not have your ASD repaired as a child, you may have other heart problems. These problems may or may not be fixed by surgery.

AFTER YOU LEAVE:

• Take your medicine as directed. Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
  
  
• Antibiotics: You may be given antibiotics before having dental care or other procedures. Taking antibiotics first may help prevent bacterial endocarditis which is an infection in the heart. Ask your caregiver how long you must wait after surgery before going to the dentist. You may need to take antibiotics before dental procedures for up to 6 months after your ASD surgery. Tell your dentist about your ASD and surgery. Always take your antibiotics as directed by your caregiver and take them until they are all gone.
  
  
• Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
  
  
• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Blood thinners: Blood thinners are medicines that help prevent blood clots from forming. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. If you are taking a blood thinner:
  
  
  • Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin and a soft toothbrush on your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports, such as football.
    
    
  • Be aware of what medicines you take. Many medicines cannot be used when taking medicine to thin your blood. Tell your dentist and other caregivers that you take blood-thinning medicine. Wear or carry medical alert information that says you are taking this medicine.
    
    
  • Take this medicine exactly as your primary healthcare provider tells you. Tell him right away if you forget to take the medicine, or if you take too much. You may need to have regular blood tests while on this medicine. Your primary healthcare provider uses these tests to decide how much medicine is right for you.
    
    
  • Talk to your primary healthcare provider about your diet. This medicine works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and other foods, such as cooked peas and kiwifruit.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.

Appointments:

• Ask for information about where and when to go for follow-up visits: For continuing care, treatments, or home services, ask for more information.
  
  
• You may have one or more of the following problems after your surgery. Most of the problems disappear in 4 to 6 weeks. It is important to tell your caregiver if you are having any of these problems:
  
  
  • Constipation.
    
    
  • Fatigue.
    
    
  • Not feeling hungry most of the time.
    
    
  • Mild disorientation (feel confused about time, where you are, who you are with). Mild memory loss (you forget about things you did today or yesterday).
    
    
  • Mood swings or feeling sad most of the time.
    
    
  • Muscle pain or tightness in the shoulders and upper back.
    
    
  • Sleeping problems.
    
    
  • Trouble staying with a task, a conversation (talking with someone), or a TV show.
    
    
  • Your heart feels like it is beating too fast or is not beating regularly. You faint or feel dizzy, weak, short of breath, or have chest pain while this is happening.

Activity:

• Be patient and allow your body time to heal itself. It may take 6 to 8 weeks before you feel completely better after surgery. When friends or family offer to help, let them help you with your daily activities. Slowly start to do more each day, but do not overdo it. You may feel like resting more after surgery. Rest when you feel it is needed.
  
  
• Avoid lifting heavy objects. Ask your caregiver when you can start doing your usual activities again.

Bathing:

Do not take a bath or go swimming until your caregiver tells you it is OK. Start by taking showers or sponge baths. Carefully wash the stitches or staples with soap and water. Allow your wound to air dry or pat it dry gently with a towel. Afterwards put on a clean, new bandage. Change your bandage any time it gets wet or dirty. Ask someone to help you if you cannot put on your bandage by yourself.

Bowel Movements:

It may be hard for you to have a bowel movement after surgery. Do not try to push the BM out if it is too hard. Walking is the best way to get your bowels moving. It also helps you feel better faster. Foods like fruit, bran, and prune juice can help you have a BM. Drinking water can help too. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.

Good nutrition for your heart:

Get enough calories, protein, vitamins, and minerals to help prevent poor nutrition and muscle wasting. You may be told to eat foods low in cholesterol or sodium (salt). You also may be told to limit saturated and trans fats. Do eat foods that contain healthy fats, such as walnuts, salmon, and canola and soybean oils. Eat foods that help protect the heart, including plenty of fruits and vegetables, nuts, and sources of fiber. Ask what a healthy weight is for you. Set goals to reach and stay at that weight.

Cardiac Rehabilitation:

This is a program that you may start as soon as possible after surgery. Cardiac rehabilitation will help you to get better faster after surgery and will teach you about healthy living. Caregivers may teach you about diet, exercise, and how to handle stress. They can run tests to see how your heart is doing. Caregivers can answer any questions you have and talk with you about feelings you have after surgery.

• Exercise Tolerance Test: You will be given an exercise tolerance test after you have recovered from surgery. This test helps caregivers see the changes that take place in your heart during exercise. It checks for blockages in the arteries of your heart. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have chest pain or trouble breathing. Be sure to tell them how you feel.
  
  
• After the exercise tolerance test, you and your caregiver can plan an exercise program for you. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy. Start exercising when your caregiver says it is OK. It is best to start slowly and do more as you get stronger.

Driving:

Your caregiver will tell you when you can start to drive again. If you had a sternotomy (middle chest bone opened) during surgery, your chest bone needs time to heal. Your caregiver may tell you to wait 4 to 8 weeks before you can drive. Ask family or friends to take you to appointments or other places you need to go while you cannot drive.

Ice and Heat:

• Do not put ice or heat over your surgery area without first talking to your caregiver. Some people have shoulder and neck pain after surgery. Heat brings blood to the area and helps it feel better. You may put a heating pad (turned on low) or a hot water bottle on your neck or shoulders. Do this for 15 to 20 minutes out of every hour if you need it.
  
  
• Do not sleep on the heating pad or hot water bottle because you could burn yourself badly. Having a family member rub your back or neck may also help. Chest pain that spreads to your arms, jaw, or back may be a sign of a heart attack. Do not ignore this pain. Call 911 for an ambulance to take you to the hospital. Do not drive yourself!

Pregnancy:

A womanʼs heart works harder during pregnancy. Talk to your caregiver if you are a woman who has had ASD surgery and you want to get pregnant. Some adults who have ASD surgery have no more heart problems after the surgery. Other adults have heart problems caused by the ASD that may need more surgery or may never go away. If you do get pregnant, make sure you tell the caregiver for your pregnancy about the ASD and surgery. It will be important to also see your heart caregiver often during your pregnancy.

Sex:

Your caregiver will tell you when you can start having sex again. Starting to have sex again may depend on how well you are feeling after surgery. You may be able to have sex again 2 to 3 weeks after leaving the hospital after your surgery. Choose a time to have sex when:

• You feel ready to starting having sex again after surgery and your caregiver has said it is OK.
  
  
• You are feeling relaxed (not stressed) and rested. Also, you are in a place where you will not be interrupted or bothered by children or others.
  
  
• You have waited at least 1 to 3 hours after eating a full meal.

Support socks:

You may need to wear support socks. The support socks are also called Ted Hose® or Jobst Stockings®. These socks may help decrease the swelling in your legs until you are walking more. They may also keep blood from staying in your legs and causing clots.

• Do not cross your ankles or legs for long periods of time.
  
  
• Start walking as soon as possible after surgery.
  
  
• Try to stand and walk every 1 to 2 hours when you travel and are sitting for a long time.
  
  
• Do not wear tight garters or girdles. Do not wear pants that are too tight.

Trouble sleeping:

Some people have strong dreams and have trouble sleeping after heart surgery. Use 2 to 3 pillows under your back and head if you have trouble lying flat in bed. Taking pain medicine before going to bed may help you sleep through the night. If you wake during the night and cannot get back to sleep, get out of bed. Read a soothing book or watch some relaxing TV for a short time. Trouble sleeping usually goes away after several weeks.

Weight:

• Weigh yourself daily before breakfast. Weight gain can be a sign of extra fluid in your lungs or body. Call your caregiver if you have gained 2 to 3 pounds in a day or 5 pounds in a week.
  
  
• Weighing too much can make your heart work harder and can cause bad health problems. You may need to talk to your caregiver about a weight loss plan.

Work:

Ask your caregiver when you can return to work.

Support:

• Having ASD and surgery may be life-changing for you and your family. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with heart disease.
  
  
• You may also want to join a support group. This is a group of people who also have heart disease. Ask your caregiver for the names and numbers of support groups in your town. You can contact the following national organization for more information.
  • American Heart Association
    7272 Greenville Avenue
    Dallas , TX 75231-4596
    Phone: 1- 800 - 242-8721
    Web Address: http://www.heart.org
    

Wellness Hints:

• Colds and Flu: Stay away from people who have colds or the flu. Get shots to keep from getting the flu and pneumonia. Also try to stay away from large groups of people. This decreases your chance of getting sick or getting an infection.
  
  
• Liquids: Drink 6 to 8 (soda pop can size) glasses of liquid each day. Or follow your caregiver's advice if you are on a fluid limit. Good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink such as coffee, tea, soda, and certain sports drinks.
  
  
• Do not smoke: If you smoke, it is never too late to quit. Ask for information about how to stop smoking if you need help.
  
  
• Manage your stress: Stress may slow healing and lead to illness. Learn ways to control stress, such as relaxation, deep breathing, and music. Talk to someone about things that upset you.

CONTACT A CAREGIVER IF:

• You have a fever.
  
  
• Your stitches or staples come apart.
  
  
• The skin around your stitches is red, swollen, or has pus coming from the incision (cut). This may mean that you have an infection.
  
  
• You have chills, a cough, or feel weak and achy. These are signs that you may have an infection.
  
  
• Your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic to your medicine.
  
  
• Your heart feels like it is beating too fast and is not beating regularly. You faint or feel dizzy, weak, short of breath, or have chest pain while this is happening.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You have questions or concerns about your surgery, illness or medicine.

SEEK CARE IMMEDIATELY IF:

• You have weakness or numbness in an arm, leg, or on your face. This can be a sign of a stroke.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• Your bandage becomes soaked with blood and you cannot stop the bleeding.
  
  
• You have signs of a heart attack:
  
  
  • Chest pain that spreads to your arms, jaw, or back.
    
    
  • Nausea.
    
    
  • Trouble breathing.
    
    
  • Sweating.
    
    
  • Lips or nailbeds that are a blue or white color.
    
    
  • This is an emergency. Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!