Atrial Septal Defect Surgical Repair

WHAT YOU SHOULD KNOW:

• Atrial (A-tree-ull) septal (SEP-tull) 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 (A-tree-uh) and the ventricles (VEN-trik-ulls). 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:

• Medicines:
  
  
  • Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
    
    
  • Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
  
  
• Antibiotics: You may be given antibiotics (an-ti-bi-AH-tiks) before having dental care or other procedures. Taking antibiotics first may help prevent bacterial (bak-TEER-e-ull) endocarditis (end-o-kar-DI-tis) 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 is medicine that may be given to help thin the blood to keep blood clots from forming.
  
  
• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Blood thinners: Blood thinners are medicines that help prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may cause you to bleed or bruise more easily. Do the following if you are taking a blood thinner:
  
  
  • Watch for bleeding from your gums or nose, or in your urine or BMs.
    
    
  • Use a soft washcloth on your skin and a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding.
    
    
  • Tell your dentist before dental cleanings, and other caregivers before other procedures, that you take blood thinning medicine.
    
    
  • If you shave, use an electric shaver.
    
    
  • Do not play contact sports since you may bleed or bruise easily.
    
    
  • Wear a MedicAlert bracelet or necklace that says you are taking a blood thinner medicine. You may get one from your local drugstore or contact the MedicAlert Foundation.
  
  
• Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
  
• Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.

Appointments:

• Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.
  
  
• 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 (feel tired).
    
    
  • 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 (BM) 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.

Diet:

• Eat a variety of healthy foods every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy.
  
  
• Ask your caregiver if you should be on a special diet. You may be told to eat foods that are low in fat or cholesterol. You may also be told to limit the amount of salt you eat. Special cookbooks can make it easier to plan low fat and low salt meals.
  
  
• Weighing too much can make your heart work harder and can cause serious health problems. Talk to your caregiver about a weight loss plan if you are overweight.

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 National Center
    7272 Greenville Avenue
    Dallas, TX 75231-4596
    Phone: 1-800-242-8721
    Web Address: http://www.americanheart.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 (new-MOAN-yuh). 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 caregiverʼs 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.
  
  
• Quit smoking: It is never too late to quit smoking. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
  
  
• Stress: Stress may slow healing and cause illness later. Since it is hard to avoid stress, learn to control it. Learn new ways to relax, such as deep breathing, meditation, relaxing muscles, music, or biofeedback. Talk to someone about things that upset you.

CONTACT A CAREGIVER IF:

• You have a fever (increased body temperature).
  
  
• 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 (uh-LER-jik) 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 questions or concerns about your surgery, illness or medicine.

SEEK CARE IMMEDIATELY IF:

• You have trouble breathing all of a sudden. This could be a sign that you have a blood clot in your lung. It could also mean that you are allergic to a medicine you are taking.
  
  
• You have weakness or numbness in an arm, leg, or on your face. This can be a sign of a stroke.
  
  
• 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 (upset stomach).
    
    
  • 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!

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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