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.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery. You may bleed more than usual, get an infection, or have trouble breathing. Blood clots or air bubbles in your blood could cause a stroke. The muscles or other valves in the heart could be damaged. You could have problems with your heartbeat or you could have a heart attack. Caregivers will watch you closely for these problems and work to decrease the problems.
  
  
• Without surgery, your shortness of breath and fatigue (tiredness) could get worse. Blood and fluid could build up in your lungs and your heart could begin to fail (wear out). Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before Surgery:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Blood transfusion: You may need a blood transfusion for certain medical conditions. You may also need a transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Pre-Op Care: Your chest may be shaved to remove hair. You may be given medicine right before surgery. This medicine may make you feel sleepy and more relaxed. You will be taken on a cart to the room where your surgery will be done. Your caregiver will help you get comfortable on the bed. A belt may be put over your legs for safety. If you get cold, ask for some warmed blankets.
  
  
• Special Tubes: Some tubes will be put into an artery or vein (blood vessel) before, during, or after surgery. These will help caregivers watch how you are doing during or after surgery. One or more of the following tubes may be put in:
  
  
  • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
    
    
  • CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.
    
    
  • Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.

During Surgery:

• You may lie on your back during surgery or you may be turned on your side after you go to sleep. A caregiver will clean your chest with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets will be put over you to keep the surgery area clean. An incision (cut) is made down the middle of your chest. A few smaller incisions will be made between your ribs on your right side instead of down the middle.
  
  
• You are connected to a heart-lung bypass machine. This machine does the work of your heart and lungs while the heart is stopped during surgery. An incision is made in the right atrium and the hole in the septum is closed. If the ASD is small, your doctor may close the hole with stitches only. Otherwise, a patch may be sewn over the hole. The patch may be a piece of heart muscle taken from the outside of your heart. A piece of man-made material may be used instead. After the repair, your heart is checked to make sure there is no bleeding and to remove air from inside your heart.
  
  
• The heart-lung machine is stopped and your own heart and lungs will start working again. A TEE or transesophageal (trans-eh-SOF-uh-G-ull) echocardiogram (eh-ko-KAR-d-o-gram) may be done to see how well your heart is working. The incision in your chest is closed with wire and stitches (thread) or staples.

After Surgery: In the recovery room or ICU you may have many tubes and equipment attached to you. The tubes and equipment may make it difficult for you to move around in bed. Some of these items will be removed when you are more awake and caregivers see that you are doing OK after surgery.

• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Bowel movements: Exercise such as walking can help you have regular bowel movements. Including foods such as fruit, bran, and prune juice, and drinking enough water can also help. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.
  
  
• Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. This lets your lungs fill up with air when you breathe and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted or the tape comes loose. You may need more than one chest tube.
  
  
• Day/night confusion: If you stay in an intensive care unit (ICU), you may not know when it is daytime or nighttime. This is common for patients staying in ICU. Having the lights on all the time can cause it. The lights may cause you to feel or act confused. When you are moved to a room on a regular floor, you will become more aware of time.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Eating: You may be able to eat when bowel sounds (stomach growling) are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope (STETH-uh-skop). Ice chips are usually given first and then liquids (water, broth, apple juice, or clear soda). If you do not have problems after drinking liquids, caregivers may then let you eat soft foods. Some examples of soft foods are ice cream, applesauce, or custard. If you do OK with soft food, you may begin eating a regular diet.
  
  
• Foley Catheter (KATH-uh-ter): This is a tube put into your bladder to drain your urine. The bladder is an organ where urine is kept. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you should be able to urinate on your own.
  
  
  • Do not pull on the catheter because this will make you hurt or bleed.
    
    
  • Do not kink or lie on the catheter tube because the urine will not be able to drain.
    
    
  • Do not lift the bag of urine above your waist. If you do this, the urine will flow back into your bladder. This can cause an infection.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Ice: You can use ice to decrease pain or swelling. It causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Ice is best started after surgery and for the next 24 to 48 hours afterward. Caregivers use crushed ice in a plastic bag or an ice pack and cover it with a towel. Put this on your incision for 15 to 20 minutes out of every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite.
  
  
• Medicines:
  
  
  • Anti-anxiety medicine: This medicine may be given to help you feel less nervous and more relaxed.
    
    
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • 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: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
    
    
  • 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.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
    
    
  • Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.
  
  
• Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.
  
  
• Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.
  
  
• Using oxygen and a ventilator: You may need extra oxygen when waking up and for a day or more after surgery. Caregivers may leave an endotracheal (end-o-TRA-kee-ull) tube (ET tube) in your throat and lungs. Oxygen can be given through the ET tube by a breathing machine called a ventilator (VEN-tuh-la-tor). Once theET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short-thin tubes in your nose).
  
  
• Physical therapy: A physical therapist helps you with special exercises. These exercises help make your bones and muscles stronger.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Temporary pacemaker:
  
  
  • This is a machine that helps your heart beat at a normal speed and in a regular rhythm. A temporary pacemaker may use large patches placed on your chest and back. These are connected to a special monitor. Sometimes, your caregiver may need to put small wires through your skin and into your heart muscle instead. The wires may then be connected to a small pacemaker box outside of your body.
    
    
  • The temporary pacemaker "reads" what your heart is doing. If your heart is beating in a different way than it should, the pacemaker takes over and controls your heartbeat. It does this by sending small electric signals to the heart muscle. This tells your heart when to beat. You may feel these signals, especially if your temporary pacemaker uses large patches on the skin. If this causes pain, use your call light and tell your caregiver. Do not get out of bed without first asking your caregiver if it is OK. You may need a pacemaker just for a short time. In some cases, you may need it for the rest of your life. If so, your caregiver may replace your temporary pacemaker with a permanent one.
  
  
• Restraints for medical management: These types of restraints are used to protect you or limit your movement. They are used to prevent you from pulling out tubes or from falling. Physical restraints can be cloth bands put on your wrists or ankles, cloth vests, or mittens. The end of the restraint is tied to something else like the side of the bed. Caregivers check on you often to make sure you are safe and all your needs are met while you are restrained. Restraints should only be used for a short time and should never be used to punish you.

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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