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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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. 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.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• 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 to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• 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 or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• 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: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

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 is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  
  
• Prevent constipation: High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.
  
  
• Chest tube: A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid 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 is an exercise to help decrease your risk for a lung infection after surgery. Do the following:
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
    
    
  • You may be given an incentive spirometer to help 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. Let out your breath and cough. Repeat the steps 10 times every hour.
  
  
• 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: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• 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:
  
  
  • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
    
    
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • 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: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
    
    
  • 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.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.
  
  
• Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  
  
• 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: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
  
  
• Pressure stockings: These are long, tight stockings that put pressure on your legs to promote blood flow and prevent clots. You may need to wear pressure stockings before or after surgery or if you have poor circulation (blood flow).
  
  
• Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.
  
  
• 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.

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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.

Learn more about Atrial Septal Defect Surgical Repair (Inpatient Care)