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.

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 could get worse. Blood and fluid could build up in your lungs and your heart could begin to fail. Call your caregiver if you are worried or have questions about your medicine or care.

Getting Ready

The Week Before Surgery:

• Ask your caregiver if you need to stop taking aspirin or any other blood thinning medicines before your procedure.
  
  
• Ask your caregiver before taking any over-the-counter medicines such as laxatives, vitamins, herbs, or food supplements.
  
  
• You may be given a tour of the ICU before your surgery. This will help you become familiar with where you will go after the surgery.
  
  
• You may need blood tests before your procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.
  
  
• You may be able to donate your own blood before surgery. This is called autologous (ah-TALL-uh-gus) blood donation. This must be done no later than 3 days before surgery. You may also ask a family member or friend with the same blood type to donate their blood. This is called directed blood donation. Talk to your caregiver for more information on autologous or directed blood donation.

The Night Before Surgery:

• You may be given a pill to take to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The Day of Surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.
  
  
• Do not wear contact lenses the day of surgery. You may wear your glasses.
  
  
• Bring your personal belongings with you to the hospital. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers. Do not wear jewelry or bring money to the hospital.
  
  
• An anesthesiologist may talk to you before your surgery. This is the caregiver who gives you medicine to make you sleep and not feel the surgery.

Informed consent

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.

Treatment

What Will Happen:

• You will be asked to change into a hospital gown. Medicine to help you relax or make you sleepy may be given through your IV. A caregiver will take you to the operating room on a wheeled cart. You will get general anesthesia to keep you completely asleep. You will be connected to a machine that does the work of your heart and lungs during surgery. A caregiver will clean your chest with soap and water. An incision (cut) may be made down the middle of your chest. A few smaller incisions may be made between the ribs on the right side of your chest instead of down the middle.
  
  
• An incision is made in the right atrium and the hole in the septum is closed. If the ASD is small, your surgeon may close the hole with only stitches. Otherwise, a patch may be sewn over the hole. The patch may be man-made material or a piece of heart muscle taken from the outside of your heart. The heart-lung machine will be stopped after the ASD repair and your own heart and lungs will start working again. The incision in your chest will be closed with wire and stitches (thread) or staples.

After Surgery:

You are taken to the recovery room or an intensive care unit (ICU). Caregivers will watch you very closely. A bandage is used to cover your stitches or staples. This bandage keeps the area clean and dry to prevent infection. A caregiver may remove the dressing shortly after surgery to check the stitches. Do not get out of bed until your caregiver says it is OK. Your family may be allowed to visit you in the ICU for a short visit several times a day.

Waiting Room:

This is a room where your family can wait until you are ready for visitors after surgery. Your doctor or nurse can then find them to let them know how the surgery went. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

Contact a caregiver if

• You cannot make it to your surgery appointment on time.
  
  
• You have a fever.
  
  
• The problems for which you are having surgery get worse.
  
  
• You have questions or concerns about your surgery.