Atrial Septal Defect

Surgery

The standard method of closing atrial septal defects has been open-heart surgery. This surgery has a very low risk and has been performed for more than 35 years. In some cases, Mayo Clinic surgeons are able to use minimally invasive surgery with smaller incisions. Long-term survival after repair of this defect is similar to that of a healthy person of the same age.

Before surgery

Mayo Clinic patients who are good candidates for open heart surgery meet with members of the specialized team that will assist in their care. Patients are instructed how to prepare for the surgery. Information about eating, drinking and taking medications before the surgery is explained. Patients meet with their anesthesiologist, nurse clinician, cardiologist and surgeon and are encouraged to ask questions about the surgery and their experience at Mayo Clinic.

Most patients are admitted to the hospital the morning of surgery.

During surgery

The total time in the operating room varies with the type and severity of the ASD. Generally, surgery averages three to four hours.

Patients are given a mild tranquilizer to help them relax before being taken into the operating room where they receive a general anesthetic.

The heart is stopped for the surgery, and a heart-lung machine oxygenates the blood and circulates it throughout the body. An incision is made through the breast bone (sternum) to reach the heart. At Mayo Clinic, an incision between the ribs on the right chest is an alternative and limited incisions can be performed. This approach is not available at all medical centers. Then, an incision is made into the heart to reach the ASD.

The defect is then closed — with stitches if it is small, or, if too large, with a patch. The material used for the patch may be a section of the patient's own pericardium (the membrane that surrounds and protects the heart) or commercially available bovine pericardium. Rarely, a synthetic material (Gore-Tex, Dacron) may be used.

Once the procedure is completed, the heart is restarted. When the surgical team is satisfied that the heart is beating strongly again, the heart-lung machine is disconnected. The chest incisions are then closed (sutured).

The sternum will knit back together in six to eight weeks and will be just as strong once healing is complete. If a minimally invasive approach is used, recovery time will typically be shorter, since cutting the sternum is avoided.

Immediately following surgery

When patients awake from the anesthesia, they are generally groggy and somewhat disoriented. The area of the incisions may be sore. Pain medication is available and patients are encouraged to take it as needed.

Patients are in the cardiac intensive care unit for 24 hours, and the remainder of their hospitalization is spent on a regular hospital unit. Typically, once patients are in the regular unit, they are ambulatory (able to walk) while attached to a small heart monitor.

Patients are in the hospital an average of four to five days. Much of that time is spent waiting for the tissue swelling to decrease and to ensure that the defect has been effectively repaired. While they are in the hospital, tests are conducted to assess and monitor the patient's condition.

After leaving the hospital

In general, recovery is complete about six to eight weeks after surgery. During that time, patients are usually given aspirin or a prescription anticoagulant to reduce the risk of blood clot formation.

Full energy levels usually return in about two to three months. Most patients can expect to feel more tired than usual, and their stamina may not yet be completely normal. After three to six months, most patients are back to normal.

The decision when to assume a full work schedule varies with the individual. For patients who have physically demanding jobs, the recovery may take longer than three months.

Many patients benefit from the structured workout of a cardiac rehabilitation program while recovering from surgery. The program starts with a walking schedule for six to eight weeks and progresses to more vigorous, supervised training.

Follow-up care

Generally, patients return to their local physician a week after being discharged from the hospital and are examined to ensure that they are healing properly. Follow-up appointments with the cardiologist take place at six months to one year.

Mayo Clinic staff works with patients, their local physician and local cardiologist to assist with a full and smooth recovery following surgery.

It is important for those who have had open heart surgery to tell their physician and dentist. Some patients may require an antibiotic before any dental or surgical procedure, because bacteria can enter the bloodstream during these procedures and get into the heart. The result could be a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis. Discuss with your doctor whether this is necessary for you.

Complications

Major complications are rare (less than 1 percent), and with improvement in technology and surgical techniques, occurrences continue to decrease. However, every open-heart surgery entails some risk. Potential complications include infection, bleeding, stroke, heart attack.