How Are Atrial Septal Defects Treated?
Treatment for an ASD will depend on the patient's age, the size of the hole, and
where it's located in the heart.
Very small ASDs might not need any treatment. In other cases, the cardiologist
may recommend follow-up visits for observation.
In most teens with ASD, though, the cardiologist will recommend having the hole
fixed, either with cardiac catheterization or heart surgery.
Cardiac Catheterization
Many ASDs can be treated with cardiac catheterization (pronounced:
CAR-dee-ack cath-uh-turr-ih-ZAY-shun), in which a thin, flexible tube (a catheter)
is inserted into a blood vessel in the leg that leads to the heart. The cardiologist
guides the tube into the heart to make measurements of blood flow, pressure, and oxygen
levels in the heart chambers. A special implant is positioned into the hole and is
designed to flatten against the septum on both sides to close and permanently seal
the ASD.
In the beginning, the natural pressure in the heart holds the device in place.
Over time, the normal tissue of the heart grows over the implant and covers it entirely.
This nonsurgical technique leaves no chest scar, has a shorter recovery time than
heart surgery, and usually needs just an overnight stay in the hospital.
If you have a cardiac catheterization, your doctor will probably recommend that
you take it easy for a few days afterward and perhaps stay out of gym class for a
week or two.
Your doctor might want you to take one aspirin each day for about 6 months to prevent
small clots from forming on the device and being sent into the arteries of the body.
Over time, the normal tissue of the heart grows over the device and the aspirin is
no longer necessary.
Heart Surgery
Sometimes, when the ASD is very large or close to the wall of the heart, a device
cannot be safely used and heart surgery is needed to close the defect.
A patient will get general anesthesia
so he or she doesn't feel pain or move around during the surgery. The surgeon will
make a cut in the chest, then stitch the hole in the atrial septum closed or sew a
patch of manmade surgical material (such as Gore-Tex) over the defect. Eventually,
the tissue of the heart heals over the patch or stitches, making the area smooth and
nearly normal in appearance.
Teens usually can leave the hospital 3 to 4 days after surgery, if there are no
problems. The first few days at home, you should hang out in bed or on the couch doing
quiet activities such as reading, sleeping, and watching TV. Within a week or two,
you'll probably feel better. Your doctor will advise you on when to go back to school.
It takes about 6 weeks for a chest incision to heal, and during that time you may
need to sit out gym class or sports. After that, if you don't have other problems
and the doctor gives the go-ahead, you should be fully recovered and able to return
to normal activities.
Heart surgery does leave a permanent scar on the chest. It will be sore at first
and your doctor will likely prescribe a pain reliever, or recommend acetaminophen
or ibuprofen. You may feel numbness, itchiness, tightness, and burning around the
cut, although these feelings shouldn't be severe.
Once a scar is healed, there's no need to keep it covered. If you want to minimize
its appearance, you can use an over-the-counter cosmetic concealer (after your doctor
gives the OK — you'll need to wait for a while after surgery to do this).
What Should I Expect After Surgery?
You'll have follow-up visits with your doctor as you recover from catheterization
or surgery. He or she may repeat an echocardiogram at these visits.
For 6 months after surgery or catheterization, ASD patients need to take antibiotics
before a visit to the dentist or if they need certain other kinds of surgery, such
as tonsil removal. This is to prevent bacteria from getting into the bloodstream and
causing infective endocarditis (pronounced: en-doe-kar-DYE-tus),
an infection of the inner surface of the heart. When the heart tissue has healed over
the closed ASD, most patients no longer need to worry about the risk of infective
endocarditis.
After their ASD is closed and they've had plenty of time to heal, most teens have
no further symptoms or problems.
What Else Should I Know?
In most cases, teens who have had ASD surgery or cardiac catheterization recover
quickly.
But some signs and symptoms may indicate a problem. If you have trouble breathing
or feel your heart racing, tell a parent or another adult so you can get medical treatment
right away.
Other signs that might indicate a problem include:
- a bluish color around the mouth or on the lips and tongue
- loss of appetite
- weight loss
- feeling lethargic
- a lasting or unexplained fever
- increasing pain, tenderness, or pus oozing from your incision
Tell an adult and seek medical help if you notice any of these signs.
Most people who have an ASD corrected during their teenage years go on to live
otherwise healthy lives. After the recovery period, they can exercise, play sports,
and do the other things they love — and perhaps do them even better than before!
Date reviewed: September 2016