Atrial septal defect (ASD) surgery | Dr Samson Olori – Paediatric Surgeon Abuja, Nigeria

What is an atrial septal defect?

An atrial septal defect (ASD) is a hole in the wall (atrial septum) between the two upper chambers of the heart. Blood can flow from the left to the right atrium, increasing the workload on the right side of the heart and the flow to the lungs. Over time this can lead to enlargement of the right heart, heart failure, arrhythmias (e.g. atrial fibrillation), stroke, or pulmonary hypertension. Small ASDs may close on their own or cause few problems; larger ones usually need repair. There are several types: secundum (most common, in the middle of the septum), primum (lower part, often with other heart defects, including in Down syndrome), sinus venosus (upper or lower back part, sometimes with abnormal pulmonary veins), and unroofed coronary sinus (rare).

Diagnosis and when repair is needed

ASD may be found on a routine check (e.g. heart murmur) or when symptoms appear: fatigue, shortness of breath, fluid in the lungs or legs, poor growth in children, or recurrent chest infections. Tests include ECG, chest X-ray, and echocardiography (transthoracic and sometimes transoesophageal or intracardiac) to see the size, position, and effect on the heart. Small ASDs with no or mild symptoms may be watched. Moderate or large defects, or those causing symptoms, usually need closure—either by a catheter-placed device (for suitable secundum ASDs) or by open-heart surgery (for primum, sinus venosus, or when device closure is not possible).

Treatment and recovery

Catheter closure avoids open surgery: a device is passed from a vein in the leg to the heart and used to seal the hole. Open-heart surgery is used for more complex ASDs: the heart is temporarily stopped, the hole is closed with stitches or a patch, and the heart is restarted. Recovery after surgery typically involves 3–4 days in hospital; complications such as bleeding or infection are uncommon. Some children may have pericarditis (inflammation around the heart) in the weeks after surgery, which usually responds to medication. Long-term outlook after repair is generally excellent with regular cardiology follow-up. We can refer you or your child to a cardiologist or cardiac surgeon for assessment and the best option.

Frequently asked questions

Can ASD be closed without open surgery?
Many secundum ASDs can be closed with a catheter-placed device. Primum and sinus venosus defects usually need open-heart surgery. Your cardiologist will determine the best approach.
What is the outlook after ASD repair?
Repair is usually successful with an excellent long-term outlook. Regular follow-up with a cardiologist is recommended to check the heart and rhythm.
Is ASD common in children?
ASD is one of the most common congenital heart defects. It can also be diagnosed in adults who have had no or mild symptoms earlier in life.