Name of the Procedure:

Repair of Atrial Septal Defect, Secundum, with Cardiopulmonary Bypass (with or without patch) Common name(s): Atrial Septal Defect (ASD) Repair

Summary

An atrial septal defect (ASD) repair is a surgical procedure to fix a hole in the wall (septum) between the heart's two upper chambers (atria). This specific type, called secundum ASD, is repaired using cardiopulmonary bypass, which temporarily takes over the function of the heart and lungs during surgery. The repair may involve stitching the hole closed or covering it with a patch.

Purpose

This procedure is performed to correct a hole in the atrial septum that allows oxygen-rich blood to mix with oxygen-poor blood. The goals are to improve heart function and prevent complications such as arrhythmias, heart failure, or pulmonary hypertension.

Indications

• Presence of a significant secundum ASD that causes symptoms like shortness of breath, fatigue, or arrhythmias.
• Enlargement of the right side of the heart due to the excess blood flow.
• Decreased exercise tolerance.
• Evidence of pulmonary hypertension or other complications related to ASD.

Preparation

• Patients may need to fast for a certain period before the surgery.
• Medication adjustments might be necessary, particularly with blood thinners or heart medications.
• Preoperative assessments include echocardiograms, electrocardiograms (ECG), chest X-rays, and blood work to evaluate the heart's condition and overall health.

Procedure Description

1. Anesthesia: General anesthesia is administered to the patient.
2. Incision: A surgical incision is made in the chest to access the heart.
3. Cardiopulmonary Bypass: The heart's function is temporarily taken over by a cardiopulmonary bypass machine.
4. Repair: The surgeon visually examines the atrial septum and either sutures the hole closed or applies a patch made of synthetic material or the patient's own tissue.
5. Closing: The heart is restarted, and the chest incision is closed with sutures or staples.

Duration

The procedure typically takes between 3 to 6 hours.

Setting

The surgery is performed in a hospital operating room equipped for cardiac surgery.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses and technicians
• Perfusionist (operates the cardiopulmonary bypass machine)

Risks and Complications

• Common risks: Infection, bleeding, arrhythmias, and adverse reactions to anesthesia.
• Rare risks: Stroke, heart attack, or complications from cardiopulmonary bypass.
• Potential complications include residual holes, heart block, or pulmonary hypertension.

Benefits

• Improved heart function and oxygenation of the blood.
• Reduced symptoms such as fatigue and shortness of breath.
• Decreased risk of future complications like heart failure or arrhythmias.
• Many patients see improvements within days to weeks after the procedure.

Recovery

• Patients typically spend a few days in the intensive care unit (ICU) followed by additional days in a regular hospital room.
• Instructions include wound care, activity restrictions, and follow-up appointments with the cardiologist.
• Full recovery may take several weeks, but many patients return to normal activities within a few months.

Alternatives

• Monitoring without immediate treatment, depending on the size of the defect and symptoms.

• Catheter-based procedures to close the ASD using a device (suitable for some secundum ASDs).

  Pros and Cons of Alternatives:

• Catheter-based procedures are less invasive and may offer quicker recovery but are not suitable for all types of ASDs.
• Conservative management may postpone surgery but can lead to worsening symptoms or complications over time.

Patient Experience

• During the procedure, the patient will be under general anesthesia and unaware of the surgery.
• Postoperatively, there may be discomfort and pain at the incision site, managed with pain medications.
• Patients might experience temporary fatigue and limitations in activities, but these typically improve as recovery progresses.