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Atrial Septal Defect ( ASD)

There are multiple defects that can happen in of the heart of the child while developing inside its mother’s womb. The most common is the atrial septal defect. It is A Hole In The Wall that separates the two Atria, viz. the right and left upper Chambers of the heart.

Blood from the left atrium thereby flows across the ASD, into the right heart and goes to the lungs. When this condition persists, the increased flow of blood to the lungs causes changes to the blood vessels in the lungs. This can result in permanent damage to the lungs known as Pulmonary hypertension. This is one of the commonest reasons for closing the ASD.

What do we do?

To close the ASD, we enter through the right Atrium surgically (Open Heart Surgery) Under vision we place a patch on this defect and fix it using stitches. And this is called atrial septal defect closure.

So, How does it look when a surgeon opens the chest? Surgery being very clean, there is nothing here that surprises us, because our cardiologists can actually see using modern technology how the inside anatomy of the heart looks. We see the heart between the diaphragm and the collar bones. The right atrium forms the right border of the heart. the right ventricle is the front of the heart. the left ventricle lies under the left  half of the chest and the left atrium lies behind all these chambers.

To do surgery, we connect the major veins and arteries, (and thereby the patient) to the heart lung machine which takes blood out of venous system (now the heart is empty) and give it back to the aorta which supplies the whole body and keeps the patient alive. Once we know that heart lung machine is able to maintain the patient’s cardiac output and keeps the patient alive, we stop the heart by giving potassium rich solution,known as cardioplegia, into the blood vessels supplying the heart muscles. Then we open the right Atrium and see within it the atrial septal defect. Once visualized, we can close the ASD in the motionless heart.

The heart is then closed, all the air inside is taken out and replaced by blood that is returned to the heart. The heart starts to beat once the muscles get normal blood,  and once the heart and lung function comes back to normal, we wean the patient off the heart lung machine and remove the tubes inserted earlier. During this entire time the patient is under anesthesia and is not aware of any of this activity.

Recent advances

Almost every country in the world has the facility to do this kind of open-heart operation. Whether in the USA, Europe, India, or anywhere else, it is associated with minimum risk to life of the patient. Many centers are now able to close ASDs using devices without surgery in all but the smallest children.

In some hospitals we are able to do this operation through small cuts, or the side of the chest using advanced instruments and techniques.

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