The heart is a hollow muscular organ that pumps blood throughout the body. The human heart consists of 4 chambers, 2 atria (receiving chambers) and 2 ventricles (discharging chambers). The atria, the upper chambers of the heart, receive deoxygenated into the right atrium and oxygenated blood into the left atrium. The two chambers are separated by a wall of tissue called the septum.
Atrial septic defect (ASD) is a defect or an opening in the septum which causes the mixing of blood between the two atrial chambers. Oxygenated blood in the left atrium mixes with deoxygenated blood in the right atrium and is sent back to the lungs for purification, although it's already refreshed with oxygen. This may overfill the lungs and overwork the heart, eventually weakening and enlarging the heart. This condition is a congenital disease that develops when errors occur during the formation of the heart as the baby is growing in the womb.
ASD repairs can be simple operations or complex procedures based on the size, characteristics, and location of the ASD.
Most ASDs can be repaired by a minimally invasive procedure, which involves inserting a catheter into the blood vessel and guiding it to the heart. An umbrella-shaped device is inserted into the blood vessel through the catheter to conceal the defect and prevent blood from flowing across.
When the ASD is large, surgery is required to repair the defect.
Open heart surgery
Surgery can be performed using traditional open heart surgery. The surgery is performed under general anaesthesia. During the procedure, a vertical incision is made down your chest and the breast bone is opened to expose the heart. Blood in the heart is redirected and passed through a bypass machine, which performs the function of your heart during the surgery. Your surgeon opens your heart to identify the defect. A small opening is closed with sutures. However, a larger opening is repaired with a small piece of tissue cut from the sac surrounding the heart (pericardium) in the size and shape of the defect, and used as a patch to cover the opening. The heart is then closed and the bypass machine is disconnected, allowing the heart to resume its normal function. The breast bone and the incision are closed, and bandages are applied on the incision site.
This approach is associated with longer hospital stay and recovery period and increased risk for infections, pain and complications.
In view of these, surgery may be conducted minimally invasively through a procedure called mini-thoracotomy. The procedure is also performed under general anaesthesia. During this minimally invasive surgery, a thin long tube and other surgical instruments are inserted through small incisions in your chest (in the spaces between the ribs). The tube contains a high definition video camera attached to it which makes it easier for your surgeon to view the surgical site. The heart is stopped and connected to a bypass machine, the ASD is repaired and the incisions are closed.
Robotic ASD repair
A newer approach to treating ASD is the robotic ASD repair. A surgical robotic system, consisting of a computerized control system, surgeon console (a device to operate the computer system), a fibre optic camera and two instrument arms, is used instead of the surgeon’s hands to perform the repair.
Your surgeon performs the entire operation at the console, where he/she controls the surgical instruments held by the robotic arms. Your doctor’s hand, wrist and finger movements are translated, relayed and mimicked by the robotic arm. Small incisions are made in the patient’s chest (in the spaces between the ribs) and the fibre optic camera and other surgical instruments held by the 2 arms of the robotic system are inserted. Your surgeon uses the fibre optic camera to view the heart as a 3D image and repairs the ASD using the other surgical instruments.
These computerized robotic systems enhance the ability of the surgeons to perform surgeries with accuracy and precision. The total duration of the surgery ranges from 2 to 3 hours.
After the surgery, your drain tubes and pace wires are removed. You will be monitored for any changes in BP, heart rate or breathing. You will be discharged from the hospital 3 to 4 days after the surgery, and your doctor will provide instructions to take care of your wound.
Risks and Complications
Like all surgical procedures, ASD repair surgery may be associated with certain complications. Some of these complications may include: