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An atrial septal defect (ASD) is an abnormal opening in the wall (septum) that divides the two upper chambers of the heart (atria). This opening may allow blood from either side of the heart to cross into the opposite atrium. Usually, because the left side of the heart is at a higher pressure than the right side, blood from the left atrium will flow to the right atrium and subsequently back to the lungs. This abnormal shunting of oxygen-rich blood back to the oxygen-poor right side of the heart is referred to as a left-to-right shunt. Normally, this will not cause cyanosis (bluish coloration of the skin caused by oxygen-poor blood reaching the general circulation). However, because the right side of the heart and the blood vessels in the lungs are not built to withstand increased volumes and pressures, left-to-right shunting may result in heart failure and heart rhythm problems.

What are the signs and symptoms of an ASD?

ASD signs and symptoms depend on its size and the amount of blood flows that flows abnormally across the defect. Symptoms may include:

• Breathing difficulties

• Enlarged heart

• Irregularities in heart rhythm (dysrhythmias), especially atrial dysrhythmias

• Heart failure

What are ASD surgical treatments?

Atrial septal defect closure is the surgical procedure for ASD.

How is atrial septal defect closure performed?

Atrial septal defect closure is considered open-heart surgery. The heart has to be opened, and the patient’s blood flow is diverted to a heart-lung bypass machine during the repair.

First, a sternotomy incision is made where the chest is opened through the breastbone. The patient then is connected to the heart-lung bypass machine and an incision is made into the right atrium. A patch is created by the surgeon from either the patient’s own pericardial tissue or a synthetic material such as Goretex®. The patch is sutured into place to close the defect. The atrial incision then is closed with sutures and the remainder of the operation completed. For certain patients undergoing ASD repair, the Texas Children’s Hospital program also offers a minimally invasive approach in which the incision is significantly shorter than the standard sternotomy incision.

If the patient has no other cardiac defects, this operation usually is considered a cure and no further operations should be needed.

See having heart surgery for general information about preparation, surgery and post-operative recovery for congenital heart surgery procedures.